Dreamzone365 Inc. is a community enrichment program from the Fellowship of New Beginnings Church located in Houston, Texas. (www.tfnb.org ) In our attempts to provide quality support to families we have created surveys that help parents and family members to understand some of the questions/conversations our kids face when alone with their peers. We encourage you to take this survey along with your youth and allow this to become a reliable tool when seeking the kids social understanding one of today's most dangerous issue's.
Please forward this email /surveys to everyone that come in contact with kids and would like to save a life.
Remember HIV/AIDS does not discriminate.....
Dreamzone356 Inc.
HIV/AIDS Knowledge Survey
This interview is for a research study that is being done by Dreamzone365 Inc. We are trying to find out what young people think about infections you get from having sex. We also seek to find out what they know about (STDs), AIDS and HIV. The results from this survey will be used to help educate young people. Remember, we are asking these questions to help educate them to make informed decisions. Please answer the following questions honestly as possible.
Please do not write any names or identifiable information on the questionnaire.
School Name: ___________________________________________
Please provide the following information: Male ______ Female ______ Age ______ Grade _______
1. Have you ever had sexual intercourse? [For the purposes of this survey, “sexual intercourse,” is defined as vaginal or anal penetrative sexual intercourse].
YES NO
2. At what age did you first have sexual intercourse? AGE [__|__]
3. What was the age of the person with whom you first had sexual intercourse? AGE [__|__]
4. When is the last time you had sexual intercourse?
1-15 DAYS AGO 1 MONTH 3 MONTHS 6 MONTHS 9 MONTHS 12+ MONTHS
5. How many people have you had sex with?
0 1-4 5-10 11-15 16-20 21-25 26-30 30+
6. The last time you had sex did you and your partner use a condom?
YES NO
7. How many people have you had sex with without using a condom? _________________
8. How often do you or your partner use condoms:
NEVER SOMETIMES MOST OF THE TIME ALWAYS
9. How many aids test have you taken in the past? _____________
10. Do you know if anybody at your school has HIV /AIDS?
YES NO DON’T KNOW
11. Describe any symptoms of STDs in women? __________________________________________________
12. Describe any symptoms of STDs in men? ____________________________________________________
13. Can HIV/AIDS be contracted thru oral sex?
YES NO NOT SURE
14. Do you know anyone who has been infected with HIV or who has died of AIDS?
YES NO DON’T KNOW
15. Do you have a close relative or friend who is infected with HIV or AIDS?
YES, A CLOSE RELATIVE YES, A CLOSE FRIEND NO
16. Can people protect themselves from the HIV virus by using a condom correctly every time they have sex?
YES NO DON’T KNOW
17. Can a person get the HIV virus from mosquito bites?
YES NO DON’T KNOW
18. Do members of the opposite sex pressure you to have sex?
YES NO
19. Do members of the same sex pressure you to have sex?
YES NO
20. Do you pressure others to have sex with you?
YES NO
21. Are you attracted to members of the: (circle one) Same sex Opposite sex Both
22. Can people protect themselves from the HIV virus by abstaining from sexual intercourse?
YES NO DON’T KNOW
23. Can a person get the HIV virus by sharing a meal with someone who is infected?
YES NO DON’T KNOW
24. Can a person get the HIV virus by getting injections with a needle that was already used by someone else that is infected?
YES NO DON’T KNOW
25. Do you think that a healthy-looking person can be infected with HIV or AIDS?
YES NO DON’T KNOW
26. How many kids do you know in High-school that’s pregnant?
0 1-4 5-10 11-15 16-20 21-25 26-30 30+
27. How many kids do you know in Middle High school that’s pregnant?
0 1-4 5-10 11-15 16-20 21-25 26-30 30+
28. How many kids do you know in High-school that has a baby?
0 1-4 5-10 11-15 16-20 21-25 26-30 30+
29. How many kids do you know in Middle High-school that has a baby?
0 1-4 5-10 11-15 16-20 21-25 26-30 30+
30. How many kids do you know in High-school that has more than one baby?
0 1-4 5-10 11-15 16-20 21-25 26-30 30+
31. How many kids do you know in Jr. High-school that has more than one baby?
0 1-4 5-10 11-15 16-20 21-25 26-30 30+
32. Can birth control pills or shots prevent you from contracting STD’s or HIV?
YES NO DON’T KNOW
33. HIV can go undetected in your body for 5 to 10 years?
TRUE FALSE
34. If there was anything that you wanted to know about Sex, STD’s or Aids, what would it be?
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