A traditional society in change encounters HIV/AIDS: knowledge, attitudes, and risk behavior among students in northwestern China

Knowledge and Perceptions of Chinese Female College Students Towards HIV/AIDS: A Qualitative Analysis

Objective

This study aims to explore knowledge and perceptions of Chinese female college students towards HIV/AIDS.

Design Method Participants and Setting

A purposive sampling method was used to recruit participants. Twenty female participants studying at a college located in Chongqing, Southwest China, were involved in the study. Semi-structured interviews were used to collect data. The face-to-face interview data were recorded and analyzed using the method of qualitative inductive content analysis.

Results

Five themes were identified from the data of transcribed interviews: HIV transmission routes (sexual transmission; blood transmission; mother-to-child transmission), sources of HIV/AIDS knowledge (education; mass media), AIDS prevention measures (avoiding sexual activity; establishing sense of self-protection; avoiding blood contact), attitudes towards PLWHA (treating all PLWHA equally; showing sympathy for the innocent PLWHA; discriminating against the immoral PLWHA), and suggested solutions to combat AIDS (assistance provided by governments; what health professionals can contribute; mobilization of social power; university intervention).

Conclusion

More efforts should be made to strengthen the HIV/AIDS education for female college students of non-medical majors in Southwest China. Accurate knowledge of HIV/AIDS and the right attitudes towards people living with HIV/AIDS (PLWHA) should be the foci of HIV/AIDS education for this population. In order to better cater future sex education in colleges to the requirements of female college students, educators and lawmakers may benefit from gaining a deeper grasp of their perspectives on HIV/AIDS.

A spatial analysis of the epidemiology of HIV-infected students in Zhejiang province, China

BACKGROUND

The upsurge in HIV infections among students is a matter of particular concern. However, few studies have explored the epidemiological characteristics including the risky sexual networking of HIV-infected students in Zhejiang province, China.

METHODS

Using the provincial surveillance data of HIV-infected students, we conducted a retrospective epidemiology study to describe the epidemiological characteristics of 628 newly diagnosed cases from 2011 to 2016 and detailed information of 124 cases from 2015 to 2016. Spatial analyses were conducted using ArcGIS software, and statistical analyses were performed using SPSS software.

RESULTS

A total of 628 cases of HIV/AIDS were diagnosed among students in Zhejiang Province, China between 2011 and 2016. The cases showed an overall increasing trend over time, while the proportions of students with HIV disease status, cases diagnosed by HIV voluntary counseling and testing (VCT), and cases of homosexual transmission remained stable over time. Significant spatial heterogeneity in the cases was seen at the county level. Detailed data on 124 HIV-positive individuals collected from the local Center for Disease Control and Prevention (CDC) from 2015 and 2016, showed that the majority of them (85.5%,) engaged in homosexual behavior, and 93.4% had sex with casual partners. These partners included not only social members, but also other students. Online dating applications represented the most common means of seeking and communicating with homosexual partners. The level of awareness regarding the risk of HIV infection, and the amount coverage of face-to-face education towards students were both low.

CONCLUSIONS

HIV infections among students were characterized by increasing trend and spatial clustering in Zhejiang Province between 2011 and 2016, with homosexual sexual activity being the main mode of infection. Interventions are urgently required to prevent HIV infection in this population by increasing awareness of the disease. HIV testing programs and information regarding disease prevention specifically through online dating applications are needed.

Interventions to improve the HIV continuum of care in China

PURPOSE OF REVIEW

To describe HIV epidemic and interventions for improving HIV continuum of care in China.

RECENT FINDINGS

The reported HIV epidemic has been continuously increasing, partially due to the expansion of active HIV testing campaign. Public health intervention programs have been effective in containing HIV spread among former plasma donors and people who inject drugs (PWID), but more infections occur among heterosexual men and women and young men who have sex with men. Of 1.25 million Chinese people are living with HIV, one-third do not know their status. About two-thirds of diagnosed individuals have used antiretroviral therapy (ART) and two-thirds of those on ART have achieved viral suppression, but some risk groups such as PWID have lower rates. The national free ART program has reduced adult and pediatric mortality and reduced heterosexual transmission. China faces great challenges to reduce HIV sexual transmission, improve the HIV continuum of care, and close the gaps to the UNAIDS Three "90" Targets.

