Electronic Journal of Human Sexuality, Volume 1, November 10, 1998


www.ejhs.org

CONDOM USE OF FEMALE COLLEGE STUDENTS AS A FUNCTION

OF INFORMATION VERSUS ROLE PLAY AND MODELING

Lisa Kirsten Hunter

Appendix E
 

Sexual History Questionnaire



Instructions: Please answer the following questions by checking a "yes" or "no" below the question. Please answer as honestly as you can. Please be sure to answer every question.
 

1. In the past 3 weeks, have you had sex with anyone?

_____ Yes _____ NO
 

If you answered "yes," please continue to fill out the rest of the questionnaire.
 

2. Have you had sex with more than one partner in the past 3 weeks?

_____ Yes _____ NO
 

How many partners have you had sex with in the past 3 weeks?

_____ 1 partners
_____ 2 partners
_____ 3 partners
_____ 4 partners
_____ 5 partners
_____ 6 or more partners
 

3. In the past 3 weeks, did you have sex with someone without discussing using condoms first?

_____ Yes _____ NO
 

4. In the past 3 weeks, did you ever have sex when you or your partner did not use a condom?

_____ Yes _____ NO
 

5. In the past 3 weeks, did you have sex with someone who refused to allow condoms to be used?

_____ Yes _____ NO
 

6. Did you go ahead and have sex with someone in the past 3 weeks even though you thought they were not a safe partner because of their drug use?

_____ Yes _____ NO
 

7. Did you have sex with someone you thought does not use safer sex practices in the past 3 weeks?

_____ Yes _____ NO
 

8. In the past 3 weeks, have you had sex in exchange for money, drugs or a place to stay?

_____ Yes _____ NO
 

9. In the past 3 weeks, have you had sex with a partner you have known for less than a day?

_____ Yes _____ NO
 

10. Have you been pressured to have unwanted sex in the past 3 weeks?

_____ Yes _____ NO
 

11. In the past 3 weeks, have you had sex after using drugs or alcohol?

_____ Yes _____ NO
 

12. Have you had anal sex in the past 3 weeks?

_____ Yes _____ NO
 

13. In the past 3 weeks, have you had sex with a partner who has used IV drugs?

_____ Yes _____ NO
 

14. In the past 3 weeks, have you purchased any condoms?
 

15. In the past 3 weeks, did you ever share needles or "works" with someone else when using IV drugs?

_____ Yes _____ NO
 

16. Do you have condoms readily available for use?
 

17. Did you have sex with someone you thought might be infected with the HIV/AIDS virus in the past 3 weeks?

_____ Yes _____ NO
 

18. Did you have sex someone in the past 3 weeks even though you had asked them to be tested for the HIV/AIDS virus and they refused?

_____ Yes _____ NO
 

19. Have you ever been tested for the HIV/AIDS virus?

_____ Yes _____ NO
 

20. Have you ever had any sexually transmitted diseases (STDs)?

_____ Yes _____ NO
 

If yes, have you had any STDs in the past 3 weeks?

_____ Yes _____ NO
 

If yes, which STDs have you had in the past 3 weeks?

_____ gonorrhea              _____ syphilis

_____ hepatitis                 _____ chlamydia

_____ crabs/pubic lice      _____ herpes

_____ genital warts

_____ other (what?)_____________________________

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