Advanced Search

Preplanned Studies: HIV-Related Knowledge, Attitude, and Practices Research Among College Students — Six Chinese Cities, 2021

View author affiliations
  • Summary

    What is already known about this topic?

    The number of newly diagnosed human immunodeficiency virus (HIV) cases among Chinese youth 15–24 years of age shows an upward trend between 2010 and 2019.

    What is added by this report?

    This survey is on a larger scale as compared to previous studies. It shows inadequate HIV knowledge — especially on HIV treatment, self-testing, and post-exposure prophylaxis — among college students. A significant gap exists between knowledge and behavior as indicated by the low condom use rate despite a high knowledge level.

    What are the implications for public health practice?

    Findings suggest priorities for future HIV education and awareness creation of existing services. A low condom use rate at sexual debut suggests that HIV prevention education should start early.

  • loading...
  • Funding: Provided by the Durex Public Welfare Foundation on college students' AIDS education
  • [1] UNAIDS. Core epidemiology slides. https://www.unaids.org/en/resources/documents/2022/core-epidemiology-slides. [2022-9-18].https://www.unaids.org/en/resources/documents/2022/core-epidemiology-slides
    [2] Zhao H, Liu H, Wang L, Yang X, Wang SR, Han MJ, et al. Epidemiological characteristics of newly-reported HIV cases among youth aged 15-24 years - China, 2010-2019. China CDC Wkly 2020;2(48):913 − 6. http://dx.doi.org/10.46234/ccdcw2020.249CrossRef
    [3] The implementation plan for the containment and control of HIV/AIDS (2019-2022). http://www.gov.cn/xinwen/2019-10/13/content_5439036.htm. [2022-9-18]. (In Chinese). http://www.gov.cn/xinwen/2019-10/13/content_5439036.htm
    [4] World Health Organization. Guidelines on HIV self-testing and partner notification: supplement to consolidated guidelines on HIV testing services. https://apps.who.int/iris/bitstream/handle/10665/251655/9789241549868-eng.pdf. [2022-9-18].https://apps.who.int/iris/bitstream/handle/10665/251655/9789241549868-eng.pdf
    [5] Mokgatle MM, Madiba S. High acceptability of HIV self-testing among technical vocational education and training college students in Gauteng and north west province: what are the implications for the scale up in south Africa? PLoS One 2017;12(1):e0169765. http://dx.doi.org/10.1371/journal.pone.0169765.http://dx.doi.org/10.1371/journal.pone.0169765
    [6] Lv Y, Li GQ, Hu MG, Xu CD, Lu HY, Chen L, et al. Anonymous linkage between college students and human immunodeficiency virus (HIV) facilities: systematic evaluation of urine self-collection for HIV testing initiative in China. Clin Infect Dis 2021;73(5):e1108 − 15. http://dx.doi.org/10.1093/cid/ciaa1816CrossRef
    [7] Lv Y, Zhu QY, Xu CD, Zhang GB, Jiang Y, Han MJ, et al. Spatiotemporal analysis of online purchase of HIV self-testing kits in China, 2015-2017: longitudinal observational study. JMIR Public Health Surveill 2022;8(9):e37922. http://dx.doi.org/10.2196/37922CrossRef
    [8] Shi Y, Liu RH, Yu HF, Fu ZH, Guo W. Sexual debut among college students in China: effects of family context. J Biosoc Sci 2021. http://dx.doi.org/10.1017/s0021932021000523.http://dx.doi.org/10.1017/s0021932021000523
    [9] Edgardh K. Sexual behaviour and early coitarche in a national sample of 17 year old Swedish girls. Sex Transm Infect 2000;76(2):98 − 102. http://dx.doi.org/10.1136/sti.76.2.98CrossRef
    [10] Zhang L, Yu H, Luo H, Rong WL, Meng XX, Du XA, et al. HIV/AIDS-related knowledge and attitudes among Chinese college students and associated factors: a cross-sectional study. Front Public Health 2022;9:804626. http://dx.doi.org/10.3389/fpubh.2021.804626CrossRef
  • TABLE 1.  Sociodemographic characteristics of college students surveyed in 6 Chinese cities, 2021 (N=54,052).

