Sexual attitudes, sexual behaviors, and use of HIV prevention services among male undergraduate students in Hunan, China: a cross-sectional survey

Analysis of risky sexual behaviors among male college students who were sexually active in Sichuan, China: a cross-sectional survey

BACKGROUND

Males have accounted for a significant share of new HIV infections among young people in the recent years. This study aimed to identify the factors associated with risky sexual behaviors, including early sexual debut, multiple sexual partnership and condomless sex, among sexually active male college students and provide implications for tailored health interventions.

METHODS

The cross-sectional study was conducted from December 2020 to December 2021 in 16 colleges that were located in Sichuan Province, one of the high-risk areas in China. Overall 1640 male college students who reported sexually experienced were analyzed in this study. Multivariable logistic regression analysis was applied to determine factors associated with early sexual debut, multiple sexual partnership and condomless sex.

RESULTS

The average age of included male students was 19.95 ± 1.56. Of them, 27.74% initiated sexual behavior early, 48.60% reported multiple sexual partnership, and 16.52% did not use condoms at the latest sexual intercourse. Students who were younger (age ≤ 19, AOR = 7.60, 95%CI: 4.84-11.93; age20-21, AOR = 3.26, 95%CI: 2.04-5.21) and self-identified as sexual minorities (AOR = 2.38, 95%CI: 1.69-3.36) were more likely to have early sexual debut. The odds of having multiple sexual partners were higher among those who were ethnic minorities (AOR = 1.79, 95%CI: 1.33-2.41) and accepted extramarital sex (AOR = 1.33, 95%CI: 1.03-1.71). The likelihood of engaging in condomless sex at the latest sexual intercourse was lower among those who had sufficient knowledgeable about HIV (AOR = 0.63, 95%CI: 0.44-0.89), were very confident in condom use efficacy (AOR = 0.26, 95%CI: 0.16-0.43) and confident (AOR = 0.48, 95%CI: 0.34-0.69). Early sexual debut was positively associated with multiple sexual partnership (AOR = 3.64, 95%CI: 2.82-4.71) and condomless sex at the latest intercourse (AOR = 1.53, 95%CI: 1.07-2.20), respectively.

CONCLUSION

Early sexual debut, multiple sexual partnership and condomless sex were of considerable concern among male college students. Comprehensive sex education curricula were advised by developing customized information on HIV prevention, sexuality and empowering students with assertiveness and negotiation skills with regard to condom use during and before college.

Latent class analysis of barriers to HIV testing services and associations with sexual behaviour and HIV status among adolescents and young adults in Nigeria

INTRODUCTION

Adolescents and young adults (AYA) face multiple barriers to accessing healthcare services, which can interact, creating complex needs that often impact health behaviours, leading to increased vulnerability to HIV. We aimed to identify distinct AYA subgroups based on patterns of barriers to HIV testing services and assess the association between these barrier patterns and sexual behaviour, socio-demographics, and HIV status.

METHODS

Data were from Nigeria's AIDS Indicator and Impact Survey (NAIIS, 2018) and included 18,612 sexually active AYA aged 15-24 years who had never been tested for HIV and reported barriers to accessing HIV testing services. A Latent class analysis (LCA) model was built from 12 self-reported barrier types to identify distinct subgroups of AYA based on barrier patterns. Latent class regressions (LCR) were conducted to compare the socio-demographics, sexual behaviour, and HIV status across identified AYA subgroups. Sex behaviour characteristics include intergenerational sex, transactional sex, multiple sex partners, condom use, and knowledge of partner's HIV status.

RESULTS

Our LCA model identified four distinct AYA subgroups termed 'low-risk perception' (n = 7,361; 39.5%), 'consent and proximity' (n = 5,163; 27.74%), 'testing site' (n = 4,996; 26.84%), and 'cost and logistics' (n = 1,092; 5.87%). Compared to adolescents and young adults (AYA) in the low-risk perception class, those in the consent and proximity class were more likely to report engaging in intergenerational sex (aOR 1.17, 95% CI 1.02-1.35), transactional sex (aOR 1.50, 95% CI 1.23-1.84), and have multiple sex partners (aOR 1.75, 95% CI 1.39-2.20), while being less likely to report condom use (aOR 0.79, 95% CI 0.63-0.99). AYA in the testing site class were more likely to report intergenerational sex (aOR 1.21, 95% CI 1.04-1.39) and transactional sex (aOR 1.53, 95% CI 1.26-1.85). AYA in the cost and logistics class were more likely to engage in transactional sex (aOR 2.12, 95% CI 1.58-2.84) and less likely to report condom use (aOR 0.58, 95% CI 0.34-0.98). There was no significant relationship between barrier subgroup membership and HIV status. However, being female, aged 15-24 years, married or cohabiting, residing in the Southsouth zone, and of Christian religion increased the likelihood of being HIV infected.

CONCLUSIONS

Patterns of barriers to HIV testing are linked with differences in sexual behaviour and sociodemographic profiles among AYA, with the latter driving differences in HIV status. Findings can improve combination healthcare packages aimed at simultaneously addressing multiple barriers and determinants of vulnerability to HIV among AYA.

Influence of HIV/AIDS knowledge on HIV testing behavior among young students (14-27 years) with a history of sexual activity: chain mediation analysis of social discrimination, self-efficacy, and sexual behavior characteristics

This study used a self-administered questionnaire to investigate the relationship between HIV/AIDS knowledge, social discrimination, HIV self-efficacy, sexual behavioral characteristics and HIV testing behavior among young students with a history of sexual activity in Chongqing. Propensity score matching was used to construct a control group with similar demographic characteristics to the HIV testing group, only without HIV testing behaviors. Structural equation modeling was used to conduct chain-mediated effect analysis. The HIV testing rate among young students with a history of sexual behavior was 17.16%. Young students with HIV testing behavior had higher levels of HIV/AIDS knowledge, lower social discrimination, better self-efficacy, and no difference in sexual behavior characteristic scores between the two groups (P = 0.062). The mediated effect values of social discrimination and self-efficacy were 0.022 and 0.063, respectively, while their chain mediated effect value was 0.007. There was no mediated effect of sexual behavior characteristics. The level of young students' HIV/AIDS knowledge does not directly influence their HIV testing behavior but plays a complete chain mediating effect on HIV testing behavior through social discrimination and self-efficacy. HIV testing behavior should be promoted through the perspectives of enhancing HIV/AIDS knowledge level, reducing social discrimination, and improving self-efficacy.

