Date______Client ID______
SISTA Questionnaire - Pre Session 2______
A. Put a check mark next to the things you have done in the last 30 days (check all that apply):
1. ___ Had unprotected vaginal sex with one sex partner
2. ___ Had unprotected vaginal sex with multiple sex partners
3. ___ Had unprotected anal sex
4. ___ Had unprotected sex with someone who has sex with other people
5. ___ Had sex after using drugs and/or alcohol
6. ___ Had sex with someone who is an injecting drug user
7. ___ Used a needle to inject drugs into your body
8. ___ Used someone else's needle to inject drugs into your body
______
B. Think about how you answered the questions above. Circle the choice below that best describes your risk for getting HIV?
No chance at all A very small chance I may or may not I will probably
of getting HIV of getting HIV get HIV get HIV
______
C. How likely you are to do the following things to keep from getting HIV. Circle the choice that best describes how likely you are to do the following things:
1. Use condoms during each sexual contact No way Small Chance Good chance For Sure
2. Use dental dams during oral sex No way Small Chance Good chance For Sure
3. Reduce the number of sex partners you have No way Small Chance Good chance For Sure
4. Get an HIV test No way Small Chance Good chance For Sure
5. Talk to your sex partner about risk reduction No way Small Chance Good chance For Sure
techniques
6. Encourage your sex partners who inject drugs to No way Small Chance Good chance For Sure
use bleach kits to clean their needles
7. Use bleach kits to clean needles you use to inject No way Small Chance Good chance For Sure
drugs into your body
8. Quit injecting drugs into your own body No way Small Chance Good chance For Sure
9 Be careful about decisions you make when you No way Small Chance Good chance For Sure
have been drinking or using other drugs
10. Other:______
______
D. What do you hope to get out of being in this group?
SISTA Pre session 2 Questionnaire 9 30 2012