Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
Nanning Center for Disease Control and Prevention, Nanning, 530023, Guangxi, China.
BMC Infect Dis. 2024 Aug 14;24(1):827. doi: 10.1186/s12879-024-09657-7.
There is an increasing number of human immunodeficiency virus (HIV) reported cases among students in Southwest China. However, the data on HIV/sex-related knowledge, attitude toward sex, sexual behaviors, and correlates of pre-exposure prophylaxis (PrEP)-eligible behaviors among college students in this area is still limited. This study aimed to assess the prevalence of HIV/sex-related knowledge, sexual attitudes, sexual behaviors, and factors associated with PrEP-eligible behaviors among college students.
An online survey from 2020 to 2021 based on a multistage stratified and cluster sampling method was conducted among college students in Southwest China, and a well-designed questionnaire collected data. Propensity score matching (PSM), logistic, and log-binomial regression were used to identify the determinants of PrEP-eligible behaviors.
A total of 108,987 students participated in the survey, and 92,946 provided valid responses. 91.6% (85,145/92,946) had good HIV-related knowledge, while only 26.0% (24,137/92,946) reported awareness of sex-related knowledge. Furthermore, more than half of the participants (64.5%) held negative stances towards engaging in "one-night stand", and 58.9% (617/1,047) reported PrEP-eligible behaviors. Log-binomial regression analysis indicated that unaware of HIV-related knowledge (aPR = 1.66, 95% CI:1.22-2.26, P = 0.001), not discussing about sex with their parent(s) (aPR = 1.16, 95% CI:1.01-1.33, P = 0.021), not receiving sex-related education in school(aPR = 1.24, 95% CI: 1.07-1.45, P = 0.005), not participating in HIV/AIDS prevention activities in the past year (aPR = 1.32, 95%CI:1.09-1.60, P = 0.004), experiencing forced sex (aPR = 2.08, 95% CI: 1.19-3.63, P = 0.010), and having the drug abuse (aPR = 22.21, 95% CI:5.59-88.31, P < 0.001) were significantly associated with increased odds of PrEP-eligible behaviors.
College students in Southwest China exhibited suboptimal HIV/sex-related knowledge, received limited sex education, reported conservative attitudes towards casual sex, and significant PrEP-eligible behaviors. These findings suggest that sexually experienced college students who were unaware of HIV-related knowledge, lacked sex education, experienced forced sex, and reported drug abuse were the key individuals for evaluating eligibility for PrEP initiation, and interventions aimed at increasing awareness of HIV/sex-related knowledge, promoting participation in sex education, addressing issues related to forced sex and tackling drug abuse could contribute to reducing the incidence of PrEP-eligible behaviors among college students.
在中国西南地区，报告的人类免疫缺陷病毒（HIV）感染病例中，学生人数不断增加。然而，该地区大学生 HIV/性相关知识、性态度、性行为以及与暴露前预防（PrEP）合格行为相关的因素的数据仍然有限。本研究旨在评估大学生中 HIV/性相关知识、性态度、性行为以及与 PrEP 合格行为相关的因素的流行情况。
本研究采用多阶段分层和聚类抽样方法，于 2020 年至 2021 年期间对中国西南地区的大学生进行了在线调查，并使用精心设计的问卷收集数据。采用倾向评分匹配（PSM）、逻辑回归和对数二项式回归来确定 PrEP 合格行为的决定因素。
共有 108987 名学生参加了调查，其中 92946 人提供了有效回复。91.6%（85145/92946）的学生对 HIV 相关知识有较好的了解，而只有 26.0%（24137/92946）的学生了解性相关知识。此外，超过一半的参与者（64.5%）对“一夜情”持有负面态度，58.9%（617/1047）报告了 PrEP 合格行为。对数二项式回归分析表明，不了解 HIV 相关知识（aPR=1.66，95%CI：1.22-2.26，P=0.001）、不与父母讨论性问题（aPR=1.16，95%CI：1.01-1.33，P=0.021）、未在学校接受性教育（aPR=1.24，95%CI：1.07-1.45，P=0.005）、过去一年未参加艾滋病预防活动（aPR=1.32，95%CI：1.09-1.60，P=0.004）、经历过强迫性行为（aPR=2.08，95%CI：1.19-3.63，P=0.010）和有药物滥用史（aPR=22.21，95%CI：5.59-88.31，P<0.001）与 PrEP 合格行为的可能性增加显著相关。
中国西南地区的大学生 HIV/性相关知识水平不理想，性教育有限，对随意性行为持保守态度，PrEP 合格行为显著。这些发现表明，对于那些不了解 HIV 相关知识、缺乏性教育、经历过强迫性行为和报告药物滥用的有过性经验的大学生，是评估 PrEP 启动资格的关键人群，通过提高 HIV/性相关知识的认识、促进性教育的参与、解决与强迫性行为相关的问题以及解决药物滥用问题，可能有助于减少大学生中 PrEP 合格行为的发生。
