What is HIV and AIDS?
What is HIV and AIDS?
What is HIV and AIDS?
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Important Note: Th<strong>is</strong> <strong>is</strong> a strictly confidential survey. Please complete the<br />
survey, fold in half <strong>and</strong> put in the collection box.<br />
1. Sex:<br />
□ male<br />
□ female<br />
2. Age:<br />
□ 15-19 years<br />
□ 20-24 years<br />
□ 25-29 years<br />
□ 30-34 years<br />
□ 35-39 years<br />
□ 40-44 years<br />
□ 45-49 years<br />
□ 50-54 years<br />
□ 55-59 years<br />
□ 60+<br />
Annex 19: KABP Example Survey<br />
3. How can <strong>HIV</strong> be transmitted? (Tick as many boxes as you like)<br />
□ Sex without a condom<br />
□ Sleeping in the same bed<br />
□ K<strong>is</strong>sing □ Mosquito bite<br />
□ Shaking h<strong>and</strong>s<br />
□ Blood transfusions<br />
□ In the womb mother-to-child<br />
□ Breast feeding<br />
□ Sharing a needle (drug use)<br />
□ Using public toilets<br />
□ Sharing a drink<br />
4. In general do you think that people who have sexually transmitted infections have<br />
been prom<strong>is</strong>cuous?<br />
□ Definitely<br />
□ Very Likely<br />
□ Likely<br />
□ Perhaps<br />
□ Not Likely
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