HIV/AIDS-related knowledge and attitudes towards HIV rapid testing among Chinese college students: Findings from a cross-sectional survey

Data of the awareness level of college students in China about Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) knowledge are limited. Also, the attitudes towards HIV rapid testing remain unknown among this population. Therefore, this study aimed to evaluate the awareness of HIV/AIDS knowledge and attitudes towards HIV rapid testing among Chinese college students. An online cross-sectional survey was performed in 2020. A total of 1,474 participants were finally included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine associated factors for the cognitive levels and attitudes by multivariable logistic regression. Spearman rank correlation was used to examine the relationship between HIV/AIDS-related knowledge and attitudes. About 91% of participants had a high cognitive level on HIV/AIDS-related knowledge and 84.7% held a positive attitude towards the HIV rapid testing. Postgraduates (OR = 1.75, 95% CI: 1.16-2.66) and females (OR = 1.69, 95% CI: 1.13-2.52) were more knowledgeable. Females' attitudes towards the HIV rapid testing were more positive (OR = 1.91, 95% CI: 1.40-2.62). Moreover, the knowledge was positively correlated with attitudes towards the rapid testing (Spearman r = 0.14, p < 0.001). In conclusion, the Chinese college students had a high cognitive level on HIV/AIDS knowledge and positive attitudes towards HIV rapid testing. A high cognitive level of knowledge paralleled with positive attitudes. Special strategies such as tailored education via HIV/AIDS curriculum and awareness campaigns are needed for undergraduates and male students to minimize the gaps regarding HIV/AIDS-related knowledge and attitudes.

Factors Associated with HIV Testing among Male Students Who Have Engaged in Sexual Behaviour in Zhejiang Province, China

Objective

This study aimed to estimate the prevalence of human immunodeficiency virus (HIV) testing, identify factors associated with HIV testing among male students who have engaged in sexual behaviour in Zhejiang province, and provide a scientific basis for the prevention and control of HIV infection on campus.

Methods

Stratified cluster random sampling analysis was performed, which included general characteristics, sexual attitudes, sexual behaviours, information on HIV testing, and self-risk assessment for HIV infection. Univariate and multivariate logistic regression analyses were conducted to identify the influencing factors.

Results

Among 2734 male students who have engaged in sexual behaviour, 319 (11.7%) had undergone HIV antibody testing in the previous year. The results of multivariate analysis demonstrated that the participants who were in the junior grade level (adjusted odds ratio (AOR) = 1.59, 95% confidence interval (95% CI): 1.10-2.30) exhibited acceptance to male homosexual behaviour (AOR = 1.73, 95% CI: 1.19-2.52), had been exposed to testing publicity in the previous year (AOR = 1.51, 95% CI: 1.06-2.15), had been exposed to self-risk assessment for HIV infection (AOR = 2.66, 95% CI: 1.99-3.55), had male or bisexual partners (AOR = 1.60, 95% CI: 1.05-2.46), had a score for the scale indicating awareness of different testing methods between 2 and 5 (AOR = 2.19, 95% CI: 1.51-3.16) or greater than 6 (AOR = 1.49, 95% CI: 1.01-2.66), and had a score for the scale indicating knowledge of different testing facilities between 3 and 5 (AOR = 1.63, 95% CI: 1.00-2.66) were inclined to engage in HIV testing.

Conclusions

In this study, the proportion of HIV-testing among male students who have engaged in sexual behaviour was low. This study revealed that students who exhibited acceptance to male homosexual behaviours had been exposed to publicity for HIV testing or a self-risk assessment for HIV infection which were more inclined to engage in HIV testing. Our study underscores the urgent need to enhance educational interventions concerning HIV risks and warnings as part of the health education curriculum on campus. The graveness of the AIDS epidemic among students necessitates this emphasis. Moreover, we recommend deploying condom-dispensing machines or HIV testing facilities across the campus for easy access to preventive and testing services for HIV.

Effectiveness of curriculum-based sexual and reproductive health education on healthy sexual behaviors among year one students at Arba Minch University: A quasi-experimental study

INTRODUCTION

Curriculum-based sexual and reproductive health education (CBSRHE) is one of the preventive strategies targeting youth in higher institutions to protect them from sexual and reproductive health problems, despite never assessing the effect in Ethiopia. Therefore, this study aimed to assess the effect of CBSRHE on knowledge and attitude about SRH services to have safer sexual behaviors among first-year students of Arba Minch University.

METHOD

We conducted a quasi-experimental study among purposively selected campuses. The campuses were allocated to (i) an intervention arm consisting of curriculum-based sexual and reproductive health, or (ii) a control arm for those who were free from intervention. Data was collected, at baseline and immediately after the intervention ended by using a structured self-administered questionnaire. To compare differences in the change from baseline to post-intervention between the two arms we use the chi-square test and independent-samples t-test. To see the effect of the CBSRHE by controlling the effect confounding inverse probability-weighted analysis was conducted.

RESULT

A total of 832 and 820 students participated in a baseline and post-test respectively. The proportion of youth who practice receptive penetrative sex decreases from 40.9% to 28.3% in the intervention arm compared to 37.6% to 37.3% in the non-intervention arm between baseline and end line, with statistically significant differences between groups. However, there are statistically significant differences between the intervention and control groups in terms of changes in contraception utilization (X2 = 1.21; P>0.05). Furthermore, there were significant improvements in knowledge and attitude among the intervention arm a comprehensive knowledge of HIV/AIDS (ATE = 0.22,95% CI, 0.14 to 0.29; p < 0.01), an average change of attitude toward HIV/AIDS(ATE = 1.32, 95% CI, 1.18 to 1.47; p < 0.01), comprehensive condom knowledge score (ATE = 0.23, 95% CI, 0.13 to 0.33; p < 0.01) and the average change of attitude toward condom score (ATE = 1.83, 95% CI, 1.19 to 2.77; p < 0.01).

CONCLUSION AND RECOMMENDATION

It was found that there was a significant difference in knowledge and attitude toward a disk sexual behaviors among r one student. This implies that the educational authority o the country can gain through the adoption of courses to all universities across the country, besides doing further comparative studies to determine the long-term effect of the course supported with models and/or theories like the theory of change.

