African American Women / HIV-AIDS Crisis

What age range do you fit into?

12-18

18-25

26-31

31-50

Have you taken an HIV/AIDS test?

Yes

No

Sexual orientation:

Gay

Straight

Bi-sexual

Marital Status

Single

Married

Divorced

Widowed

Do you practice safe sex?

Yes

No

Sometime

Never

What precautions do you take to avoid sexual transmitted diseases?

Condom use

Abstinence

limit sexual partners

only have sex with spouse

Have you had more than one sexual partner within the last year?

Yes

No

In the last five year, how many sexual partners have you had?

1-5

5-10

10 - 20

or more

How much information do you know about how this disease is spread?

Some

Very Little

None at all

Are you aware that African American women rank number 1 in the US infected with HIV/AIDS?

Yes

No