HIV/AIDS Knowledge of Undergraduate Students at a Historically Black College and University

OBJECTIVE

This study among 400 undergraduate students enrolled at Jackson State University (JSU) study aimed to assess knowledge about HIV and AIDS among African-American undergraduate students attending a historically black college and university. A cross-sectional survey was conducted. Data were collected using a validated, self-administered, and standardized questionnaire on knowledge regarding risks for HIV and AIDS. Three hundred and eighty-six students (96.5%) had good knowledge about HIV and AIDS, although some participants had misconceptions about the modes of HIV infection transmission. There were no significant gender differences for HIV and AIDS knowledge among the participants (χ² = 3.05; P = 0.08). In general we concluded that JSU undergraduate students had adequate knowledge about HIV transmission modes and AIDS, although some participants had misconceptions about the routes of HIV infection transmission. Hence, this study calls for strengthening HIV and AIDS awareness education among undergraduate students.

HIV/AIDS knowledge and attitudes among Chinese college students in the US

This study assessed knowledge and attitudes about HIV/AIDS and sources of HIV/STI information among Chinese college students living in the USA and explored specific factors associated with knowledge levels and types of sources of information. We surveyed 133 Chinese students enrolled in three US universities. About 41.4 % believed that HIV could be contracted through mosquito bites, and 22.6 % were unaware that condoms could prevent HIV. Sources of HIV/STI information were the mass media. Males were more likely to demonstrate a higher HIV/AIDS knowledge level than females. Graduate students were more likely to cite television as a source of information, and less likely to mention school teachers, than were undergraduate students. These ethnic minority immigrant students held misconceptions about HIV transmission and prevention, and possibly utilized information of varying quality. Accordingly this study identifies specific objectives for education, including basic biology and diversity issues from evidence-based sources.

Factors that influence utilisation of HIV/AIDS prevention methods among university students residing at a selected university campus

Various studies have reported that university students, who are mostly young people, rarely use existing HIV/AIDS preventive methods. Although studies have shown that young university students have a high degree of knowledge about HIV/AIDS and HIV modes of transmission, they are still not utilising the existing HIV prevention methods and still engage in risky sexual practices favourable to HIV. Some variables, such as awareness of existing HIV/AIDS prevention methods, have been associated with utilisation of such methods. The study aimed to explore factors that influence use of existing HIV/AIDS prevention methods among university students residing in a selected campus, using the Health Belief Model (HBM) as a theoretical framework. A quantitative research approach and an exploratory-descriptive design were used to describe perceived factors that influence utilisation by university students of HIV/AIDS prevention methods. A total of 335 students completed online and manual questionnaires. Study findings showed that the factors which influenced utilisation of HIV/AIDS prevention methods were mainly determined by awareness of the existing university-based HIV/AIDS prevention strategies. Most utilised prevention methods were voluntary counselling and testing services and free condoms. Perceived susceptibility and perceived threat of HIV/AIDS score was also found to correlate with HIV risk index score. Perceived susceptibility and perceived threat of HIV/AIDS showed correlation with self-efficacy on condoms and their utilisation. Most HBM variables were not predictors of utilisation of HIV/AIDS prevention methods among students. Intervention aiming to improve the utilisation of HIV/AIDS prevention methods among students at the selected university should focus on removing identified barriers, promoting HIV/AIDS prevention services and providing appropriate resources to implement such programmes.

HIV knowledge and behavior among Chinese college students in China and the United States

Disease prevention can be improved with a better understanding of student-environment interactions. The purposes of the study were (a) to compare HIV/AIDS-related knowledge, attitudes, sexual behaviors, and sources of HIV/STI information and (b) to investigate the association between sources of HIV/STI information and HIV/AIDS-related knowledge, attitudes, and sexual behaviors among Chinese college students in China and the United States. Comparative, correlational analysis of survey data from 608 students in two countries was conducted. Chinese students in the United States scored higher on knowledge questions. More students in the United States received HIV/STI information from the Internet and family members than did students in China. Traditional media and schoolteachers had a stronger association with participants' HIV-related knowledge, age at first intercourse, and number of sexual partners in both samples than did other sources. The survey revealed incomplete knowledge within both groups. Prevention programs should focus on risky misconceptions and should teach about strategic utilization of media.

Sexual behaviors, decisional balance, and self-efficacy among a sample of Chinese college students in the United States

OBJECTIVES

To assess sexual behaviors and condom use including perceived benefits, barriers, and self-efficacy among Chinese college students in the United States.