Uptake of HIV testing and its correlates among sexually experienced college students in Southwestern, China: a Web-Based online cross-sectional study

BACKGROUND

The prevalence of human immunodeficiency virus (HIV) is becoming more common among college students in China. However, latest data on the prevalence and correlates of HIV testing among sexually experienced college students is rarely.

METHODS

An online survey was conducted among college students aged 18 years or older using multistage stratified cluster sampling from 16 colleges. Data on socio-demographic, HIV testing, HIV-related awareness, attitudes, sexual education and behaviors were collected. Propensity score matching (PSM) and logistic regression model were used to identify factors associated with HIV testing.

RESULT

A total of 108,987 students participated the survey, of which 13,201 sexually experienced college students were included in this study. 1,939 (14.69%) college students with sexual experience reported uptake of HIV testing in the preceding year. The uptake of HIV testing increased for college students with a rising HIV knowledge score and sexual health knowledge. Being awareness of HIV-related knowledge (aOR = 1.15, 95%CI: 1.01-1.30), accepting one-night stands (aOR = 1.16, 95%CI:1.03-1.32), obtaining satisfactory sexual interpretation from parent(s) (aOR = 1.24, 95%CI: 1.07-1.43), ever had unintended pregnancy (aOR = 1.78, 95%CI: 1.32-2.38), ever had received HIV-related preventive service(s) (aOR = 1.37, 95%CI: 1.10-1.70), ever had participated HIV-related preventive services (aOR = 3.76, 95%CI: 2.99-4.75) and ever had anal sex (aOR = 2.66, 95%CI: 2.11-3.34) were positively associated with uptake of HIV testing. However, accepting premarital sex (aOR = 0.76, 95%CI: 0.66-0.88), accepting cohabitation (aOR = 0.75, 95%CI: 0.61-0.92), occasionally discussing sex with parent(s) (aOR = 0.68, 95%CI: 0.50-0.91), and being with moderate satisfaction of school sex courses (aOR = 0.74, 95%CI: 0.58-0.95) were negatively associated with uptake of HIV testing.

CONCLUSION

The prevalence of HIV testing was relatively low. Participation in HIV-related services and high-risk sexual behaviors were important enablers for testing. Improving sex education for students, increasing HIV preventive services on campus, and improving family sex education are necessary to increase HIV testing among college sexually experienced students.

Social media promotion, risk perception, and parental support for adolescent girls' HPV vaccination: Taking consideration of future consequences and sexual attitudes as moderators

HPV vaccine hesitancy in Asia is unique compared to western countries. Concerning whether social media promotion about HPV vaccine will be related with parental support for Chinese adolescent girls, we investigated the correlation among social media promotion, risk perception of HPV vaccine and parental support. Through the theoretical lens of Health Action Process Approach model (HAPA), we found that social media promotion could reduce the risk perception of HPV vaccine and promoted parental supportive decision, and risk perception played a mediation role between social media information exposure to vaccine and parental support. Consideration of future consequences has been found to play a moderating role between social media promotion and risk perception, and parents' sexual attitudes moderated the effect of social media promotion on parental support. Implications of the findings are discussed.

Prevalence of unprotected anal intercourse and associated factors among male students who have sex with men in Qingdao, China: A cross-sectional study

The significant rise of human immunodeficiency virus (HIV) epidemic among young students has become a new feature of acquired immune deficiency syndrome in China, and unprotected anal intercourse (UAI) among male students who have sex with men (SMSM) played a central role in this process. The aim of this study was to investigate the prevalence of UAI, as well as analyze the factors associated with UAI among SMSM in Qingdao, China. From May 2021 to April 2022, men who aged 15 to 30, studied in a high school or college in Qingdao and had anal sex with men in the past 6 months were recruited through snowball method relying on the nongovernmental organization. An anonymous electronic questionnaire was administrated to collect information on socio-demographic characteristics, sexual behaviors, substance use before sex, HIV prevention services and self-esteem. Univariate and multivariate logistic regressions were used to assess factors related to UAI. Among the 341 SMSM included in the study, 40.5% engaged in UAI in the past 6 months. Being migrants from other provinces [odds ratios (OR) = 2.04, 95% confidence intervals (CI): 1.10-3.78], failing to use condoms for the first anal intercourse (OR = 3.38, 95% CI: 1.85-6.18), drinking alcohol before sex (OR = 2.31, 95% CI: 1.25-4.28) and being low level self-esteem (OR = 1.77, 95% CI: 1.09-2.87) were positively associated with UAI. SMSM who had homosexual intercourse more than once a week (OR = 1.76, 95% CI: 1.03-3.00) or had multiple male sex partners (OR = 1.99, 95% CI: 1.20-3.30) were more likely to engage in UAI. Received peer education in the past 12 months (OR = 0.48, 95% CI: 0.27-0.86) was associated with lower odds of UAI. The situation of UAI among SMSM in Qingdao was a public health issue of concern. It is necessary to take targeted measures, such as focusing on first-time sex, advancing sexual health education, expanding peer education, implementing alcohol use screening and maintaining the self-esteem of SMSM, so as to reduce the occurrence of high-risk behaviors among SMSM and curb the spread of HIV on campus.

Analysis of Multiple Sexual Partners among 2665 Male College Students Who Have Sexual Behaviour in Zhejiang Province, China

