| 1. |
Are you sexually active? |
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| 2. |
Do you practice any of the following sexual acts with a woman whose HIV-status is unknown to your? |
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| 3. |
Do you practice oral sex on a woman? |
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| 4. |
Do you perform or receive oral-anal sex? |
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| 5. |
Do you have contact with urine - "golden showers" or "water sports" - on unbroken skin from a woman with an unkown HIV-status? |
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| 6. |
Do you perform vaginal penetration? |
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| 7. |
Have you ever had a sexual encounter with a man? |
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| 8. |
Do you receive anal penetrative sex? |
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| 9. |
Do you share uncovered sex toys? |
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| 10. |
Do you come in contact with your lover's menstrual blood? |
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| 11. |
How many sex partners did you have the past 5 years? |
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| 12. |
Do you know with absolute certainty that your sex partner is HIV-negative? |
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| 13. |
Do you use intravenous drugs? |
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