HIV survey form

1. HIV SURVEY QUESTIONS
1. What is your gender
-Male ( )
-Female ( )
2. What is your level of education
- Foundation or equivalent level
- Bachelor
- Master
- Doctorate
- Others :
The following survey questions will be conducted in the format of Yes/No
scale. Circle or tick the answer you think is right.
1. Do you think HIV and AID are the same disease?
- Yes -No
2. HIV is the cause of most deaths every year
- Yes -No
3. A HIV patient can transmit HIV if there's any body contact or shared of
saliva with the patient.
- Yes - No
4. HIV can be fully cured
-Yes - No
5. A HIV patient have a maximum life span of 5-10 years.
- Yes - No
6. A HIV patient can not have any interaction with extreme sports.
- Yes - No
7. Can HIV be transmitted through oral sex?
-Yes - No
8. Which country has the highest rate of HIV patient?
- South Africa
- USA
- Togo
- Comoros
9. Which of the following are the symptoms of HIV?
i) Fever
ii) Sore throat
iii) Fatigue
iv) None of the above
- i, ii - ii, iii - i, ii and iii - iv
10. Can a HIV patient die from extreme cough and flu due to weak immune
system.
- Yes - No
11. Is HIV first transmitted from animals to human?
-Yes - No
12. What is the percentage of condom preventing HIV from transmitting
while sexual intercourse between two gender.
- 50%-60% - 70%-80% - 80%-90% -90%-99%
13. The color of the ribbon which is used an awareness symbol for HIV
/AIDS is red
- Yes - No
14. Is it possible that a HIV mother pass down the disease to her offspring.
-Yes - No
15. What is the possible treatment for HIV patient
- Antiretroviral Therapy - Chemotherapy
Thank you very much for your time and consideration.