    CharacteristicnPercentage (95% CI)
    Sex
    Male21,87440.5 (40.1, 40.9)
    Female32,17859.5 (59.1, 59.9)
    Age (years)
    ≤176821.3 (1.2, 1.4)
    18–11,63521.5 (21.2, 21.9)
    19–19,76136.6 (36.2, 37.0)
    20–11,11820.6 (20.2, 20.9)
    ≥2110,85620.1 (19.7, 20.4)
    School level
    First-tier29,25254.1 (53.7, 54.5)
    Second-tier18,09633.5 (33.1, 33.9)
    Third-tier2,1113.9 (3.7, 4.1)
    Vocational college4,5938.5 (8.3, 8.7)
    City of residence
    Tianjin7,60314.1 (13.8, 14.4)
    Changchun8,76216.2 (15.9, 16.5)
    Hangzhou11,71521.7 (21.3, 22.0)
    Changsha15,13628.0 (27.6, 28.4)
    Guangzhou7,20913.3 (13.1, 13.6)
    Chengdu3,6276.7 (6.5, 6.9)
    Grade
    Freshman30,21155.9 (55.5, 56.3)
    Sophomore12,51623.2 (22.8, 23.5)
    Junior7,50213.9 (13.6, 14.2)
    Senior2,7145.0 (4.8, 5.2)
    Graduate and higher1,1092.1 (1.9, 2.2)
    Sexual orientation
    Heterosexual46,98586.9 (86.6, 87.2)
    Homosexual9301.7 (1.6, 1.8)
    Bisexual3,0585.7 (5.5, 5.9)
    Not sure3,0795.7 (5.5, 5.9)
    Sexual experience
    Yes5,38410.0 (9.7, 10.2)
    No48,66890.0 (89.8, 90.3)
    Self-reported HIV testing result
    Positive260.05 (0.03, 0.07)
    Negative8541.6 (1.5, 1.7)
    Unknown2260.4 (0.4, 0.5)
    Not tested52,94698.0 (97.8, 98.1)
    Abbreviation: CI=confidence interval; HIV=human immunodeficiency virus.
    Download: CSV

    TABLE 2.  HIV/AIDS-related knowledge, attitudes of college students surveyed in 6 Chinese cities, 2021 (N=54,052).

    CharacteristicnPercentage (95% CI)
    Basic HIV knowledge
    Q1. AIDS cannot be cured
    Yes38,35871.0 (70.6, 71.3)
    No15,69429.0 (28.7, 29.4)
    Q2. A healthy-looking person can have HIV
    Yes47,04687.0 (86.8, 87.3)
    No7,00613.0 (12.7, 13.2)
    Q3. It is illegal to transmit HIV intentionally
    Yes50,89694.2 (94.0, 94.4)
    No3,1565.8 (5.6, 6.0)
    Q4. HIV among young Chinese students is mainly through male homosexual behavior
    Yes36,11266.8 (66.4, 67.2)
    No17,94033.2 (32.8, 33.6)
    Q5. Infection with STDs could increase the risk of HIV infection
    Yes35,18765.1 (64.7, 65.5)
    No18,86534.9 (34.5, 35.3)
    Q6. Substance abuse could increase the risk of HIV infection
    Yes46,00385.1 (84.8, 85.4)
    No8,04914.9 (14.6, 15.2)
    Q7. Proper use of condoms during sex reduces the risk of HIV transmission
    Yes51,12894.6 (94.4, 94.8)
    No2,9245.4 (5.2, 5.6)
    Q8. It is necessary to use condoms even when having sex with acquaintances
    Yes50,19192.9 (92.6, 93.1)
    No3,8617.1 (6.9, 7.4)
    Q9. Condoms should be used even if the genital looks normal
    Yes50,11092.7 (92.5, 92.9)
    No3,9427.3 (7.1, 7.5)
    Knowledge and attitudes toward PEP
    Heard of PEP
    Yes34,95864.7 (64.3, 65.1)
    No19,09435.3 (34.9, 35.7)
    Knowledge on where to get PEP drugs (n=34,958)
    Centers for Disease Control and Prevention
    Yes28,77382.3 (81.9, 82.7)
    No6,18517.7 (17.3, 18.1)
    Hospitals
    Yes29,06783.1 (82.8, 83.5)
    No5,89116.9 (16.5, 17.2)
    Community-based organizations
    Yes7,17620.5 (20.1, 21.0)
    No27,78279.5 (79.0, 79.9)
    Purchase online
    Yes4,74613.6 (13.2, 13.9)
    No30,21286.4 (86.1, 86.8)
    Willing to use PEP after risky behavior
    Yes49,54991.7 (91.4, 91.9)
    No8001.5 (1.4, 1.6)
    Not sure3,7036.9 (6.6, 7.1)
    Knowledge and attitudes toward HIV testing and counseling
    I should seek HIV testing and counseling after risky behavior
    Yes52,69797.5 (97.4, 97.6)
    No1,3552.5 (2.4, 2.6)
    Testing helps me know my status, start early treatment, and suppress HIV replication
    Yes52,85997.8 (97.7, 97.9)
    No1,1932.2 (2.1, 2.3)
    HIV testing gives me peace of mind
    Yes53,08298.2 (98.1, 98.3)
    No9701.8 (1.69, 1.91)
    Worry about others’ attitude after HIV testing
    Yes20,20437.4 (37.0, 37.8)
    No33,84862.6 (62.2, 63.0)
    Worry about positive HIV testing results
    Yes10,66919.7 (19.4, 20.1)
    No43,38380.3 (79.9, 80.6)
    Heard of HIV self-testing
    Yes22,73142.1 (41.6, 42.5)
    No31,32157.9 (57.5, 58.4)
    Abbreviation: AIDS=acquired immunodeficiency syndrome; CI=confidence interval; HIV=human immunodeficiency virus; PEP=post-exposure prophylaxis; STDs=sexually transmitted diseases.
    Download: CSV

