UNIVERSITY OF NORTH CAROLINA WILMINGTON

Abrons Student Health Center

Are you at risk for infection with HIV or another Sexually Transmitted Disease?

1.  How many sex partners have you had within the past year

o None o One o 2-5 o 6-10 o more than 10

2.  About how many sex partners have you had in your lifetime?

o None o One o 2-5 o 6-10 o more than 10

3.  Have you ever had sex with a person with HIV or AIDS? o Yes o No o Unsure

4.  Have you ever had a sexually transmitted disease (of any type)? o Yes o No o Unsure

5.  If you are male, have you ever had sex with men? o Yes o No

6.  If you are female, have you had sex with men who have had sex with men? o Yes o No o Unsure

7.  Have you ever had anal intercourse without a condom? o Yes o No

8.  How often do you currently use condoms with your sex partner(s)?

o Always o Usually o Sometimes o Seldom o Never

9.  Have you ever regularly had sex without a condom? o Yes o No

10.  Do you have unprotected oral sex that involves ejaculation? o Yes o No

11.  Have you ever injected (shot-up) drugs or used crack cocaine? o Yes o No

12.  Have you ever had sex with an injecting drug user? o Yes o No o Unsure

13.  Have you ever had sex with someone who used crack cocaine? o Yes o No o Unsure

14.  Have you ever drank alcohol or used drugs and then engaged in o Yes o No

risky behavior/sex?

15.  Have you ever traded sex for drugs or alcohol or money? o Yes o No

16.  Have you ever had sex with a prostitute? o Yes o No

17.  Have you ever had sex with someone you met at a sex club/internet sex site? o Yes o No

18.  Have you ever been forced to have sex (any type) against your will? o Yes o No

A positive response to questions 1-18 increases your risk

A positive response to the next question can help minimize your risk

19. Are you presently involved in an ongoing long-term sexual relationship o Yes o No

with one and only one person with known negative HIV status?

After answering the above questions, what do estimate your risk of being infected with HIV?

o no risk o low risk o medium risk o high risk o very high risk o not sure

SHC rev 11/08