05.52 SIG POST-TEST Name Participant ID Date Test Type Pre-Test Post-Test Instruction: Please complete this form as honestly and thoroughly as possible. The following questions ask demographic information about you. Circle your responses as necessary.1. How old are you? 2. What is the highest grade of school that you have complted?No formal schoolingLess than a high school diplomaA high school doplomaSome college or a 2-year degree4-year college degree or graduate work3. What is your employment status?UnemployedPart-timeFull-time4. What is your total monthly income? (Not including your parent's) I have no monthly income My monthly income is $$ 5. Do you currently have medical insurance? (i.e., Medicaid/Medical)YesNo6. Are you currently married?YesNo7. How long have you and your main partner been together? I do not have a main partner We have been together for (days/months/year) 8. Are you living with your main partner?YesNo9. In the past 3 months, how often did you drink beer, wine or liquor?Not at allA few timesA few times each weekEveryday10. In the past 3 months, how often did you use drugs to get high or relax (i.e., marijuana, cocaine, crack)?Not at allA few timesA few times each weekEverydayInstruction: 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 NotProbably NotProbably YesDefinitely Yes2. Can you insist on condom use if your main partner does not want to use one?Definitely NotProbably NotProbably YesDefinitely Yes3. Can you stop and look for condoms when you are sexually aroused?Definitely NotProbably NotProbably YesDefinitely Yes4. Can you insist on condom use every time you have sex even when you are under the influence of drugs?Definitely NotProbably NotProbably YesDefinitely Yes5. Can you insist on condom use every time you have sex even when your main partner is under the influence of drugs?Definitely NotProbably NotProbably YesDefinitely Yes6. Can you put a condom on your main partner without spoilling the mood?Definitely NotProbably NotProbably YesDefinitely Yes7. Can you insist on condom use every time you have sex even if your main partner uses another method to prevent pregnancy?Definitely NotProbably NotProbably YesDefinitely YesInstruction: 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 ConfidentSomewhat ConfidentVery Confident2. Unroll a condom down correctly on the first try.Not ConfidentSomewhat ConfidentVery Confident3. Start over with a new condom if you placed it on the wrong way.Not ConfidentSomewhat ConfidentVery Confident4. Unroll a condom fully to the base of the penis.Not ConfidentSomewhat ConfidentVery Confident5. Squeeze air from the tip of a condom.Not ConfidentSomewhat ConfidentVery Confident6. Take a male condom off without spilling the semen or cum.Not ConfidentSomewhat ConfidentVery Confident7. Take a male condom off before partner loses their hard on.Not ConfidentSomewhat ConfidentVery Confident8. Dispose of a used condom properly.Not ConfidentSomewhat ConfidentVery Confident9. Use lubricant with a condom.Not ConfidentSomewhat ConfidentVery ConfidentInstruction: The next 10 questions are about your knowledge of HIV. Choose TRUE of FALSE1. Condoms can help protect you from transmitting or becoming infected with HIV.TrueFalse2. Having sex with someone who has HIV is the only way to becoming infected with HIV.TrueFalse3. Female condoms are effective in preventing HIV infection.TrueFalse4. There is a cure for AIDS.TrueFalse5. A positive HIV Antibody test means that you have AIDS.TrueFalse6. To know if you have HIV you have to take a test.TrueFalse7. Having unprotected anal sex increases a person's chance of getting HIV.TrueFalse8. HIV is passed most effectively in semen and blood.TrueFalse9. Women can not pass HIV to men.TrueFalse10. The safest way to prevent getting HIV is to abstain from sex.TrueFalseInstruction: The next few questions are about having sex and using condoms.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?YesNo6. The next time you have sex do you plan to use a condom?YesNo7. In the next 3 months, do you plan on using a condom if you have sex?YesNo8. In the next 3 months, do you plan on using a female condom?YesNo9. In the past 3 months, did you attempt to use a female condom?YesNo
