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STI Questionnaire

Have you had vaginal, anal or oral sex without a condom in the past 12 months?
Yes
No
Have you ever had an STI, including HIV?
Yes
No
I don't know
Have any of your partners had an STI?
Yes
No
I don't know
Have you or any of your partners ever used illicit substances?
Yes
No
I don't know
Have you exchanged sex for needs (money, housing, drugs, etc.) in the past 12 months?
Yes
No
Is it possible that any of your sex partners in the past 12 months had sex with someone else while they were still in a sexual relationship with you?
Yes
No
I don't know
In recent months, how many sex partners have you had?
1
2
3
4+
If you use prevention tools, what methods do you use?
How often do you use this/these method(s)?
Rarely
Sometimes
Almost all the time
All of the time
Are you or your partner using contraception or practicing any form of birth control?
Yes
No
Do you think you would like to have (more) children at some point?
Yes
No
I don't know
Do you need any information on birth control?
Yes
No
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