Objective. The objective of this study was to understand multiple sexual partners and related factors among male college students who exhibited sexual behaviour to provide a scientific basis for formulating HIV/AIDS prevention measures among college students. Methods. A stratified cluster random sampling method was conducted among 2665 male students who had sexual behaviour and were informed of the number of sexual partners from 13 colleges/universities in 11 cities in Zhejiang Province in 2018. Demographic characteristics, sexual attitudes, sexual behaviour, interventions, and related information were collected using a homemade online questionnaire. The chi-square test or univariate logistic regression in different groups was conducted for multiple sexual partners, and a logistic regression model was used in the related factor analysis. Results. A total of 2665 college students who engaged in sexual behaviour were involved in the research; among them, 485 students (18.20%) had multiple sexual partners. The results of multivariate analysis showed that the participants whose sexual orientation was homosexual ( $\text{adjusted}\text{OR}=4.10$ , $95\%\text{CI}=2.89-5.80$ ), those who had received school education about HIV testing in the previous year ( $\text{adjusted}\text{OR}=1.55$ , $95\%\text{CI}=1.20-1.99$ ), those who had accepted one-night stands ( $\text{adjusted}\text{OR}=3.29$ , $95\%\text{CI}=2.43-4.47$ ), those who had accepted commercial sex ( $\text{adjusted}\text{OR}=1.89$ , $95\%\text{CI}=1.44-2.48$ ), and those who were very confident in a condom use measure of self-efficacy ( $\text{adjusted}\text{OR}=1.78$ , $95\%\text{CI}=1.31-2.41$ ) were more likely to have multiple sexual partners. The participants who were senior students ( $\text{adjusted}\text{OR}=0.51$ , $95\%\text{CI}=0.31-0.84$ ), those whose monthly living expenses were 1001-1500 renminbi ( $\text{adjusted}\text{OR}=0.69$ , $95\%\text{CI}=0.51-0.93$ ), those who had known that “daily life and study contact cannot spread HIV” ( $\text{adjusted}\text{OR}=0.59$ , $95\%\text{CI}=0.43-0.80$ ), and those who knew that the CDC provides HIV testing ( $\text{adjusted}\text{OR}=0.66$ , $95\%\text{CI}=0.46-0.95$ ) were less likely to have multiple sexual partners. Conclusion. Multiple sexual partners were quite common among male college students who engaged in sexual behaviour. They had a separation of HIV/AIDS knowledge and action and a low rate of HIV testing. Further health education and intervention, including informing friends of strategies, are needed to guide students in correct sexual attitudes, safe sexual behaviour, and prevention of the spread of disease.

Differences in Sexual Behavior and Partner Notification for Sexually Transmitted Infections Between the Out of School Youth and University Students in a Peri-Urban District in South Africa-A Cross-Sectional Survey

The increase in sexually transmitted infections (STIs) in young people is a public health concern. Among those in university and out of school, different contextual factors contribute to their risky sexual behavior and increased susceptibility to STIs and HIV. There are limited comparative studies examining risky sexual behavior and partner notification (PN) between these two groups, particularly in South Africa. We investigated sexual behaviors, self-reported STI diagnosis, health seeking behavior, and preferred PN methods of university students and out of school youth. A descriptive cross-sectional survey was used using convenient sampling to select 917 students across five health sciences universities and through periodic sampling 699 out of school youth were selected from two main local shopping centers in South Africa. Descriptive statistics, bivariate and multivariable logistic analysis were performed using Stata IC version 14. More university students (71.7%) than out of school youth were in casual relationships (28.3%), with half of out of school youth being in steady relations (50.2%). Moreover, university students (65.7%) used a condom in the past 6 months compared to their counterparts (34.3%). Of the 124 youth who were diagnosed with STI in the past 12 months, majority (n = 106, 85%) were out of school youth. The probability of notifying a partner about a STI infection was 82% among university students compared to their counterparts (p = >0.05). The odds of notifying a partner was 1.79 times more for those having multiple sexual partners than those who had only one partner. Both groups preferred a face-to-face STI disclosure with partner; however, more university students (67%) preferred SMS notification than PN referral slips as compared to out of school youth (42%). Both the university students and the out of school youth engaged in risky sexual behaviors. Both groups preferred face-to-face and clinic SMS partner notifications, even though university students were in the majority. There is a need for developing health promotion scripts on disclosing STIs to sexual partners to empower the majority of the youth who prefer face-to-face PN over the prescribed methods.

Structural Equation Model Analysis of HIV/AIDS Knowledge, Attitude, and Sex Education Among Freshmen in Jiangsu, China

Background

The study of acquired immunodeficiency syndrome (AIDS) related knowledge, attitude, and sex education status of Jiangsu freshmen was conducted, which can provide data support directionally for the prevention work of HIV/AIDS among this population.

Methods

Male students (4,006) and female students (4,279) were selected from 20 universities or colleges in the Jiangsu province. The knowledge, attitudes, and sex education of freshmen were conducted with an online questionnaire. The log-binomial regression model was used to analyze the influencing factors of HIV/AIDS knowledge. In addition, a structural equation model was used to analyze students' health needs that affect knowledge awareness and knowledge mastery.

Results

The overall awareness rate of AIDS knowledge was 87.4%. The students in undergraduate colleges (OR = 2.523, 95% CI=2.223~2.864) and independent colleges (OR = 1.389, 95%CI = 1.172~1.646) were more likely to have a higher awareness compared with the students in junior colleges. In this study, 2,011 freshmen approved of premarital behavior, 4,921 freshmen insisted on using condoms when having sex, and 8,138 freshmen were willing to take HIV antibody test when they suspected they were infected. In total, 4,703 freshmen believed that sexual health education was necessary for colleges and universities, and most of them (57.2%) hoped that sex education in schools should be improved. The direct effect of sex education on knowledge awareness and attitude is 0.15 and 0.58. The mediation effect test found that the pass ability knowledge path of sex education indirectly affected sexual attitudes (0.05).

Conclusion

The awareness rate of HIV/AIDS among Jiangsu freshmen has not reached the national standard. Health education has a significant positive effect on knowledge awareness and attitude; however, students' needs in terms of time, place, and degree of sex education have not been met in time. It is necessary to strengthen the HIV/AIDS health education of college students in multiple ways.

Associations between impulsive personality traits and HIV-related knowledge, beliefs and behaviours among college students in Chengdu, China: a cross-sectional study

BACKGROUND

Impulsive personality traits (IPTs) are key predictors of individuals' engagement in sexual risk behaviours. This study investigated the associations between IPTs and HIV-related knowledge, beliefs and behaviours among Chinese college students.

METHODS

A sample of 1062 freshmen (first year) and sophomore (second year) students was obtained through stratified random sampling from 11 universities and colleges in Chengdu, China. The sociodemographic information, and HIV-related knowledge, beliefs and behaviours were investigated. A 20-item Short UPPS-P Impulsive Behaviour Scale (S-UPPS-P) was employed to estimate IPTs. Contingency table analyses (χ2) and adjusted logistic regression were used to analyse the association between IPTs and HIV-related knowledge, beliefs and behaviours.

