SIG PRE-TEST / POST-TEST

Directions
Please complete this form as honestly and thoroughly as possible. The following questions ask demographic information about you. Circle your responses as necessary.
Particant ID*

Enter here your birth month and birth day with no spaces. This is your anonymous Participant ID.
Survey Type*
- Pre-Test
- Post-Test
1. How old are you?*
- Under 20
- 20-24
- 25-30
- 31-40
- 41-50
- Over 50
2. What is the highest grade of school that you have complted?
No formal schooling Less than a high school diploma A high school doploma Some college or a 2-year degree 4-year college degree or graduate work
3. What is your employment status?
Unemployed Part-time Full-time
4. What is your total monthly income? (Not including your parent's)
5. Do you currently have medical insurance? (i.e., Medicaid/Medical)
Yes No
6. Are you currently married?
Yes No
7. How long have you and your main partner been together? If you have no partner at this time, write, "I do not have a partner."
8. Are you living with your main partner?
Yes No
9. In the past 3 months, how often did you drink beer, wine or liquor?
Not at all A few times A few times each week Everyday
10. In the past 3 months, how often did you use drugs to get high or relax (i.e., marijuana, cocaine, crack)?
Not at all A few times A few times each week Everyday

Part Two
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.
1. Can you discuss condom use with your main partner?
Definitely Not Probably Not Probably Yes Definitely Yes
2. Can you insist on condom use if your main partner does not want to use one?
Definitely Not Probably Not Probably Yes Definitely Yes
3. Can you stop and look for condoms when you are sexually aroused?
Definitely Not Probably Not Probably Yes Definitely Yes
4. Can you insist on condom use every time you have sex even when you are under the influence of drugs?
Definitely Not Probably Not Probably Yes Definitely Yes
5. Can you insist on condom use every time you have sex even when your main partner is under the influence of drugs?
Definitely Not Probably Not Probably Yes Definitely Yes
6. Can you put a condom on your main partner without spoilling the mood?
Definitely Not Probably Not Probably Yes Definitely Yes
7. Can you insist on condom use every time you have sex even if your main partner uses another method to prevent pregnancy?
Definitely Not Probably Not Probably Yes Definitely Yes

Part Three
Instructions for Part Three: 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...
1. Put a condom on a hard penis.
Not Confident Somewhat Confident Very Confident
2. Unroll a condom down correctly on the first try.
Not Confident Somewhat Confident Very Confident
3. Start over with a new condom if you placed it on the wrong way.
Not Confident Somewhat Confident Very Confident
4. Unroll a condom fully to the base of the penis.
Not Confident Somewhat Confident Very Confident
5. Squeeze air from the tip of a condom.
Not Confident Somewhat Confident Very Confident
6. Take a male condom off without spilling the semen or cum.
Not Confident Somewhat Confident Very Confident
7. Take a male condom off before partner loses their hard on.
Not Confident Somewhat Confident Very Confident
8. Dispose of a used condom properly.
Not Confident Somewhat Confident Very Confident
9. Use lubricant with a condom.
Not Confident Somewhat Confident Very Confident

Part Four
Instruction: The next 10 questions are about your knowledge of HIV. Choose TRUE of FALSE
1. Condoms can help protect you from transmitting or becoming infected with HIV.
True False
2. Having sex with someone who has HIV is the only way to becoming infected with HIV.
True False
3. Female condoms are effective in preventing HIV infection.
True False
4. There is a cure for AIDS.
True False
5. A positive HIV Antibody test means that you have AIDS.
True False
6. To know if you have HIV you have to take a test.
True False
7. Having unprotected anal sex increases a person's chance of getting HIV.
True False
8. HIV is passed most effectively in semen and blood.
True False
9. Women can not pass HIV to men.
True False
10. The safest way to prevent getting HIV is to abstain from sex.
True False
Instruction: The next few questions are about having sex and using condoms.

Part Five
1. In the past 3 months, how manu times have you sex with a man who put his penis into your vagina?

(# 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.
2. In the past 3 months, when you had sex with a man who put his penis into your vagina, how many times of these times was a condom used?

(# 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.
3. In the past 3 months, how many men have put their penis into your vagina?

(# 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.
4. In the past 3 months, how many times did you exchange sex for drugs, shelter, food or cash?

(# 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.
5. The last time you had sex did you use a condom?
Yes No
6. The next time you have sex do you plan to use a condom?
Yes No
7. In the next 3 months, do you plan on using a condom if you have sex?
Yes No
8. In the next 3 months, do you plan on using a female condom?
Yes No
9. In the past 3 months, did you attempt to use a female condom?
Yes No

Directions