    TABLE 3.  Sex experience and HIV testing among college students in 6 Chinese cities, 2021 (N=5,384).

    CharacteristicnPercentage (95% CI)
    First sex (n=5,384)
    Age at sexual debut (years)
    ≤171,20322.3 (21.2, 23.5)
    18–1,79033.2 (32.0, 34.5)
    19–89716.7 (15.7, 17.7)
    20–93717.4 (16.4, 18.4)
    ≥2155710.3 (9.6, 11.2)
    Forced sex at sexual debut
    Yes1162.2 (1.8, 2.6)
    No5,26897.8 (97.4, 98.2)
    Partner type at sexual debut
    Heterosexual4,89590.9 (90.1, 91.7)
    Homosexual4899.1 (8.33, 9.9)
    Condom use at sexual debut
    None1,14221.2 (20.1, 22.3)
    Incorrect use3466.4 (5.79, 7.12)
    Correct use3,89672.4 (71.1, 73.5)
    Sex behavior (past 12 months; n=4,573)
    Sex with fixed partner (past 12 months)
    Yes4,30794.2 (93.5, 94.8)
    No2665.8 (5.2, 6.5)
    Condom use with fixed sex partner (past 12 months; n=4,307)
    None2886.7 (6.0, 7.5)
    Not consistent use94321.9 (20.7, 23.2)
    Consistent use3,07671.4 (70.0, 72.8)
    Casual sex (past 12 months)
    Yes1,35929.7 (28.4, 31.1)
    No3,21470.3 (68.9, 71.6)
    Condom use with casual sex partner (past 12 months; n=1,359)
    None20415.0 (13.2, 17.0)
    Not consistent use26519.5 (17.4, 21.7)
    Consistent use89065.5 (62.9, 68.0)
    Commercial sex (past 12 months)
    Yes70815.5 (14.5, 16.6)
    No3,86584.5 (83.4, 85.5)
    Condom use with commercial sex partner (past 12 months; n=708)
    None15221.5 (18.5, 24.7)
    Not consistent use10114.3 (11.8, 17.1)
    Consistent use45564.3 (60.6, 67.8)
    Male homosexual behavior (past 12 months)
    Yes2926.4 (5.1, 7.1)
    No4,28193.6 (92.9, 94.3)
    Sex role (past 12 months; n=292)
    Receptive10536.0 (30.5, 41.8)
    Insertive8729.8 (24.7, 35.5)
    Receptive and insertive10034.2 (28.9, 40.0)
    Homosexual sex partner number (past 12 months; n=292)
    116957.9 (52.0, 63.6)
    2–910034.2 (28.9, 40.0)
    10–237.9 (5.2, 11.7)
    Condom use with homosexual partner (past 12 months; n=292)
    None8930.5 (25.3, 36.2)
    Not consistent use6421.9 (17.4, 27.2)
    Consistent use13947.6 (41.8, 53.5)
    Any drug use before/during sex (past 12 months)
    Yes1092.4 (1.97, 2.9)
    No4,46497.6 (97.1, 98.0)
    HIV testing and counseling practices (n=1,106)
    Number of HIV tests taken
    174667.5 (64.6, 70.2)
    2–34431.1 (28.4, 33.9)
    10–50.5 (0.2, 1.1)
    20–111.0 (0.5, 1.8)
    The last HIV test was in the past
    6 months53148.0 (45.0, 51.0)
    7–12 months14813.4 (11.5, 15.6)
    1–2 years17716.0 (13.9, 18.3)
    ≥2 years25022.6 (20.2, 25.2)
    Ever had HIV self-testing
    Yes36132.6 (29.9, 35.5)
    No74567.4 (64.5, 70.1)
    Reason for not doing HIV self-testing (n=745)
    Unaware of where to obtain HIV self-testing kits
    Yes18625.0 (21.9, 28.3)
    No21328.6 (25.4, 32.0)
    No answer34646.4 (42.8, 50.1)
    Unsure about how to conduct HIV self-testing
    Yes13618.3 (15.6, 21.3)
    No26335.3 (31.9, 38.9)
    No answer34646.4 (42.8, 50.1)
    Distrustful of the result of HIV self-testing
    Yes557.4 (5.7, 9.6)
    No34446.2 (42.6, 49.8)
    No answer34646.4 (42.8, 50.1)
    Unsure about what to do after HIV self-testing
    Yes7510.1 (8.1, 12.5)
    No32443.5 (39.9, 47.1)
    No answer34646.4 (42.8, 50.1)
    Abbreviation: CI=confidence interval; HIV=human immunodeficiency virus.
    Download: CSV