RESULTS

The S-UPPS-P scale measure of IPTs yielded scores among college students ranging from 26 to 70. Students with a greater level of IPTs were more likely to have a high level of HIV stigma (aOR=1.46, 95% CI: 1.13-1.89), and a low level of HIV knowledge (aOR=1.41, 95% CI: 1.11-1.80) and HIV prevention beliefs (aOR=1.40, 95% CI: 1.09-1.80). All variables of HIV-related behaviours were not significantly associated with IPTs (all P>0.05).

CONCLUSIONS

Future campus health education should provide HIV education without neglect of early identification of students' IPTs.

Predictors for HIV testing among Chinese workers in infrastructure construction enterprises in Kenya

BACKGROUND

There are increasing Chinese migrants in sub-Saharan Africa currently. Most of them are engaged in infrastructure construction. Research has shown that they stay at particular risk of HIV and are recommended for HIV testing. However, their HIV testing behavior, and its relevant factors, have not been researched among them by now. This study describes the recent HIV testing behavior and relevant factors among Chinese migrant workers in Kenya.

METHODS

A cross-sectional survey was conducted among 110 male Chinese workers from six different Chinese infrastructure construction enterprises in Kenya. Furthermore, a two-stage cluster random sampling method was used to select participants. We used a questionnaire that included HIV testing history, demographic characteristics, and putative multilevel facilitators of HIV testing. Logistic regression was used to explore the predictors of recent HIV testing behavior among Chinese migrant workers in Kenya.

RESULT

Of the 110 participants, 30 (27.27%) were tested for HIV in the recent year. All participants were male, and the majority were married (73.2%). The mean age was 37.49 years (SD = 9.73; range: 23 to 63), and a considerable proportion refused to answer questions about transactional sexual behaviors in the last year. Most were able to obtain HIV-related information (91.8%) and were exposed to HIV-related information in the last year (68.2%), but only 47.6% had sufficient HIV knowledge. Nearly one-fifth of them believed that selling sex and paying for sex is acceptable. Multiple logistic regression analysis indicated that participants who could accept the 'pay for sex' (OR: 2.74; 95% CI: 1.02, 7.36) and exposed to HIV related information (OR: 4.75; 95% CI: 1.29, 17.44) were more likely to test for HIV in the recent 1 year.

CONCLUSION

Higher current HIV test rates were associated with a more open sexual attitude towards paying for sex and being exposed to HIV-related information in the last year among Chinese workers in Kenya. More specific attention to HIV should be attached to this population to increase the rate of HIV testing among them.

Sexual and reproductive health knowledge, sexual attitudes, and sexual behaviour of university students: Findings of a Beijing-Based Survey in 2010-2011

BACKGROUND

Although several studies have attempted investigating sex-related knowledge, attitudes, and practices among young people in China, deeper insights were still needed to further understand how this population could be supported to make healthy and safe sexual choices. Against this background, this study used a large set of secondary data to examine associations among sexual and reproductive health (SRH) knowledge, sexual attitudes, and sexual behaviour.

METHODS

A cross-sectional study was employed to explore the associations among SRH knowledge, sexual attitudes, and sexual behaviour with a publicly available survey data among the 1196 university students from freshmen to Ph.D. candidates. Descriptive analysis was used to describe the sociodemographic characteristics of the university students by gender. Associations of sociodemographic factors with sources and categories of SRH knowledge, categories of contraceptive knowledge, sexual attitudes, and sexual behavior were explored with Poisson regressions and logistic regressions, respectively. The mediating effects of sociodemographic factors on the associations between SRH knowledge and sexual behavior, observed sexual attitudes on the associations of SRH knowledge with sexual behavior, and latent sexual attitudes on the relationship between SRH knowledge and sexual behavior were analyzed in order.

RESULTS

Descriptive analysis showed that the sample was dominated by age group (18 to 24 years), undergraduates, females, limited contraceptive knowledge, unfavorable sexual attitudes, and insufficient knowledge sources. Regression analyses showed that sociodemographic factors had significant associations with SRH knowledge, sexual attitudes, and sexual behavior. Subsequently, the mediating effects of sociodemographic factors on the associations of SRH knowledge and sexual attitudes with sexual behavior were confirmed. Controlling for sociodemographic factors, the effects of sexual attitudes on the associations between SRH knowledge and sexual behaviour could be verified. Structural equation modeling indicated that the linear sequence of sources and categories of SRH knowledge → sexual attitudes → sexual behaviour model and the triangle mediating effects of sexual behaviour → sexual attitudes → SRH knowledge model existed.

CONCLUSIONS

Sociodemographic factors and observed sexual attitudes mediated the associations between SRH knowledge and sexual behaviour. The sequence relationship: sources and categories of SRH knowledge → sexual attitudes → sexual behavior and the mediating relationship: sexual behavior → sexual attitude → sources and categories of SRH knowledge & sexual behavior → sources and categories of SRH knowledge and sexual behavior → sexual attitude → categories of contraceptive knowledge & sexual behavior → categories of contraceptive knowledge were confirmed in the sample. This study also identified an urgent need for the university students to access to SRH comprehensive knowledge.

Factors associated with unsafe sexual behavior among sexually active Chinese University students, Hebei Province, 2019

Background

Healthy sexual behavior is critical for controlling the HIV/AIDS epidemic among university students, particularly in regions with increasing infection rates among university students in China.

Methods

This study investigated the prevalence of unhealthy sexual behavior in the past 6 months and the associated demographic and psychosocial factors among sexually active Chinese university students. Self-identified sexually active Chinese university students were recruited for the study.

Results

The study found that most students used condoms inconsistently during sexual intercourse (54.8%), and logistic regression showed that condomless sex was associated with being raised by a single parent (AOR = 1.934, 95% CI 1.234–3.031) or by grandparents or others (AOR = 1.583, 95% CI 1.003–2.50) and with sometimes using dating apps (AOR = 1.496, 95% CI 1.106–2.024). The independent protective factors for condomless sex were HIV knowledge scores between 15 and 18 compared to scores of 0 to 4 (AOR = 0.434, 95% CI 0.244–0.771). Among sexually active university students, 15.5% reported that they had multiple sexual partners; having multiple sexual partners was associated with sometimes (AOR = 2.543, 95% CI 1.553–4.167) or always (AOR =4.048, 95% CI 2.177–7.527) using dating apps. Being female (AOR = 0.402, 95% CI 0.231–0.699) and in a relationship (AOR = 0.236, 95% CI 0.154–0.363) were protective factors against having multiple sexual partners.

