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1. How old are you? (Required.)

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2. What is your gender? (Required.)

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3. Which city do you live in?

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4. Do you think it’s important to practice safe sex in your relationship?

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5. Would you say that you and your partner are actively ensuring that you’re having safe sex at all times?

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6. Are able to talk to your partner about practicing safe sex?

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7. Do you know your HIV status and that of your sexual partner/s?

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8. Do you use a condom every time you have sex?

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9. True or False - Being faithful to each other in a relationship is one way to live a sexually healthy life.

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10. Do you sometimes have unprotected sex with your partner?

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11. Do you or your partner believe that you don’t need to use a condom because you’re in a committed relationship?

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12. Do you know about Choma? (Required.)

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13. If you answered yes, have you used the Choma platforms (Website, Social Media)? (Required.)

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14. How long have you used the Choma platforms? (Required.)

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