Table 1.

Sexual history questionnaire.

Eligibility Questions	Answers	Eligibility
Have you ever had vaginal sexual intercourse?	Yes	Eligible
	No	Ineligible
Have you had vaginal sexual intercourse in the past 3 months?	Yes	Eligible
	No	Ineligible
Are you taking or using anything to prevent pregnancy?	Yes	Eligible
	No	Eligible
Have you ever had oral sex?	Yes	Eligible
	No	Eligible
Have you ever had anal sex?	Yes	Eligible
	No	Eligible
Sexual preference—who do you have sex with? (check):	Men exclusively	Eligible
	Women exclusively	Ineligible
	Both men and women	Eligible
	Any gender, non-binary	Eligible
Scored HIV Risk Assessment Questions	Answers	Pointsa
Are you <= 25 years old?	Yes	1
	No	0
How many partners do you currently have?	0	0
	1	0
	2	1
How many sex partners have you had in the last 3 months?	0–1	0
	2–4	1
	5–9	2
	10 or more	3
Have you had a new sex partner or multiple partners within the last 3 months?	Yes	1
	No	0
When you have sex, do you use condoms?	Never	3
	Sometimes	3
	Always	0
Have you ever been told you had, or been treated for, a sexually transmitted infection?	Yesb	1
	No	0
Unscored HIV Risk Assessment Questions
Have you ever had an HIV test?	Yes
	No
Do you have sex with a partner who injects illegal drugs?	No
	Yes, within the past 6 months
	Yes, more than 6 months ago
Have you had sex with a partner who has sex with both men and women?	Never
	Yes, within the past 6 months
	Yes, more than 6 months ago
Have you had sex for money, drugs, or other payment?	Never
	Yes, within the past 6 months
	Yes, more than 6 months ago
Have you had sex with a partner infected with HIV?	Never
	Yes, within the past 6 months
	Yes, more than 6 months ago

^a Low Risk Score = 0 –3; Medium/High Risk Score = 4–10 or any affirmative “Yes, within the past 6 months” response to unscored questions.

^b If Yes to an STI, then a selection of options are displayed. If the patient selects “HIV”, then she will be ineligible.