PARTICIPANTS

One hundred thirty-three Chinese undergraduate and graduate students studying at 3 US universities.

METHODS

Self-report Internet questionnaire grounded in the Transtheoretical Model (TTM) framework analyzed with multivariate linear regression.

RESULTS

More than half (57.9%) have initiated sex. Only 27.3% used condoms every time. Frequent reasons for not using condoms were trust in partner, reduced pleasure, and partner dislike for condoms. Participants in the earlier TTM stages (precontemplation, contemplation, preparation) reported more worry about making partners angry if condoms were used and lower self-efficacy in situations involving alcohol or drug use and perceived low-risk scenarios.

CONCLUSIONS

Interventions should increase condom availability to students and should also make condom use more acceptable, more often expected, and easier to discuss.

Factors that influence health quotient in Chinese college undergraduates

AIM AND OBJECTIVES

The purpose of this study was to describe the health quotient of Chinese undergraduates, to discern whether socio-demographic characteristics, academic achievements and perceived health status significantly affect the health quotient of Chinese college students and to identify the predictable factors of health quotient in undergraduates.

BACKGROUND

Rapidly increasing enrollment in higher education in China in recent years has brought growing concern about undergraduate health and lifestyle. The Health Quotient profile questionnaire, which assesses self-reported holistic health, provides opportunity to study the health of Chinese undergraduates.

DESIGN

A descriptive cross-sectional study.

METHODS

The study was conducted with 1874 Chinese undergraduates aged 15-28 from eight colleges in Changsha. Students were recruited by a multistage cluster stratified random sampling method.

RESULTS

The mean score of the Health Quotient questionnaire indicated a positive health quotient; however, 32.1% of the sample scored below the criterion score for a positive health quotient. Undergraduates scored low on knowledge of health. Gender, residence before university, father's educational background, self-rated health, college category, achievement in study and status as student chief significantly predicted health quotient scores.

CONCLUSIONS

Holistic health of college students is important and implies positive health behaviours and a focus on health promotion. The overall holistic health of the subjects was good, and students appear capable of managing their own health. Poor health knowledge may be an important factor in college students' future health status. Risk factors associated with health quotient of undergraduates should be considered in college health care.

RELEVANCE TO CLINICAL PRACTICE

The health quotient is one instrument that can be used to assess college students' holistic health and target health promotion interventions. Health knowledge dissemination could be a core task for Chinese college nurses. Further, international research that examines the relationship of student characteristics, college location, culture, health behaviours, health status and holistic health is indicated.

Young people of Chinese origin in western countries: a systematic review of their sexual attitudes and behaviour

People of Chinese origin are a growing population group in western countries. The community is seen to be marginalised, under-researched and neglected, in fact the least understood ethnic minority. This paper reports on a systematic review of sexual attitudes and behaviour among ethnic Chinese young people (mainly aged 13-25 years) living in western countries. An extensive literature search was conducted to cover the period of 1989 and 2009 using Medline, CINAHL, PsycINFO and ScienceDirect databases. There has been a dearth of literature in this area. However, results from existing literature show that ethnic Chinese youth reported poorer sexual health knowledge than white young people in their host countries, while they were found to be more likely to disapprove of uncommitted sex, be virgins, lose their virginity at a later age and have fewer sexual partners. Factors associated with their sexual attitudes and behaviour have also been identified. Countries like the United Kingdom, United States and Canada have become multicultural societies with many diverse ethnic groups. Without doubt educators and sexual health professionals need to provide sex education and services which should be culturally appropriate to people from diverse ethnic backgrounds. An understanding of their sexual values, sexual behaviour and associated factors is the first step towards achieving this goal.

Relationship between HIV/AIDS knowledge and attitude among student nurses: a structural equation model

With the rising incidence of HIV/AIDS in China, nurses will increasingly be caring for patients with HIV/AIDS. Thus, it is necessary that they have enough knowledge to reduce the risk of occupationally acquired HIV infection and that they change their attitude to care for HIV/AIDS patients. The objective of this study is to explore the relationship between student nurses' HIV/AIDS knowledge and their attitude using a structural equation model (SEM). A cross-sectional survey was conducted in January 2008 among 528 student nurses at the technical secondary school of the China Medical University. An SEM is proposed to determine the direction and magnitude of the interdependent effects between the latent factors. The SEM was built using LISREL version 8.5. The measurement properties of the latent factors underlying the questionnaire were based on a confirmatory factor analysis (CFA). Our results as following, HIV/AIDS knowledge and attitude may be measured by seven underlying constructs, namely, preventive knowledge, knowledge of transmission routes, specialty knowledge, knowledge of nontransmission routes, positive attitude toward HIV/AIDS, negative attitude toward HIV/AIDS, and occupational attitude. The SEM fits the data well. The interdependent relationships between these constructs identified the factors of preventive knowledge, specialty knowledge, and attitude toward HIV/AIDS as having both direct and indirect effects on occupational attitude. In conclusions, our results represent an initial effort to assess the relationship between student nurses' HIV/AIDS knowledge and their attitude toward the disease. CFA and SEM analysis have demonstrated their usefulness in evaluating multifactor complex constructs.

HIV/AIDS awareness, attitudes and risk behavior among university students in Wuhan, China

Background:

In China, the estimated number of HIV positives in 2007 was 700,000 and the epidemic continues to expand. Because of their attitudes towards sexual behavior, young people are considered to be a group at high risk.

Methods:

Eight hundred sixty-eight undergraduate students at Wuhan University were selected through stratified cluster sampling, to answer a questionnaire. They were divided into three main groups: Chinese medical students, foreign medical students and Chinese students from other faculties. Fourteen interviews were conducted in addition.

Results:

Ninety-nine percent of the students had heard of HIV/AIDS and 76% of the students could distinguish HIV from AIDS. The main route of transmission was believed by the Chinese students to be blood transfusion and sexual intercourse by the foreign medical students. The female students knew more about the routes of transmission than the male students. Medical students had a higher level of knowledge than non-medical students, and among the medical students, the foreign students were more knowledgeable than the Chinese students. Only 8 % of the students were sexually active.

Conclusion:

The students had an accepting attitude towards people living with HIV and no extensive risk behavior. Overall, the knowledge level was found to be moderate.

The relationship between Chinese construction workers' HIV/AIDS-related knowledge, attitudes and behaviour: a structural equation model

This study explored the relationship between human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS)-related knowledge, attitudes and behaviour in migrant urban construction workers using structural equation modelling (SEM). A cross-sectional study was conducted among 428 male subjects on three building sites in Shenyang City. The SEM model of HIV/AIDS-related knowledge, attitudes and behaviour was built using LISREL version 8.5 and it fitted the data well, as shown by an adjusted goodness of fit index of 0.82 and a root mean square error of approximation of 0.094. Knowledge of HIV/AIDS was closely correlated with attitudes and behaviour. Age was an important factor affecting HIV/AIDS-related knowledge, attitudes and behaviour. These findings suggest that increasing HIV/AIDS-related knowledge could improve the attitude and behaviour of migrant urban construction workers, enabling them to avoid high-risk behaviour that increases the spread of HIV/AIDS. Any intervention used will need to take the important factor of age into consideration.

HIV/AIDS awareness and risk behavior among students in Semey, Kazakhstan: a cross-sectional survey

BACKGROUND

Until recently, young people in Kazakhstan have been only moderately affected by the global HIV epidemic. Today, however, the HIV epidemic in Central Asia is one of the most rapidly increasing epidemics in the world. It is mainly concentrated to vulnerable groups such as intravenous drug users, sex workers, the purchasers of sexual services and the financially marginalized. Young, sexually active people may however be the gateway for the epidemic to the general population, and knowledge about their attitudes and behavior is therefore important in planning preventive measures.

METHODS

To gather information about young students and their attitudes and knowledge about HIV/AIDS, we collected 600 structured questionnaires and made 23 semi-structured interviews among three groups of students. Response rate was 99%.

RESULTS

Almost 99% of the respondents had heard of HIV/AIDS, and 89% could identify ways to protect oneself against sexually transmitted HIV/AIDS. The main routes of transmission, sexual contact without condom and intravenous drug use, were both identified by 97% of the students. Twenty-five percent of the female students and 75% of the male students had had one or more sexual partners. More than 30% of the young men had purchased sex, and homosexuality was widely stigmatized.

CONCLUSION

Risks for the spread of HIV/AIDS among young people in Kazakhstan include prostitution as well as stigmatization of the HIV positive and of homosexuals. Protective factors are good knowledge about risks and protection, and opportunities to talk and gather information about sexuality and HIV/AIDS.