Citation:

通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索
Turn off MathJax
Article Contents

Article Metrics

Article views(5067) PDF downloads(61) Cited by()

Share

Related

HIV-Related Knowledge, Attitude, and Practices Research Among College Students — Six Chinese Cities, 2021

View author affiliations

Summary

What is already known about this topic?

The number of newly diagnosed human immunodeficiency virus (HIV) cases among Chinese youth 15–24 years of age shows an upward trend between 2010 and 2019.

What is added by this report?

This survey is on a larger scale as compared to previous studies. It shows inadequate HIV knowledge — especially on HIV treatment, self-testing, and post-exposure prophylaxis — among college students. A significant gap exists between knowledge and behavior as indicated by the low condom use rate despite a high knowledge level.

What are the implications for public health practice?

Findings suggest priorities for future HIV education and awareness creation of existing services. A low condom use rate at sexual debut suggests that HIV prevention education should start early.

  • 1. National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing Municipality, China
  • 2. Chinese Association of STD and AIDS Prevention and Control, Beijing Municipality, China
  • 3. Beijing Chaoyang Kangzhong Health and Education Center, Beijing Municipality, China
  • 4. Tianjin Center for Disease Control and Prevention, Tianjin Municipality, China
  • 5. Jilin Provincial Center for Disease Control and Prevention, Changchun City, Jilin Province, China
  • 6. Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou City, Zhejiang Province, China
  • 7. Hunan Provincial Center for Disease Control and Prevention, Changsha City, Hunan Province, China
  • 8. Guangdong Provincial Association of STD and AIDS Prevention and Control, Guangzhou City, Guangdong Province, China
  • 9. Chengdu Center for Disease Control and Prevention, Chengdu City, Sichuan Province, China
  • Corresponding author:

    Mengjie Han, mjhan@chinaaids.cn

  • Funding: Provided by the Durex Public Welfare Foundation on college students' AIDS education
  • Online Date: November 25 2022
    Issue Date: November 25 2022
    doi: 10.46234/ccdcw2022.210
  • Globally, around 4,000 new human immunodeficiency virus (HIV) infections occur daily including among 1,100 youth aged 15–24 years (1). In China, newly diagnosed HIV cases among 15–24-year-olds — including young students — increased from 9,373 in 2010 to 15,790 in 2019 (2). To reduce new infections among students, a combination of prevention education and behavioral as well as biomedical interventions was implemented. This implementation calls for a geographically larger-scale study to assess and identify gaps in students’ HIV-related knowledge, attitudes, and practices (KAP). A survey of college students in 6 large cities was thus conducted in 2021, with a total of 54,052 respondents. In addition to finding knowledge gaps on HIV, especially on treatment, HIV self-testing (HIVST) and post-exposure prophylaxis (PEP), significant knowledge and behavior gaps in practicing safe sex were identified. These gaps, coupled with early sexual initiation, suggest that comprehensive prevention education should start early.