Conclusions

There is an urgent need to promote HIV prevention and to implement psychosocial interventions by providing comprehensive sex education and access to condoms and health care on campuses to decrease the potential factors related to unhealthy sexual behaviors among university students.

Association of Sexual Attitudes with Sexual Function: General vs. Specific Attitudes

Background: Sexual attitudes are related to the expression of sexuality and have been associated with indicators for sexual health. The main aim of this study was to determine the explanatory capacity of general (i.e., erotophilia) and specific (i.e., toward sexual fantasies and masturbation) sexual attitudes on different sexual functioning dimensions (sexual desire, sexual arousal, lubrication/erection, ability to have an orgasm and orgasm satisfaction). Methods: The sample consisted of 2000 heterosexual adults (1044 women, 956 men) aged 18-83 years. Results: The explanatory models for women mainly showed that positive attitudes toward sexual fantasies (β range = -0.35, -0.249) and age (β range = -0.111, 0.086) explained sexual function. The models proposed for men revealed a more diverse pattern, although the variable essential for explaining sexual function was a positive attitude toward sexual fantasies (β range = -0.266, -0.097). Conclusions: These results indicate that specific sexual attitudes, particularly in relation to sexual fantasies, are more sensitive variables than erotophilia in examining sexual health.

Factors associated with risk sexual behaviours of HIV/STDs infection among university students in Henan, China: a cross-sectional study

Background

This study aimed to identify factors associated with risk sexual behaviours and target high-risk groups at risk of HIV/STDs infection among university students.

Methods

The cross-sectional study was conducted from 1 November to 31 December 2020 in one university, located in Henan Province. A total of 1602 individuals who reported having ever had sex were analyzed as the subjects of this study. Descriptive analysis and multivariable logistic regression analysis were applied for this study to assess factors associated with risk sexual behaviours among university students.

Results

University students who reported having ever had sex accounted for about 9%, with an average age of 19.37 ± 1.03. Of them, having multiple sexual partners and inconsistent condom use during the last 6 months were 37.3% and 35%, respectively. Over 50% of participants had their sexual debut before the age of 18. Bisexual students (AOR = 0.27; 95% CI 0.16, 0.44) and those who lived on over 3000 Yuan per month (AOR = 0.50; 95% CI 0.28, 0.91) were consistently less likely to engage in condom use during the last 6 months. University students who were from high-grade (AOR = 1.56; 95% CI 1.12, 2.18 for sophomore; AOR = 1.84; 95% CI 1.28, 2.65 for junior; AOR = 2.07; 95% CI 1.38, 3.11 for senior), who lived on over 3,000 Yuan per month (AOR = 4.19; 95% CI 2.17, 8.11) or who reported being homosexual (AOR = 3.92; 95% CI 2.17, 7.06) and bisexual (AOR = 33.22; 95% CI 13.11, 84.15) were more likely to have multiple sexual relationships. University students who had sexual debut before the age of 18 were more likely to engage in risk sexual behaviours.

Conclusions

The prevalence of sexual activity among Chinese university students is generally low, but risk sexual behaviours are of considerable concern. University students with higher living expenses, who are not heterosexual and who are younger at first sexual intercourse tend to engage in risk sexual behaviours. The scale-up of intervention is the need to prevent the expansion of the HIV epidemic among young students.

The HIV epidemic among university students is considerable, with the tendency of the high-risk population towards the general population. University students at risk of HIV/STDs infection tend to engage in risk sexual behaviours and were targeted for assessing factors corelated with their risk sexual behaviours in this study. Participants who reported having had sexual relations were selected. Information on the practice of risk sexual behaviours including multiple sexual partners and inconsistent condom use were collected and analyzed using a multivariable logistic regression model.

Bisexual students were consistently less likely to use condoms within the last 6 months. University students from high-grade, who lived on over 3000 Yuan monthly, homosexual students and bisexual students were more likely to have multiple sexual relationships. University students who had sexual debut before the age of 18 were more likely to engage in risk sexual behaviours.

In conclusion, University students with high cost of living per month, non-heterosexual, who are younger at first sexual intercourse tend to engage in risk sexual behaviours. Intensified intervention is the need to prevent the expansion of the HIV epidemic amongst young students.

Service acceptance of HIV non-occupational post-exposure prophylaxis(nPEP) among college students: a cross-sectional study in China

Background

College students were the key group we should pay more attention for acquired immune deficiency syndrome (AIDS) prevention and control in recent years in China. Few studies of HIV non-occupational post-exposure prophylaxis (nPEP) knowledge and service acceptance had been conducted among them in China. This study conducted a cross-sectional survey to understand the service acceptance of nPEP and its influencing factors among college students in the three cities of China.

Methods

A questionnaire survey was conducted to collect information on socio-demographic, behavioral characteristic, HIV/AIDS knowledge, nPEP knowledge, acceptance of nPEP services among the college students in Beijing, Shenzhen, and Kunming of China from March to April of 2019. Each participant completed an anonymous questionnaire on line by computer-assisted or mobile phone-assisted self-interview with informed consent. Multivariable logistic regression analyses identified predictors for service acceptance of nPEP.

Results

A total of 4698 students were surveyed with the average age of 20 years old. 98.0% (4605/4698) of them were undergraduates, 21.8%(1022/4698) had sexual intercourse; 48.6% (2282/4698) heard of nPEP, among which 4.95%(113/2282) received nPEP services. The awareness rate of HIV/AIDS knowledge was 85.6% (5495/4698) with the differences statistically significant between the three cities. The awareness rate of nPEP knowledge was 16.5% (774/4698). There were significant differences in receiving nPEP services among students of different ages, genders, sexual behaviors, and knowledge of HIV/AIDS by univariate analysis. Multivariable analyses indicated that age group of 18 and under (OR = 2.551, 95% CI = 1.153–5.646), male (OR = 3.131, 95% CI = 1.866–5.253), homosexual behavior (OR = 4.661,95%CI = 2.658–8.172), heterosexual behavior (OR = 1.676, 95% CI = 1.040–2.947), no awareness of AIDS knowledge (OR = 3.882, 95% CI = 2.371–6.356) and nPEP (OR = 4.788, 95% CI = 2.50–9.169) knowledge, were associated with the service acceptance of nPEP among the college students.

