05.51 SIG PRE-TEST

take survey
    Instruction: Please complete this form as honestly and thoroughly as possible. The following questions ask demographic information about you. Circle your responses as necessary.
  • No formal schoolingLess than a high school diplomaA high school doplomaSome college or a 2-year degree4-year college degree or graduate work
  • UnemployedPart-timeFull-time
  • YesNo
  • YesNo
  • YesNo
  • Not at allA few timesA few times each weekEveryday
  • Not at allA few timesA few times each weekEveryday
    Instruction: The next question ask about what kinds of situation are more difficult for you to use condoms when you have sex with your main partner. Even if the situation has not happened to you, try to imagine how you would handle it if it ever happened. Place check mark under your choice.
  • Definitely NotProbably NotProbably YesDefinitely Yes
  • Definitely NotProbably NotProbably YesDefinitely Yes
  • Definitely NotProbably NotProbably YesDefinitely Yes
  • Definitely NotProbably NotProbably YesDefinitely Yes
  • Definitely NotProbably NotProbably YesDefinitely Yes
  • Definitely NotProbably NotProbably YesDefinitely Yes
  • Definitely NotProbably NotProbably YesDefinitely Yes
    Instruction: The next questions are about your confidence in using condoms with your main partner. Please check mark under your choice. Even if you've never used condoms before, how confident or sure are you that you could...
  • Not ConfidentSomewhat ConfidentVery Confident
  • Not ConfidentSomewhat ConfidentVery Confident
  • Not ConfidentSomewhat ConfidentVery Confident
  • Not ConfidentSomewhat ConfidentVery Confident
  • Not ConfidentSomewhat ConfidentVery Confident
  • Not ConfidentSomewhat ConfidentVery Confident
  • Not ConfidentSomewhat ConfidentVery Confident
  • Not ConfidentSomewhat ConfidentVery Confident
  • Not ConfidentSomewhat ConfidentVery Confident
    Instruction: The next 10 questions are about your knowledge of HIV. Choose TRUE of FALSE
  • TrueFalse
  • TrueFalse
  • TrueFalse
  • TrueFalse
  • TrueFalse
  • TrueFalse
  • TrueFalse
  • TrueFalse
  • TrueFalse
  • TrueFalse
    Instruction: The next few questions are about having sex and using condoms.
  • (# of times had sex with a man who put his penis in your vagina, in the past 3 months.)
    999 = I have not had sex with a man who put his penis into my vagina in the past 3 months.
  • (# of times used a condom, in the past 3 months)
    999 = I have not had sex with a man who put his penis into my vagina in the past 3 months.
  • (# of men who have put their penis into your vagina in the past 3 months)
    999 = I have not had sex with a man who put his penis into my vagina in the past 3 months.
  • (# times of exchanged sex in the past 3 months)
    999 = I have not exchanged sex for drugs, shelter, food or money in the past 3 months.
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo