SURVEY ON AWARENESS OF SEXUALLY TRANSMITTED DISEASES

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The code name should be 6 to 12 characters long. Use only alphabets [a-z] and numbers [0-9]. No blank spaces. This same code name should be used by you if you fill out the survey later in life.

Please answer all questions. Skip questions only if they absolutely do not apply to you.

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  1. GIVE YOURSELF A CODE NAME THAT YOU WILL REMEMBER:

  2. TODAY's DATE (dd/mm/yyyy):

  3. YOUR AGE:

  4. YOUR SEX:

    Male  
    Female

  5. YOUR SCHOOL'S NAME:

  6. CLASS YOU ARE IN AT SCHOOL (OR YOUR HIGHEST DEGREE):

  7. NAME OF CITY YOU LIVE IN:

  8. NAME OF COUNTRY YOU LIVE IN:

  9. YOUR PARENTS (OR YOUR) PROFESSION

    PROFESSIONAL (doctor, lawyer, teacher ...)   
    BUSINESSPERSON, SHOPKEEPER  
    WORKER (factory, farm, municipal, house)  
    POLITICIAN  
    PROFESSIONAL SPORTSPERSON  
    NEWSPAPER, TV, REPORTER  
    ARTIST (MUSICIAN, PAINTER, DANCER)  
    OTHER SPECIFY

  10. YOUR FAMILY's ECONOMIC STATUS

    POOR   
    LOWER MIDDLE CLASS  
    MIDDLE CLASS   
    UPPER MIDDLE CLASS  
    RICH   
    VERY RICH   
    OTHER SPECIFY

  11. WHAT ARE YOUR SOURCES FOR LEARNING ABOUT SEX?

    FRIENDS   
    TV   
    RADIO   
    MAGAZINES  
    MOVIES   
    PARENTS   
    TEACHERS   
    OTHER, SPECIFY 

  12. HOW ARE SEXUALLY TRANSMITTED DISEASES (STD) SPREAD?

    BEING IN THE SAME ROOM  
    SHARING FOOD OR DRINK  
    SHARING CLOTHES  
    CONTACT OF GENITALS WITH THE MOUTH (ORAL SEX)   
    ANAL INTERCOURSE  
    VAGINAL INTERCOURSE   

  13. WHICH STD'S DO YOU KNOW ABOUT?

    GONORRHEA   
    CLAMYDIA   
    SYPHILIS   
    TRICHOMONAISIS   
    HERPES SIMPLEX   
    HUMAN PAPILOMA VIRUS (HPV)   
    HEPATITIS B   
    HIV/AIDS   

  14. FOR WHICH OF THE FOLLOWING STD'S IS THERE A CURE?

    GONORRHEA   
    CLAMYDIA   
    SYPHILIS   
    TRICHOMONAISIS   
    HERPES SIMPLEX   
    HUMAN PAPILOMA VIRUS (HPV)   
    HEPATITIS B   
    HIV/AIDS   

  15. IS THE RISK OF TRANSMISSION OF INFECTION HIGHER FROM

    WOMAN TO MAN  
    MAN TO WOMAN  
    PLEASE GIVE YOUR REASONS IN THE BOX BELOW 

  16. DO INFECTED MEN ALWAYS HAVE SYMPTOMS OF STD'S THAT ARE EASY TO SPOT?

    YES IN 0-20% OF THE CASES  
    YES IN 21-40% OF THE CASES  
    YES IN 41-60% OF THE CASES  
    YES IN 61-80% OF THE CASES  
    YES IN 81-100% OF THE CASES  
    NOT SURE  

  17. DO INFECTED WOMEN ALWAYS HAVE SYMPTOMS OF STD'S THAT ARE EASY TO SPOT?

    YES IN 0-20% OF THE CASES  
    YES IN 21-40% OF THE CASES  
    YES IN 41-60% OF THE CASES  
    YES IN 61-80% OF THE CASES  
    YES IN 81-100% OF THE CASES  
    NOT SURE  

  18. IF THE MAN/WOMAN KNOWS OR SUSPECTS THEY HAVE A STD, SHOULD HE/SHE TELL HIS/HER PARTNER EVEN IF THEY ARE NOT HAVING ANY SYMPTOMS?

