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Have you ever been tested for HIV/AIDS?
 
Yes
 
No
 
 
 
How many sexual partners have you had?
 
Quarterly
 
 
 
What age range do you fall into?
 
12-18
 
19-25
 
26-31
 
31-50
 
 
 
What is your marital status?
 
Single
 
Married
 
Divorced
 
Widowed
 
 
 
Do you practice safe sex?
 
Yes
 
No
 
Sometime
 
Never
 
 
 
Do you condoms every time you have sex?
 
Yes
 
No
 
Sometime
 
Never
 
 
 
Do you have more than one sexual partner?
 
Yes
 
No
 
 
 
How many sexual partners have you had in the past year?
 
1 to 5
 
5 to 10
 
10 to20
 
or more
 
 
 
How much information do you know about the spread of HIV/AIDS
 
Some
 
Very little
 
None at all
 
 
 
Are you aware that HIV/AIDS can be spread through kissing?
 
Yes
 
No
 
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