Name *

First

Last

Email *

What are the ways that a person can protect themselves from being transmitted with HIV?

Avoid kissing *

• Yes
• No
• I Don't know

Believe in traditional healer/taaveez/prayers *

• Yes
• No
• I Don't know

Avoid sharing razor blades, knives or any sharp objects *

• Yes
• No
• I Don't know

Avoid mosquito bites *

• Yes
• No
• I Don't know

Avoid unsterilized needles and injections *

• Yes
• No
• I Don't know

Require partner to take HIV Test *

• Yes
• No
• I Don't know

Avoid sex with homosexuals *

• Yes
• No
• I Don't know

Avoid sex with person who inject drugs intravenously *

• Yes
• No
• I Don't know

Avoid blood transfusion that has not gone through HIV Screen Test *

• Yes
• No
• I Don't know

Avoid red light district or having sex with commercial sex workers *

• Yes
• No
• I Don't know

Abstain from sex *

• Yes
• No
• I Don't know

Limit number of sexual partners *

• Yes
• No
• I Don't know

Use condoms *

• Yes
• No
• I Don't know

Stay faithful to one partner (monogamous relationship) *

• Yes
• No
• I Don't know

Avoid sex with multiple partners (polygamous) *

• Yes
• No
• I Don't know

If you have NEVER been tested, why have you NOT been tested?

Not likely to have HIV infection at all *

• Yes
• No
• I Don't know

Afraid of the result *

• Yes
• No
• I Don't know

Prefer not to think about HIV *

• Yes
• No
• I Don't know

I have never been injected or had transfusion *

• Yes
• No
• I Don't know

I have never been to red light area *

• Yes
• No
• I Don't know

I am a virgin *

• Yes
• No
• I Don't know

I am worried about someone will find out my test report *

• Yes
• No
• I Don't know

I am afraid of losing job/family/house/respect/friends if tested positive *

• Yes
• No
• I Don't know

I don’t know how to disclose to my better half or anyone if tested positive *

• Yes
• No
• I Don't know

What do you do to avoid getting infected with HIV/AIDS?

Advise spouse/sexual partner to take care *

• Yes
• No
• I Don't know

Say a prayer/Believe in a prayer *

• Yes
• No
• I Don't know

Practice sexual abstinence *

• Yes
• No
• I Don't know

Avoid blood transfusions and injections *

• Yes
• No
• I Don't know

Keep away from a person who is HIV positive *

• Yes
• No
• I Don't know

Use Condoms with:

All other partners except spouse *

• Yes
• No
• I Don't know

Commercial sex workers/Bar girls *

• Yes
• No
• I Don't know

People you don’t know *

• Yes
• No
• I Don't know

People you think might be infected *

• Yes
• No
• I Don't know

Masturbation *

• Yes
• No
• I Don't know

Avoid having sexual intercourse with:

Any partners except spouse *

• Yes
• No
• I Don't know

Commercial sex workers/Bar girls *

• Yes
• No
• I Don't know

Many Partners *

• Yes
• No
• I Don't know

People unknown to me *

• Yes
• No
• I Don't know

People you think might be infected *

• Yes
• No
• I Don't know

People of the same sex or homosexuals or bisexuals *

• Yes
• No
• I Don't know

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