Knowing Is Positive

HIV Awareness Campaign targeting Women of Color and their Partners

Survey

Please select the responses that describes your feelings, awareness and/or actions after after listening to the Knowing Is Positive HIV Awareness CD, reviewing the HIV information on the website or attending one of our workshops:
I took an HIV TEST. I KNOW my HIV status.
My partner took an HIV TEST and KNOWS their status
I KNOW my partner’s HIV RISK FACTORS
I KNOW my partner’s HIV status
I pledge to always use condoms during sex.
I spoke with or Contacted an HIV Agency;
Learned more about HIV/AIDS.
Talked to my partner about HIV.
Modified my HIV Risk behavior.
Learned about Substance Abuse Prevention
Shared HIV information with someone else.
The following questions are demographic questions.  Please check the appropraite box that best describes you.Gender:
Female
Male
Transgender
Race:
Afr.Am/Black
Latino/Hispanic
Asian
White
Other
Age Range:
13-18 yrs.
18-24 yrs.
25-45 yrs.
45-above
Sexual Behavior:
Abstinent
Monogamous
Multiple Partners
Always use condoms when having sex
Ocassionally use condoms when having sex
Never use condoms when havng sex
Status:
Single
Committed Relationship
Married
Separated/Divorced
Sexual Orientation:
Heterosexual
Bi-Sexual
Homosexual
MSM
Other
Drug History
I used drugs in the past
I used IV Drugs in the past
My Partner used drugs in the past
My partner used IV drugs in the past
I take recreational drugs now
I take IV drugs now
Have Shared/ Share IV Drug Needles
Never Used Drugs
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