AGE:
M/F:
DO YOU HAVE SEX:
YES NO
IF YES PLEASE GO ON IF NO THIS SURVEY DOES NOT APPLY TO YOU.
DO YOU STILL HAVE FREQUENT SEX:
YES NO
WHAT AGE DID YOU START HAVING SEX
BELOW 12 YEARS
13-15 YEARS
16-18 YEARS
HOW OFTEN DO YOU HAVE SEX PER MONTH
1-3 TIMES
4-8 TIMES
9-11TIMES
11+
DON’T KNOW
NONE OF THE ABOVE
HOW MANY DIFFERENT PARTNERS DO YOU HAVE SEX WITH PER MONTH
1
2
3
4
5
DON’T KNOW
NONE OF THE ABOVE
HAVE YOU EVER HAD UNPROTECTED SEX
YES NO
HOW OFTEN DO YOU HAVE UNPROTECTED SEX:
NEVER SOMETIMES ALWAYS
IF YOU HAVE EVER HAD UNPROTECTED SEX ARE ANY OF THE FOLLOWING REASONS WHY
1.PEER PREASURE 2.YOU WERE UNDER THE INFLUENCE OF ALCHOLE OR ANY TYPE OF DRUG
IF YOU HAVE EVER HAD UNPROTECTED SEX STATE SOME REOSONS WHY
IF NOT SKIP TO THE NEXT QUESTION
1.
2.
3.
DO YOU HAVE A SPECIFIC REASON WHY YOU HAVE UNPROTECTED SEX?
1.RELIGION
2.CULTURE
3.BELIEFS
4.PERSONAL CHOICE
5.PARTNERS CHOICE
6.OTHER
IF YOU DON’T HAVE UNPROTECTED SEX, WHAT IS YOUR REASON WHY
1.RELIGION
2.CULTURE
3.BELIEFS
4.PERSONAL CHOICE
5.PARTNERS CHOICE
6.OTHER
DO YOU KNOW ABOUT THE RISK FACTORS OF HAVING UNPROTECTED SEX IE. STD’s, PREGNANCIE
YES NO UNSURE
DOES YOUR SCHOOL EDUCATE YOU ON UNPROTECTED SEX
YES NO SOMETIMES
DOES YOURE SCHOOL EDUCATE YOU ON THE DISEASES OR RISKS ON UNPROTECTED SEX
YES NO SOMETIMES
M/F:
DO YOU HAVE SEX:
YES NO
IF YES PLEASE GO ON IF NO THIS SURVEY DOES NOT APPLY TO YOU.
DO YOU STILL HAVE FREQUENT SEX:
YES NO
WHAT AGE DID YOU START HAVING SEX
BELOW 12 YEARS
13-15 YEARS
16-18 YEARS
HOW OFTEN DO YOU HAVE SEX PER MONTH
1-3 TIMES
4-8 TIMES
9-11TIMES
11+
DON’T KNOW
NONE OF THE ABOVE
HOW MANY DIFFERENT PARTNERS DO YOU HAVE SEX WITH PER MONTH
1
2
3
4
5
DON’T KNOW
NONE OF THE ABOVE
HAVE YOU EVER HAD UNPROTECTED SEX
YES NO
HOW OFTEN DO YOU HAVE UNPROTECTED SEX:
NEVER SOMETIMES ALWAYS
IF YOU HAVE EVER HAD UNPROTECTED SEX ARE ANY OF THE FOLLOWING REASONS WHY
1.PEER PREASURE 2.YOU WERE UNDER THE INFLUENCE OF ALCHOLE OR ANY TYPE OF DRUG
IF YOU HAVE EVER HAD UNPROTECTED SEX STATE SOME REOSONS WHY
IF NOT SKIP TO THE NEXT QUESTION
1.
2.
3.
DO YOU HAVE A SPECIFIC REASON WHY YOU HAVE UNPROTECTED SEX?
1.RELIGION
2.CULTURE
3.BELIEFS
4.PERSONAL CHOICE
5.PARTNERS CHOICE
6.OTHER
IF YOU DON’T HAVE UNPROTECTED SEX, WHAT IS YOUR REASON WHY
1.RELIGION
2.CULTURE
3.BELIEFS
4.PERSONAL CHOICE
5.PARTNERS CHOICE
6.OTHER
DO YOU KNOW ABOUT THE RISK FACTORS OF HAVING UNPROTECTED SEX IE. STD’s, PREGNANCIE
YES NO UNSURE
DOES YOUR SCHOOL EDUCATE YOU ON UNPROTECTED SEX
YES NO SOMETIMES
DOES YOURE SCHOOL EDUCATE YOU ON THE DISEASES OR RISKS ON UNPROTECTED SEX
YES NO SOMETIMES