    The survey was conducted from September to December 2021 at 30 colleges and universities in 6 large cities (Tianjin Municipality, Changchun City, Hangzhou City, Changsha City, Guangzhou City, and Chengdu City) that rank high in newly identified student infections. Convenience sampling along with a minimum number of classes per grade and a minimum of 600 samples per school was used. A WeChat-based anonymous questionnaire was distributed and accessed by respondents via a quick response (QR) code scan. Each internet protocol (IP) address was set for one enrollment. This structured online questionnaire included both sociodemographic and KAP questions related to HIV. The KAP questions focus on basic HIV information, PEP, HIVST, and sexual experiences. Results were presented with descriptive statistics, including proportions and their 95% confidence intervals (CIs). R software (Version 4.1.3, R Foundation for Statistical Computing, Vienna, Austria) was used for data cleaning and analysis.

    A total of 54,052 valid questionnaires were collected, of which 59.5% (32,178/54,052) were female and 55.9% (30,211/54,052) were freshmen. Regarding sexual orientation, 86.9% (46,985/54,052) reported being heterosexual, whereas 1.7% (930/54,052) and 5.7% (3,058/54,052) reported being homosexual or bisexual, respectively. In addition, 10.0% (5,384/54,052) of respondents reported having had sexual experience, and 0.05% (26/54,052) reported testing positive for HIV in the latest test (Table 1).

    CharacteristicnPercentage (95% CI)
    Sex
    Male21,87440.5 (40.1, 40.9)
    Female32,17859.5 (59.1, 59.9)
    Age (years)
    ≤176821.3 (1.2, 1.4)
    18–11,63521.5 (21.2, 21.9)
    19–19,76136.6 (36.2, 37.0)
    20–11,11820.6 (20.2, 20.9)
    ≥2110,85620.1 (19.7, 20.4)
    School level
    First-tier29,25254.1 (53.7, 54.5)
    Second-tier18,09633.5 (33.1, 33.9)
    Third-tier2,1113.9 (3.7, 4.1)
    Vocational college4,5938.5 (8.3, 8.7)
    City of residence
    Tianjin7,60314.1 (13.8, 14.4)
    Changchun8,76216.2 (15.9, 16.5)
    Hangzhou11,71521.7 (21.3, 22.0)
    Changsha15,13628.0 (27.6, 28.4)
    Guangzhou7,20913.3 (13.1, 13.6)
    Chengdu3,6276.7 (6.5, 6.9)
    Grade
    Freshman30,21155.9 (55.5, 56.3)
    Sophomore12,51623.2 (22.8, 23.5)
    Junior7,50213.9 (13.6, 14.2)
    Senior2,7145.0 (4.8, 5.2)
    Graduate and higher1,1092.1 (1.9, 2.2)
    Sexual orientation
    Heterosexual46,98586.9 (86.6, 87.2)
    Homosexual9301.7 (1.6, 1.8)
    Bisexual3,0585.7 (5.5, 5.9)
    Not sure3,0795.7 (5.5, 5.9)
    Sexual experience
    Yes5,38410.0 (9.7, 10.2)
    No48,66890.0 (89.8, 90.3)
    Self-reported HIV testing result
    Positive260.05 (0.03, 0.07)
    Negative8541.6 (1.5, 1.7)
    Unknown2260.4 (0.4, 0.5)
    Not tested52,94698.0 (97.8, 98.1)
    Abbreviation: CI=confidence interval; HIV=human immunodeficiency virus.

    Table 1.  Sociodemographic characteristics of college students surveyed in 6 Chinese cities, 2021 (N=54,052).

