05.004 Risk Assesment Battery

RISK ASSESMENT BATTERY

Purpose

The Risk Assessment Battery is an easy to administer risk assessment for HIV.

See attached Battery and Assessment form, this assessment can be self-administered and then scored to asses risk.

Risk Assessment EZ Answer Sheet 111.8.19.13.1c.2.f9 111.8.19.13.1b.1a.f4

Please record your answers on the left side below by entering the number of the answer for each question. For example, if the answer to question 1 is “No” you would record “0” on line 1, if the answer to question 1 is “Yes”, you would record “1” on line 1.

1.

2.

3.

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5.

6.

7.

8.

9.

10.

11.

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13.

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18.

This side is for staff use.

Total of 1- 8

Total of 9 - 13

Highest single one of 14-17 Total

Total /40

Higher of Total/40 or #18.

NIDA v. 2.1 DH rev DH 7/24/2014

Risk Assessment Battery

R A B

111.8.19.13.1c.2.f9.1

111.8.19.13.1b.1a.f3

Please read each of the following questions very carefully. As you will see, many of these questions are personal. We understand this and will make every effort to protect the privacy of your answers.

It is very important that you answer every question honestly. In fact, it’s better not to answer a question than to tell us something that is not accurate or true.

Some questions may not seem to have an answer that is true for you. When this happens, you should choose the answer that is most right. Don’t spend too much time on any one question. Remember; always ask for help if you’re unsure what to do.

Thank-you for your time and cooperation.

Part I: Needle Use

In the past six months, have you injected drugs?
1. No
2. Yes
3. In the past six months, have you shared needles or works?
  1. No or I have not shot up in the past six months.

3. Yes

With how many different people did you share needles in the past six months?
1. 0 or I have not shot up in the past six months.
2. 1 other person
3. 2 or 3 different people
4. 4 or more different people
5. In the past six months, how often have you been to a shooting gallery/house or other place where users go to shoot up?
  1. Never
  2. A few times or less
  3. A few times each month
  4. Once or more each week
6. In the past six months, how often have you shared rinse water?
  1. Never or I have not shot up in the past 6 months
  2. A few times or less
  3. A few times each month
  4. Once or more each week
7. In the past six months, how often have you shared a cooker?
  1. Never or I have not shot up in the past 6 months
  2. A few times or less
  3. A few times each month
  4. Once or more each week
8. In the past six months, how often have you shared a cotton?
  1. Never or I have not shot up in the past 6 months
  2. A few times or less
  3. A few times each month
  4. Once or more each week
9. In the past six months, how often have you divided or shared drugs with others by using one syringe (your’s or someone elses) to squirt or load the drugs into the other syringe(s). (backloading, for example)?
  1. Never or I have not shot up in the past 6 months
  2. A few times or less
  3. A few times each month
  4. Once or more each week
10. In the past six months, how often have you been to a Crack House or other place where people go to smoke crack?
  1. Never
  2. A few times or less
  3. A few times each month
  4. Once or more each week

Part II: Sexual Practices

How would you describe yourself?
1. Straight

3 . Gay or Homosexual

3. Bisexual

Please note: For the following questions, sex means any vaginal intercourse, anal intercourse

(in the butt) or oral sex (blowjobs, for example)

With how many men have you had sex in the past six months)?
1. 0 men
2. 1 man
3. 2 or 3 men
4. 4 or more men
With how many women have you had sex in the past six months)?
1. 0 women
2. 1 woman
3. 2 or 3 women
4. 4 or more women
In the past six months, how often did you use condoms when you had sex?
1. I have not had sex in the past 6 months

All the time
Most of the time
Some of the time
None of the time
1. In the past six months, how often have you had sex so that you could get drugs)?
  1. Never
  2. A few times or less
  3. A few times each month
  4. Once or more each week
2. In the past six months, how many times have you given drugs to someone so you could have sex with them?
  1. Never
  2. A few times or less
  3. A few times each month
  4. Once or more each week
3. In the past six months, how often were you paid money to have sex someone?
  1. Never
  2. A few times or less
  3. A few times each month
  4. Once or more each week
4. In the past six months, how often did you give money to someone so could have sex with them?
  1. Never
  2. A few times or less
  3. A few times each month
  4. Once or more each week
5. Were you ever told you had the HIV/AIDS virus?
  1. No

I never got the results
Yes