Conclusion

The low acceptance of nPEP services was mainly affected by low level of nPEP knowledge among the college students. Further publicity and education of nPEP knowledge were necessary, as well as promotion of knowledge of HIV/AIDS prevention and treatment. More attention should be paid to the factors associated with acceptance of nPEP services.

Condom Use Consistency and Associated Factors Among College Student Men Who Have Sex with Men from Seven Colleges in Changsha City: A Cross-Sectional Survey

Background

College student men who have sex with men (MSM) are at high risk for HIV infection due to multiple social and behavioral factors. Consistent condom use is nationally advocated for HIV prevention. This study explored the sexual behaviors and factors associated with condom use consistency in the past six months among college student MSM from seven colleges in Hunan Province, China.

Methods

A cross-sectional survey was conducted from September 2017 to March 2018. Condom use consistency, sexual behaviors, HIV testing performance, substance use, and alcohol consumption were examined using researcher-created questionnaires. Condom use self-efficacy and HIV-related knowledge were assessed using the Condom Use Self-Efficacy Scale and the unified National AIDS Sentinel Surveillance Questionnaire. Univariate and multivariate logistic regressions were used. P <0.05 was considered significant.

Results

In the 214 respondents, the rate of consistent condom use was 56% (n = 119) during the past six months. Participants who were studying at first-tier universities (odds ratio [OR]: 2.522, 95% confidence interval [CI]: 1.255–5.067) and had higher scores for condom use self-efficacy (OR: 2.617, 95% CI: 1.462–4.685) were more likely to report consistent condom use than the others. The risk factor was having suspicious symptoms of sexually transmitted diseases (OR: 0.357, 95% CI: 0.163–0.780).

Conclusion

Numerous students were at high risk of HIV infection with inconsistent condom use. Comprehensive and specific topics about safe sex education from parents and peers should be offered on campuses in China.

Factors associated with past HIV testing among men who have sex with men attending university in China: a cross-sectional study

Background HIV prevalence has been rapidly increasing among men who have sex with men (MSM) attending university in China, but HIV testing rates remain suboptimal. The factors associated with past HIV testing in this population in Beijing, China, were investigated.

METHODS

This study used data from the baseline survey of an HIV intervention clinical trial among MSM who did not have a history of a positive HIV diagnosis. This analysis focused on the HIV testing experience in a subgroup of university student MSM participants. Log-binomial models were used to evaluate factors associated with past HIV testing.

RESULTS

Of 375 university student MSM, the median age was 22 years; 89.3% were Han ethnic. Approximately half (50.4%, n = 189) had ever taken an HIV test before the survey. In a multivariable log-binomial model, older age (adjusted prevalence ratio (APR), 1.04; 95% confidence interval (CI), 1.02-1.06), had first sexual intercourse at age <18 years (APR, 1.35; 95% CI, 1.08-1.45) and knew someone living with HIV (APR, 1.33; 95% CI, 1.07-1.61) were associated with a higher likelihood of past testing. Self-reported barriers to taking a test included perceived low HIV risk, fear of a positive diagnosis, did not know where to get tested and fear of discrimination. Facilitators included anonymity in taking a test, confidentiality of testing results and availability of home-based and rapid testing.

CONCLUSIONS

The HIV testing rate among university student MSM was low. Interventions should be implemented to address structural, institutional and individual barriers to HIV testing in this vulnerable population.

A national survey of HIV knowledge, sexual practices and attitude towards homosexuality for HIV elimination among young people in China

Background Elimination of HIV is a public health priority in China, but there has been reports of an upsurge in HIV among young people. A nationwide cross-sectional survey was conducted to assess the awareness of HIV knowledge, attitudes towards homosexuality and practice of sexual behaviours among Chinese aged 15-24 years.

METHODS

The face-to-face survey was conducted from June to August 2017, collecting data on sociodemographic characteristics, HIV-related knowledge, attitudes towards homosexuality and practice of sexual behaviours among Chinese senior high school and university students. A generalised linear model (GLM) was used to assess the different levels of HIV knowledge between groups, and identify the key contributors to HIV knowledge scores.

RESULTS

The survey was completed by 73.6% (1355/1840) of the students approached. The overall level of HIV-related knowledge was low (58.9%, 10.6/18); 48.0% (650/1355) supported same-sex marriage; and 6.9% (93/1355) self-identified as homosexual or bisexual. The major factors associated with higher scores [mean ± standard deviation (s.d.)] in HIV knowledge among students included: having received school-based HIV education (11.47 ± 3.51 vs 9.02 ± 4.14, P < 0.05); support for same-sex marriage (11.69 ± 3.33 vs 9.49 ± 4.29, P < 0.05) and older age (11.61 ± 2.78 vs 9.87 ± 4.17, P < 0.05). Compared with females, males were significantly more likely (all P < 0.05) to report masturbation (60.7% vs 7.6%), pornography experiences (77.4% vs 35.3%), sexual encounters (24.6% vs 12.3%), casual sex (37.0% vs 18.1%) and sex under the influence of alcohol (29.5% vs 12.8%).

CONCLUSIONS

There is is still much room for improvement in terms of HIV/AIDS prevention and health education for Chinese young people, and more comprehensive and diverse models of education for HIV prevention are urgently needed.

Sexual and reproductive health knowledge, attitudes and behaviours of Chinese international students studying abroad (in Australia, the UK and the US): a scoping review

International students within Australia are disproportionately affected by adverse sexual and reproductive health (SRH) outcomes. Chinese international students represent the majority of international students in Australia, and a large proportion of students in other high-income countries such as the United States and the United Kingdom, making them an important priority group. However, the SRH issues of this priority group have received little attention from international researchers. This review provides an overview of global studies surrounding the SRH knowledge, attitudes and behaviours of Chinese international students studying abroad. Ten articles were deemed relevant and findings from both the qualitative and quantitative data synthesis were categorised into six codes: (1) knowledge; (2) sources of information; (3) attitudes; (4) behaviours; (5) barriers; and (6) recommendations. The findings provide valuable understanding to inform the development of targeted, culturally sensitive and inclusive health promotion initiatives and policies. It is recommended that further research is conducted in this field to reduce evident health disparities.