    The survey consisted of 9 questions on basic HIV knowledge. Knowledge of condom use (Q7, Q8, Q9) was relatively high with an over 90% passing rate. Nearly everyone (94.2%; 50,896/54,052) knew that intentional HIV transmission was illegal (Q3). However, as many as 29.0% (15,694/54,052) of respondents did not know that HIV cannot be cured (Q1). Furthermore, 34.9% (18,865/54,052) were unaware that being infected with sexually transmitted diseases (STDs) increases the risk of HIV infection (Q5), and 33.2% (17,940/54,052) were unaware that male homosexual behavior is the main route of HIV transmission among young Chinese students (Q4). Only 64.7% of respondents reported having heard of PEP, but nearly all respondents (91.7%, 49,549/54,052) expressed willingness to take the drug after possible HIV exposure to prevent seroconversion. When asked the multiple-choice question on where to find PEP drugs, the answers were Centers for Disease Control and Prevention (82.3%, 28,773/34,958), hospitals (83.1%, 29,067/34,958), community-based organizations (20.5%, 7,176/34,958), and online purchases (13.6%, 4,746/34,958). Nearly all respondents knew that an HIV test should be taken after risky behaviors (97.5%, 52,697/54,052) to know their status, start treatment, and suppress HIV replication (97.8%, 52,859/54,052). Furthermore, 98.2% (53,082/54,052) indicated that HIV testing could give them peace of mind. However, 37.4% (20,204/54,052) of respondents worry about others’ attitudes, and 19.7% (10,669/54,052) worry about a positive result. Still 57.9% (31,321/54,052) have not heard of HIV self-testing (HIVST) (Table 2).

    CharacteristicnPercentage (95% CI)
    Basic HIV knowledge
    Q1. AIDS cannot be cured
    Yes38,35871.0 (70.6, 71.3)
    No15,69429.0 (28.7, 29.4)
    Q2. A healthy-looking person can have HIV
    Yes47,04687.0 (86.8, 87.3)
    No7,00613.0 (12.7, 13.2)
    Q3. It is illegal to transmit HIV intentionally
    Yes50,89694.2 (94.0, 94.4)
    No3,1565.8 (5.6, 6.0)
    Q4. HIV among young Chinese students is mainly through male homosexual behavior
    Yes36,11266.8 (66.4, 67.2)
    No17,94033.2 (32.8, 33.6)
    Q5. Infection with STDs could increase the risk of HIV infection
    Yes35,18765.1 (64.7, 65.5)
    No18,86534.9 (34.5, 35.3)
    Q6. Substance abuse could increase the risk of HIV infection
    Yes46,00385.1 (84.8, 85.4)
    No8,04914.9 (14.6, 15.2)
    Q7. Proper use of condoms during sex reduces the risk of HIV transmission
    Yes51,12894.6 (94.4, 94.8)
    No2,9245.4 (5.2, 5.6)
    Q8. It is necessary to use condoms even when having sex with acquaintances
    Yes50,19192.9 (92.6, 93.1)
    No3,8617.1 (6.9, 7.4)
    Q9. Condoms should be used even if the genital looks normal
    Yes50,11092.7 (92.5, 92.9)
    No3,9427.3 (7.1, 7.5)
    Knowledge and attitudes toward PEP
    Heard of PEP
    Yes34,95864.7 (64.3, 65.1)
    No19,09435.3 (34.9, 35.7)
    Knowledge on where to get PEP drugs (n=34,958)
    Centers for Disease Control and Prevention
    Yes28,77382.3 (81.9, 82.7)
    No6,18517.7 (17.3, 18.1)
    Hospitals
    Yes29,06783.1 (82.8, 83.5)
    No5,89116.9 (16.5, 17.2)
    Community-based organizations
    Yes7,17620.5 (20.1, 21.0)
    No27,78279.5 (79.0, 79.9)
    Purchase online
    Yes4,74613.6 (13.2, 13.9)
    No30,21286.4 (86.1, 86.8)
    Willing to use PEP after risky behavior
    Yes49,54991.7 (91.4, 91.9)
    No8001.5 (1.4, 1.6)
    Not sure3,7036.9 (6.6, 7.1)
    Knowledge and attitudes toward HIV testing and counseling
    I should seek HIV testing and counseling after risky behavior
    Yes52,69797.5 (97.4, 97.6)
    No1,3552.5 (2.4, 2.6)
    Testing helps me know my status, start early treatment, and suppress HIV replication
    Yes52,85997.8 (97.7, 97.9)
    No1,1932.2 (2.1, 2.3)
    HIV testing gives me peace of mind
    Yes53,08298.2 (98.1, 98.3)
    No9701.8 (1.69, 1.91)
    Worry about others’ attitude after HIV testing
    Yes20,20437.4 (37.0, 37.8)
    No33,84862.6 (62.2, 63.0)
    Worry about positive HIV testing results
    Yes10,66919.7 (19.4, 20.1)
    No43,38380.3 (79.9, 80.6)
    Heard of HIV self-testing
    Yes22,73142.1 (41.6, 42.5)
    No31,32157.9 (57.5, 58.4)
    Abbreviation: AIDS=acquired immunodeficiency syndrome; CI=confidence interval; HIV=human immunodeficiency virus; PEP=post-exposure prophylaxis; STDs=sexually transmitted diseases.

