Date______Client ID______

SISTA Questionnaire – Pre Session 1

A. Background information
1. Age: Circle the answer that describes your age
15-19 20-24 25-29 30-34 35-39 40-44 45-54 55+
2. Race/Ethnicity: Circle all the answers that you think best describe your background
Black Hispanic Native American White Asian Other:______
3. Education: Circle the last schooling you completed.
Elementary School
Middle School
High School / GED
Some college, technical, or vocational school
Bachelor’s degree or more

B. Answer the questions below by circling True, False or Don’t Know

1. AIDS is caused by the Human Immunodeficiency Virus (HIV). / True / False / Don’t Know
2. You can contract HIV from using a water fountain or toilet used by
an HIV+ person . / True / False / Don’t Know
3. There is a cure for HIV/ AIDS. / True / False / Don’t Know
4. Using condoms correctly will reduce your chances of getting HIV or an STD.
/ True / False / Don’t Know
5. Viral STDs like Herpes and Hepatitis C are curable. / True / False / Don’t Know
6. You cannot get a sexually transmitted disease from oral sex. / True / False / Don’t Know
7. You can get HIV by sharing a needle with someone who is HIV+, getting a
Tattoo, or getting a body piercing. / True / False / Don’t Know
8. You cannot get HIV from any kind of casual contact, like shaking hands with a person who has HIV.
/ True / False / Don’t
Know
9. Heterosexual and homosexual men and women can get HIV if they do not
protect themselves. / True / False / Don’t
Know
10. Most of the time, you can tell by looking at a person if he has an STD,
especially HIV/AIDS. / True / False / Don’t Know
11. The best time to talk to your partner about safer sex is after a sexual
contact has occurred. / True / False / Don’t Know
12. Being tested and treated for HIV and other STDs early can help lessen the
effects of the disease. / True / False / Don’t Know
13. HIV destroys the immune system. / True / False / Don’t Know
14. Sheepskin condoms are the best at stopping the spread of HIV and STDs. / True / False / Don’t Know

SISTA Pre session 1 Questionnaire 9 30 2012