Knowledge, Attitude, and Practices of Jimma Teacher Training College Students Toward Risky Sexual Behaviors, Jimma, Ethiopia

BACKGROUND

College students represent the huge section of teenagers in Ethiopia, and a growing number of them practice unsafe sex and hence face unwanted sexual health outcomes. Despite this, little has been explored about the college students' knowledge, attitude, and practice toward risky sexual behaviors (RSBs) in the study area. Therefore, this study aimed to assess the knowledge, attitude, and the practice of Jimma teacher training college students toward RSBs, Jimma town, southwest Ethiopia, in 2018.

METHODS

An institution-based quantitative cross-sectional study was conducted. Data were collected through a pretested, structured, and self-administered questionnaire. A total of 395 respondents were selected using a simple random sampling technique. The collected data were checked manually for completeness and consistency, entered into Epi-data, version 3.1, data entry software, and exported to SPSS, version 20, statistical software for analysis. Descriptive statistics were used to summarize the outcome and explanatory variables.

RESULTS

Among the total 360 respondents, 140 (38.9%) had poor knowledge of RSBs. The majority 78 (36.6%) of the respondents described radio as their main source of information about RSBs. More than three-quarters, 163 (76.6%) respondents define practicing oral and/or anal sex as RSBs and 194 (91%) reported sexually transmitted infections including HIV/AIDS as the main consequence of RSBs. This study also revealed 156 (43.4%) participants had an unfavorable attitude toward RSBs. 60 (16.7%) participants disagree with the idea that condoms prevent HIV/AIDS and nearly all respondents (340 [94.5%]) agreed homosexuality brings sexual risks. Among those who had sexual experience, 83 (32.4%) had 2 or more sexual partners, more than two-third (176 [68.8%]) had sexual practice after drinking alcohol, and 90 (35.1%) participants reported they did not use a condom when they had sex.

CONCLUSION

A significant percentage of the students have poor knowledge, attitude, and practice toward RSBs. Tesfaye Y, Agenagnew L. Knowledge, Attitude, and Practices of Jimma Teacher Training College Students Toward Risky Sexual Behaviors, Jimma, Ethiopia. Sex Med 2020;8:554-564.

Acceptability and correlates of HIV self-testing among university students in northern Nigeria

Concerns about stigma and confidentiality limit the uptake of HIV testing and counseling (HTC) among young adults. HIV self-testing has been offered as a youth-friendly alternative to conventional HTC. We conducted a cross-sectional study to assess HTC uptake, willingness to self-test, and their predictors among university students (n = 399) in Kano, Nigeria. Anonymous self-administered questionnaires were provided to participants. Adjusted odd ratios were generated for predictors with logistic regression models. The results showed that only 35.8% (n = 143) of participants had previous HTC.Most respondents (70.4%, n = 281) were willing to self-test. HTC was associated with year of college (500 Level vs. 100 Level), adjusted odds ratio (AOR, [95% Confidence Interval (CI)] = 0.44 (0.19-0.97), campus residence (off- vs. on-campus, AOR = 0.45; 95%CI: 0.28-0.73), sexual activity in the past six months (AOR = 0.39; 95%CI: 0.24-0.64), willingness to self-test (AOR = 0.38; 95%CI: 0.22-0.66), and consistent condom use (AOR = 4.45; 95%CI: 1.41-14.08). Students who were older (≥ 30 vs. <20 years, AOR = 0.20; 95%CI: 0.05-0.90) and female (AOR = 0.56; 95%CI: 0.32-0.98) were less likely to be willing to self-test, whereas students who were more senior (500 Level vs. 100 Level, AOR = 5.24; 95%CI: 1.85-14.84), enrolled in clinical science programs (vs. agriculture, AOR = 4.92; 95%CI: 1.51-16.05) or belonging to "other" ethnic groups (vs. Hausa-Fulani, AOR = 2.40; 95%CI: 1.11-5.19) were more willing to self-test. Overall HTC uptake was low, but acceptability of self-testing was high. College seniority, age, ethnicity, and program of study were associated with willingness to self-test. Our findings support the feasibility of scaling up HIV self-testing among university students in Nigeria.

Epidemiological characteristics of HIV infection among college students in Nanjing, China: a cross-sectional survey

OBJECTIVE

This study aimed to investigate the epidemiological characteristics and HIV/AIDS-related knowledge, attitudes and practice (KAP) among HIV-positive college students.

DESIGN

A cross-sectional study.

SETTING

Five districts of Nanjing, China.

PARTICIPANTS

A total of 156 college students with newly diagnosed HIV infection between September 2015 and July 2017.

MAIN OUTCOME MEASURES

Social-demographic characteristics, mode of HIV acquisition, infection of sexually transmitted diseases, risky sexual behaviours and HIV/AIDS-related KAP were collected by a face-to-face questionnaire administered by trained interviewers.

RESULTS

About 98.7% (154/156) of HIV-positive college students in our study were men, and 96.1% (148/154) of them were infected by sexual intercourse with men. More than half (52.5%, 82/156) of participants were freshmen or sophomores. Nearly 30% (44/154) of male students did not realise the severe status of the HIV/AIDS epidemic among students who are men who have sex with men (MSM). More than four-fifths of male students did not know if their male regular (83.0%, 93/112) or casual (95.9%, 94/98) sexual partners were HIV-positive, while less than half of them had high-risk perceptions towards HIV infection from male regular and occasional sexual partners. Approximately one-half and four-fifths of male students had more than two regular (54.5%, 61/112) and occasional (79.6%, 78/98) partners during lifetime, respectively. However, only 62.5% (70/112) and 66.3% (65/98) of male students used condoms consistently during sexual intercourse with regular and casual partners, respectively. Geosocial networking apps have become the most dominant way for male students to seek sexual partners.

CONCLUSIONS

This study reported a low level of HIV/AIDS-related knowledge, a high level of exposure to risky sexual behaviours and some valuable epidemiological characteristics among HIV-positive college students, which highlighted the importance of carrying out HIV/AIDS prevention education and risk warning education early and timely towards college students on campus.