    YES  
    NO  
    NOT SURE  

  19. WHAT MEDICAL PROBLEMS ARISE IN MEN IF BACTERIAL STD'S ARE NOT TREATED EARLY?

    SORES AND LESIONS  
    STERILITY  
    BODY WIDE INFECTION THROUGH DISSEMINATION BY BLOOD  
    DEATH  
    OTHER, PLEASE SPECIFY  

  20. WHAT MEDICAL PROBLEMS ARISE IN WOMEN IF BACTERIAL STD'S ARE NOT TREATED EARLY?

    SORES AND LESIONS  
    STERILITY  
    BODY WIDE INFECTION THROUGH DISSEMINATION BY BLOOD  
    PELVIC INFLAMMATION DISEASE  
    CERVICAL CANCER  
    DEATH  
    OTHER, PLEASE SPECIFY  

  21. WHO SUFFERS MORE SERIOUS DISEASES AND CONSEQUENCES OF STD'S -- MEN OR WOMEN ? AND WHY?

    MEN BY FAR  
    MEN  
    EQUAL  
    WOMEN  
    WOMEN BY FAR  
    NOT SURE  

  22. TO WHOM WOULD YOU GO, FOR HELP AND ADVISE, IF YOU SUSPECT HAVING GOTTEN AN STD?

    MOTHER  
    FATHER  
    SISTER  
    BROTHER  
    RELATIVE  
    FRIEND  
    FAMILY DOCTOR  
    DOCTOR IN A HOSPITAL WHO DOES NOT KNOW YOU  
    NOBODY AND TRY TO HIDE IT  

  23. WHAT IS RISKY SEX?

    SEX WITH MANY DIFFERENT PARTNERS  
    SEX WITH SOMEONE WHO MAY BE HAVING SEX WITH OTHERS  
    SEX WITH PROSTITUTES  
    SEX WITH SERVANTS  

  24. WHAT IS PROTECTED SEX WITH RESPECT TO SEXUALLY TRANSMITTED DISEASES?

    SEX USING A CONDOM  
    SEX USING A SPERMICIDE  
    SEX USING A MICROBICIDE  
    FEMALE PARTNER IS TAKING BIRTH CONTROL PILLS  
    FEMALE PARTNER IS USING AN IUD  

  25. WHAT IS SAFE SEX?

    SEX WITH ONLY ONE PARTNER WHO IS ONLY HAVING SEX WITH YOU  
    SEX WITHOUT PENETRATION  
    SEX WITHOUT CONTACT BETWEEN GENITALS  
    SEX USING A CONDOM  

  26. DO YOU AND YOUR FRIENDS DISCUSS WHAT IS SAFE SEX AND HOW TO TAKE THE RIGHT PRECAUTIONS?

    YES  
    NO  
    SOMETIMES  

  27. WHAT IS HIV/AIDS?

    IT IS A VIRUS   
    IT INFECTS ONLY HUMANS   
    OVER TIME IT DESTROYS THE IMMUNE SYSTEM   
    INFECTION LEADS TO DEATH   

  28. DO YOU KNOW HOW HIV/AIDS IS TRANSMITTED?

    YES  
    NO  
    NOT SURE  

  29. CONTACT WITH WHICH OF THE FOLLOWING ARE HIGH RISK FOR TRANSMITTING HIV?

    BLOOD OF AN INFECTED PERSON   
    SEMEN IN MAN   
    VIGINAL FLUIDS IN WOMAN   
    MOSQUITO OR ANIMAL BITES   
    AIR   
    WATER   
    FOOD   
    USING THE SAME TOILETS   
    BREAST MILK   
    SALIVA   
    SWEAT   
    USE OF UNSTERILISED NEEDLES   
    OTHER, SPECIFY 

  30. HOW CAN YOU AVOID/REDUCE RISK OF GETTING HIV/AIDS?

    ABSTINENCE TILL MARRIAGE   
    SAFE SEX   
    SEX USING A CONDOM   
    MUTUAL MASTURBATION WITHOUT EXCHANGE OF BODILY FLUIDS  

  31. DO YOU KNOW WHY HIV INFECTION IS MORE DANGEROUS THAN ALL THE OTHER STD'S?

    NO CURE   
    NO VACCINE   
    PATIENT SUFFERS MANY DANGEROUS AND PAINFUL DISEASES   
    KILLS THE PERSON IN 5-10 YEARS   
    DESTROYS NOT ONLY YOU BUT THE WHOLE FAMILY   

  32. WHICH OF THE FOLLOWING ACTIVITIES CANNOT TRANSMIT HIV/AIDS FROM A HIV+ PERSON?

    TOUCHING THEM   
    PLAYING WITH THEM   
    HUGGING THEM   
    BEING IN THE SAME ROOM WITH THEM   
    BEING IN THE SAME SWIMMING POOL, SHOWER   
    SHARING CLOTHES, BOOKS, TOYS   

