DelaWear One Enrollment - Delaware HIV Consortium

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Your age

Your Zip Code

I am *

What is your race? *

What is your ethnicity *

I have sex with *

Before now, where did you normally get your condoms? (Please check all that apply) *

From your answers listed above, how far do you travel to get to the place you get condoms most frequently? (Use your best estimate) *

Have you ever been tested for HIV? *

Do you know the HIV status of your partner(s)? *

In the last 3 months, when I had sex, it was with: (Please check all that apply) *

How often do you currently use a condom? (select one only) *

When I have used condoms it is because: (Please check all that apply) *

If "Other" chosen above, please describe reason for using condoms

When I have sex, I use a condom or dental dam when I have... : (Please check all that apply) *

In the past what has stopped you from using condoms? (Please check all that apply) *

If "Other" chosen above, please specify what has stopped you from using condoms in the past