2NP

All information collected is for record keeping strictly accessed only by

Us Helping Us Personnel. Any and all information shared will not be shared.

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Sexual Behaviors:

Your last known HIV status:

In the past 12 months, have you smoked or snorted drugs?

In the past 12 months, have you had sex with a female partner?

In the past 12 months, have you used a needle by another person for drugs, vitamins, steroids, hormones, body piercings or tattooing?

In the past 12 months, have you had vaginal or anal sex with a transgender partner?

In the past 12 months, have you had vaginal or anal sex with someone you don't know?

In the past 12 months, have you had vaginal or anal sex while high on drugs or alcohol?

In the past 12 months, have you had vaginal or anal sex with someone who injects drugs?

In the past 12 months, have you had vaginal or anal sex for drugs, housing, money or food, etc?

In the past 12 months, have you had vaginal or anal sex with someone else who has sex for drugs, housing, money or food, etc.

In the past 12 months, have you had vaginal or anal sex with someone whose HIV status you did not know?

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Have you attended a previous UHU retreat?

Your application has been sent. A Us Helping Us rep will reach out to you shortly to schedule your upcoming intervention retreat.