HIV Screening — Simplified

1) Date of birth

Service for people 18+ only. If under 18 contact MyHealth: 📞 061 375 950

Month

Day

Year

2) Medical Aid

Choose one

3) Gender

Choose one

4) HIV status

Status

On ART?

ART adherence

How often?

Viral load tested in last 6 months?

Was it undetectable?

Last refill / clinic visit

When?

Side effects?

Choose

Disclosure

Have you told a trusted person?

Contact follow-up

Would you like a provider to contact you?

Recent exposure

PEP Contraindications (select any)

Select any that apply

>72 hours since exposure Liver disease Known allergy

Risk behaviors (past 6 months) — select any

Multiple partners Sex without condoms Injecting drugs / needles

Low Risk Identified

You are low risk. Test every 3–6 months.

PrEP Contraindications (select any)

Hepatitis B untreated Poor adherence history

Follow-up (Non-positive)

Would you like us to contact you?

HIV Screening (short)