  33. CAN HIV+ PERSON WITH NO SYMPTOMS STILL SPREAD THE DISEASE TO OTHERS VIA SEX OR BLOOD CONTACT?

    YES  
    NO  
    NOT SURE  

  34. CAN ANYONE TELL WHETHER A PERSON HAS HIV INFECTION BY JUST LOOKING AT THEM?

    YES  
    SOMETIMES  
    NO. ONLY BY A VERY SPECIFIC BLOOD TEST CAN A DOCTOR TELL  
    NOT SURE  

  35. IS THERE ANY CURE FOR HIV/AIDS?

    YES  
    NO  
    NOT SURE  

  36. IS THERE ANY VACCINE AVAILABLE FOR PREVENTION OF HIV/AIDS?

    YES  
    NO  
    NOT SURE  

  37. ARE THERE TREATMENTS THAT HELP PEOPLE WITH HIV LIVE LONGER AND BETTER LIVES?

    YES  
    NO  
    NOT SURE  

  38. WHY ARE THESE TREATMENTS AND MEDICINES NOT AVAILABLE TO MOST PEOPLE IN THE DEVELOPING WORLD?

    THEY ARE TOO EXPENSIVE   
    INSUFFICIENT MEDICAL INFRASTRUCTURE   
    IT IS NOT A GOVERNMENT PRIORITY  
    SOCIETY DOES NOT CARE ABOUT THOSE INFECTED   

  39. DO YOU FEEL COMFORTABLE ASKING YOUR PARENTS ABOUT CHANGES IN YOUR BODY THAT ARE RELATED TO REPRODUCTIVE ORGANS?

    YES  
    NO  
    SOMETIMES  

  40. ARE YOU ABLE TO CONFIDE IN YOUR PARENTS ABOUT MATTERS OF SEX?

    YES  
    NO  
    SOMETIMES  

  41. WHAT IS EXPECTED OF YOU BY YOUR PARENTS REGARDING SEX?

    ABSTINENCE TILL MARRIAGE   
    NO FRIENDSHIP WITH MEMBERS OF OPPOSITE SEX   
    FRIENDSHIP BUT NO PHYSICAL CONTACT  
    NO GUIDANCE FROM PARENTS ON THIS MATTER   
    NOT SURE   
    OTHER, SPECIFY 

  42. WHAT IS EXPECTED OF YOU BY YOUR FRIENDS REGARDING SEX?

    ABSTINENCE TILL MARRIAGE   
    NO PHYSICAL CONTACT   
    SOME EXPLORING   
    FULL FREEDOM TO TRY EVERYTHING   
    NOT SURE   
    OTHER, SPECIFY 

  43. ABOUT WHICH OF THE FOLLOWING BAD CONSEQUENCES OF RISKY SEX DO YOU AND YOUR FRIENDS KNOW ABOUT?

    PREGNANCY   
    EMOTIONAL AND PSYCHOLOGICAL TRAUMA/FEAR   
    SEXUALLY TRANSMITTED DISEASES INCLUDING HIV/AIDS  
    DISTRESS TO YOU, YOUR PARENTS, YOUR FAMILY   

  44. ARE YOU OR YOUR FRIENDS CONCERNED ABOUT GETTING SEXUALLY TRANSMITTED DISEASES (STD)?

    YES  
    NO  
    SOMEWHAT  

  45. ARE YOU OR YOUR FRIENDS CONCERNED ABOUT GETTING PREGNANT IF YOU HAVE SEX?

    YES  
    NO  
    SOMEWHAT  

  46. DO YOU KNOW THAT PROSTITUTES AND SERVANTS OFTEN HAVE MANY SERIOUS DISEASES THAT ARE SEXUALLY TRANSMITTED INCLUDING HIV/AIDS?

    YES  
    NO  
    NOT SURE  

  47. DOES FEAR OF HIV, STD, PREGNANCY, EMOTIONAL TRAUMA CONVINCE YOU TO NOT HAVE SEX BEFORE MARRIAGE?

    YES  
    NO  
    SOMEWHAT  

  48. WHY DO YOU THINK FEAR OF HIV INFECTION IS NOT ALWAYS SUFFICIENT TO PREVENT PEOPLE FROM HAVING RISKY SEX?

    THEY DONT KNOW ABOUT HIV AND HOW SERIOUS IT IS   
    THEY ARE UNDER THE INFLUENCE OF ALCOHOL OR DRUGS   
    ARE TOO EXCITED TO CARE ABOUT RISK   
    TOO DEPRESSED OR DESPERATE TO CARE   
    DONT BELIEVE THEY WILL GET INFECTED   
    TRUST THEIR PARTNER'S FIDELITY