Please enable JavaScript in your browser to complete this form.1. How do you self-identify? *MaleFemaleTranswomanTransmanBisexualNon-binaryOther (Please specify below)2. How do you describe your sexuality? *GayLesbianBisexualHeterosexualOther (Please specify below)Next3. Where are you living? *HanoiHo Chi Minh CityDong Nai ProvinceOther (Please specify below)4. Year of Birth: *PreviousNext5. Your highest education level? *Not attending schoolElementaryJunior High SchoolHigh SchoolCollege, Vocational Training or Vocational SchoolUniversityHigher Education6. Your current occupation? *StudentOfficerUnskilled labourSex workerOther (please specify below)7. Your estimated monthly income within last year? *Below 2 million VNDFrom 2-5 million VNDFrom 5-10 million VNDMore than 10 million VNDPreviousNext8. How many sex partners have you had in the past 3 months?12Other (Please specify below)9. How often do you use a condom when having sex? *EverytimeMost timesNeverSometimesDid you use a condom when your last had sex? YesNoNever had sex beforePreviousNext11. Which position do you prefer when having sex? *InsertiveReceptiveVersatile12. Have you ever had sex when you are “high” with drug use (ice, ecstasy, marijuana, ke, etc.)? *YesNo13. Have you been diagnosed or treated an STI (Sexually transmitted infection) in the past 3 months? *YesNo14. Have you used PEP (anti-retroviral drug to treat after exposure to HIV) in the past 3 months? *YesNoPreviousNext15. Have you heard about PrEP yet? (anti-retroviral drug to prevent HIV) *YesNo16. Have you ever used PrEP? *YesNo17. Have you ever tested for HIV? *YesNo18. If yes, when did your last test? *Last 3 monthsLast 6 monthsLast 12 monthsMore than 12 months19. Which social media channels have you used to look for sex partners? (Can select multiple answers) *Social Media (Facebook, Twitter, ...)BluedGrindrJack'DHornetTinderBar, Park, MassageOther (Please specify below)PreviousSubmitYour risk of HIV infection is VERY HIGH. You should test for HIV to clarify your status, and use preventive measures like PrEP and condom to protect yourself! See the addresses for HIV testing and PrEP service below: 1. Website Toihen.vn 2. Website Xomcauvong.com or contact us at Facebook.com/XomCauVong Your risk of HIV infection is HIGH. You should test for HIV every 3-6 months, and use preventive measures like PrEP and condom to protect yourself! See the addresses for HIV testing and PrEP service below: 1. Website Toihen.vn 2. Website Xomcauvong.com or contact us at Facebook.com/XomCauVong Your risk of HIV infection is MEDIUM. You should use preventive measures like PrEP and condom to protect yourself! See the addresses for HIV testing and PrEP service below: 1. Website Toihen.vn 2. Website Xomcauvong.com or contact us at Facebook.com/XomCauVong Your risk of HIV infection is LOW. You should continue to use preventive measures like condom, and PrEP to protect yourself! More information about HIV testing and PrEP service: 1. Website Toihen.vn 2. Website Xomcauvong.com or contact us at Facebook.com/XomCauVong From which sources do you know about this HIV Risk Calculator? *Xom Cau Vong Facebook PageXom Cau Vong WebsiteGlink ClinicMSMTG GroupVenus GroupNiem Tin Xanh GroupOther (Please specify)Do you want to apply for any of the services below? *[Only in Hanoi] – Receive an OraQuick HIV self-test kit for freeApply for a free subsidized PrEP counseling and dispensing programNo thanksNextPlease fill out all the information below accurately so we can deliver the OraQuick HIV self-test kit to you without delay.1. Your name: *2. Contact number: *3. How do you want to receive your HIV self-test kit? *MailGrab ExpressSelf-pick up at CBO/ClinicYour shipping address: *[Hanoi] Which CBO/Clinic do you want to self-pick up? *- Please choose the best option -Glink Clinic – No.18, Lane 9 Minh Khai, Hai Ba Trung Bien Viet Clinic – No. 18NV1, Tan Trieu, Thanh TriMat Troi Cua Be Group – No. 86 Tho Nhuom, Hai Ba TrungLove boy Hanoi – No. 16 Dinh Ngang, Cua NamVenus Group – No. 70B, Lane 192 Le Trong Tan, Thanh Xuan[Hanoi] Which Clinic do you want to register for the PrEP services program? *- Please choose the best option -Glink Clinic – No.18, Lane 9 Minh Khai, Hai Ba Trung Bien Viet Clinic – No. 18NV1, Tan Trieu, Thanh Tri[HCMC] Which Clinic do you want to register for the PrEP services program? *- Please choose the best option -Galant Clinic District 5 - 19 Tran Binh Trong Street, Ward 2, Dist. 5Outpatient Clinic District 9 - 107 Nguyen Van Tang, Long Thanh My, Dist. 9Outpatient Clinic District 11 - 72A, No. 5 Road, Binh Thoi, Ward 8, Dist. 11Outpatient Clinic District Thu Duc - 2 Nguyen Van Lich, Ward Linh Tay, Dist. Thu DucThank you for your participation! All information collected in this calculator is completely confidential, and is only used for assessing your HIV risk and connecting you to appropriate services.EmailSubmit