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HIV Risk Assessment Questionnaire

1. Have you or your sexual partner(s) had other sexual partners in the past year?

2. Have you ever had a sexually transmitted infection?

3. Are you pregnant or considering becoming pregnant?

4. Have you or your sexual partner(s) injected drugs or other substances and/or shared needles with another person?

5. Have you ever had sex with a male partner who has had sex with another male?

6. Have you ever had sex with a person who is HIV infected?

7. Have you ever been paid for sex and/or had sex with a prostitute/sex worker?

8. Have you engaged in behavior resulting in blood to blood contact (e.g. S & M, tattooing, piercing)

9. Have you or your sexual partner(s) received a blood transfusion or blood products before 1985?

10. Have you been the victim of rape, date rape or sexual abuse?

If you answered yes to any of these questions, you should consider having an HIV test.