Expressions of HIV-related stigma among rural-to-urban migrants in China

In China, HIV-related stigma is considered as a formidable barrier in the combat against the HIV epidemic. There have been few qualitative investigations on HIV-related stigma in China, especially among a vulnerable population of rural-to-urban migrants. Based on 90 in-depth interviews conducted in 2002-2003 with rural-to-urban migrants in Beijing and Nanjing, China, this study examines the forms and expressions of HIV-related stigma from migrants' perspectives regarding HIV infection and individuals at risk of HIV infection. Consistent with the general framework on stigma, Chinese rural-to-urban migrants' attitudes toward HIV infected individuals take forms of denial, indifference, labeling, separation, rejection, status loss, shame, hopelessness, and fear. These stigmatizing attitudes were mainly derived from fears of AIDS contagion and its negative consequences, fears of being associated with the diseases, and culturally relevant moral judgments. In addition to universal AIDS stigma, both traditional Chinese culture and socially marginalized position of rural migrant population have contributed to culturally unique aspects of stigmatizing attitudes among rural-to-urban migrants. These multifaceted manifestations of HIV-related stigma suggest that HIV stigma reduction intervention needs to address multiple aspects of HIV stigma and stigmatization including personal, cultural, institutional, and structural factors.

Syphilis in China: the great comeback

China is currently witnessing a major resurgence of syphilis from the elimination of the disease in the 1960s to 5.3 per 100,000 people incidence in 2000-2005. The reasons for the elimination and subsequent resurgence of syphilis in China lie at the heart of much public health debate, highlighting both the relationship between politics and public health, and the role of government in controlling disease. Were the Draconian measures to control syphilis during the early Mao years a price worth paying for the effective control? Is the recent resurgence of syphilis an inevitable consequence of economic development and greater freedom for the individual, which will ultimately lead to better health for the majority of the population? Could tougher control measures such as those of the early Mao years be re-introduced in the current social and economic climate in China? In this review, we briefly chart the history of the syphilis epidemic in China, its elimination in the 1960s, and its gradual resurgence in the past two decades. We explore the reasons for this resurgence, and we conclude with a discussion on the options for control.

A comparison of voluntary counseling and testing uptake between a China CARES county and a county not designated for the china CARES program

A cross-sectional study employing two-stage cluster sampling was conducted between December 2005 and March 2006 to compare adults' knowledge of HIV/AIDS voluntary counseling and testing (VCT) and the attitudes toward and acceptance of VCT between a county in which a comprehensive HIV/AIDS program, China CARES (CC), was available, and a county where it was not. Information on HIV/AIDS knowledge, awareness of VCT, and attitudes was collected. All participants were given a coupon for free VCT after the cross-sectional interview. Uptake of VCT was measured within 2 months of the interview. More participants in the CC county knew someone infected with HIV, had participated in AIDS-related activities, and/or had heard about China CARES. In the control county, education and income levels were higher, there were fewer minorities, and there was a higher proportion of women. VCT uptake was low. Overall, no significant differences in uptake were found between the two counties. Urban residents of the CC county had higher HIV/AIDS knowledge levels than urban residents of the comparison county (p = 0.002). Residents of the CC county were more discriminative against HIV/AIDS and persons living with HIV/AIDS (PLWHA) and had lower perceptions of risk. The differences may be due to the higher proportion of rural residents in the CC county (p < 0.001). The China CARES program may have had a positive effect on urban areas of Guizhou Province in terms of improving HIV/AIDS and VCT knowledge and reducing discrimination, but had little impact in the rural areas. If the China CARES program is to be successful, it must implement a more effective education program and increase the acceptability of testing.

HIV-related stigma in health care settings: a survey of service providers in China

We examined how individual and institutional factors in health care settings affected discrimination toward persons with HIV/AIDS. A representative sample of 1101 Chinese service providers was recruited in 2005, including doctors, nurses, and laboratory technicians. Multiple regression models were used to describe associations among identified variables, the relationships with HIV-related personal prejudicial attitudes, and perceived institutional support and discrimination at work. Multivariate analyses revealed that respondents' general view of persons living with HIV/AIDS and their perceived levels of support from their institutions regarding protection procedures were both important predictors for discrimination intent. Perceived institutional support varied according to age, gender, ethnicity, and training background. A better understanding of HIV-related discrimination in health care settings requires consideration of both individual and institutional factors.