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this is off redcross.org
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had a tattoo within the last 12 months
ever had Creuzfeldt-Jakob Disease, or if any blood relative (parent, grandparent, sibling, aunt, uncle, or child) has or has had it, or been told that your family is at risk for Creutzfeldt-Jakob Disease
ever received a dura mater (or brain covering) transplant during head or brain surgery
received an injection since 1980 of bovine (beef) insulin made from cattle in the United Kingdom
had hepatitis on or after the age of 11
had malaria in the past 3 years
during 1980 though 1996 spent a total time that adds up to 6 months or more in the United Kingdom (England, Northern Ireland, Scotland, Wales, Isle of Man, or the Channel Islands)
been held in a correctional facility (including jail, prison, or detention center) for more than 72 straight hours in the last 12 months.
had or been treated for syphilis or gonorrhea or tested positive for syphilis in the last 12 months.
been raped in the last 12 months.
taken (snorted) cocaine or any other street drug through your nose in the last 12 months.
AIDS or one of its symptoms, including ?
unexplained weight loss (10 pounds or more in less than 2 months)
night sweats
blue or purple spots on or under the skin
long-lasting white spots or unusual sores in your mouth
lumps in your neck, armpits, or groin, lasting longer than one month
diarrhea lasting longer than one month
persistent cough and shortness of breath, or
fever higher than 99°F lasting more than 10 days
done something that puts you at risk for becoming infected with HIV, the virus that cause AIDS.
You are at risk for getting infected if you have:
taken illegal or non-prescription drugs by needle, even once
taken clotting factor concentrates for a bleeding disorder such as hemophilia
tested positive for any AIDS virus
been given money or drugs for sex, since 1977
had a sexual partner who puts you at risk for AIDS infection. This means:
you have had sex in the last 12 months with someone who is at risk for being infected with the AIDS virus (described above)
if you are a male, had sex even once with another male since 1977; or within the last 12 months, given a female money or drugs to have sex with you, or
if you are a female, within the last 12 months, given anyone money or drugs to have sex with you; or had a male sex partner who had sex with another male even once since 1977
been born in, or lived in, Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria since 1977.
since 1977, received a blood transfusion or medical treatment with a blood product in any of these countries, or
had sex with anyone who, since 1977, was born in or lived in any of these countries.
Tell the interviewer
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