    Table 2.  HIV/AIDS-related knowledge, attitudes of college students surveyed in 6 Chinese cities, 2021 (N=54,052).

    Among those who reported sexual experience, 33.2% (1,790/5,384) first had sex at the age of 18, followed by 22.3% (1,203/5,384) at 17 or below, and 17.4% (937/5,384) at 20. Among the first sexual experiences, 2.2% (116/5,384) were forced sex, 9.1% (489/5,384) were sex between males, and 72.4% (3,896/5,384) were with correct condom use. Among them, 84.9% (4,573/5,384) had sex in the past 12 months, of which 94.2% (4,307/4,573) reported having a fixed partner. Of those with fixed partners, 71.4% (3,076/4,307) reported consistent condom use. However, 29.7% (1,359/4,573) reported casual sex, with 65.5% (890/1,359) reporting consistent condom use. In addition, 15.5% (708/4,573) reported sex with a commercial partner, during which 64.3% (455/708) reported consistent condom use. Furthermore, 2.4% (109/4,573) reported drug use before/during sex. Approximately 6.4% (292/4,573) reported male homosexual intercourse in the past 12 months, of whom 36.0% had a role of either exclusively receptive anal sex (36.0%, 105/292) or mixed receptive and insertive anal sex (34.2%, 100/292). Among them, 42.1% (123/292) reported having more than one homosexual partner in the past 12 months. Overall, only 47.6% (139/292) reported consistent condom use during sex with another male (Table 3).

    CharacteristicnPercentage (95% CI)
    First sex (n=5,384)
    Age at sexual debut (years)
    ≤171,20322.3 (21.2, 23.5)
    18–1,79033.2 (32.0, 34.5)
    19–89716.7 (15.7, 17.7)
    20–93717.4 (16.4, 18.4)
    ≥2155710.3 (9.6, 11.2)
    Forced sex at sexual debut
    Yes1162.2 (1.8, 2.6)
    No5,26897.8 (97.4, 98.2)
    Partner type at sexual debut
    Heterosexual4,89590.9 (90.1, 91.7)
    Homosexual4899.1 (8.33, 9.9)
    Condom use at sexual debut
    None1,14221.2 (20.1, 22.3)
    Incorrect use3466.4 (5.79, 7.12)
    Correct use3,89672.4 (71.1, 73.5)
    Sex behavior (past 12 months; n=4,573)
    Sex with fixed partner (past 12 months)
    Yes4,30794.2 (93.5, 94.8)
    No2665.8 (5.2, 6.5)
    Condom use with fixed sex partner (past 12 months; n=4,307)
    None2886.7 (6.0, 7.5)
    Not consistent use94321.9 (20.7, 23.2)
    Consistent use3,07671.4 (70.0, 72.8)
    Casual sex (past 12 months)
    Yes1,35929.7 (28.4, 31.1)
    No3,21470.3 (68.9, 71.6)
    Condom use with casual sex partner (past 12 months; n=1,359)
    None20415.0 (13.2, 17.0)
    Not consistent use26519.5 (17.4, 21.7)
    Consistent use89065.5 (62.9, 68.0)
    Commercial sex (past 12 months)
    Yes70815.5 (14.5, 16.6)
    No3,86584.5 (83.4, 85.5)
    Condom use with commercial sex partner (past 12 months; n=708)
    None15221.5 (18.5, 24.7)
    Not consistent use10114.3 (11.8, 17.1)
    Consistent use45564.3 (60.6, 67.8)
    Male homosexual behavior (past 12 months)
    Yes2926.4 (5.1, 7.1)
    No4,28193.6 (92.9, 94.3)
    Sex role (past 12 months; n=292)
    Receptive10536.0 (30.5, 41.8)
    Insertive8729.8 (24.7, 35.5)
    Receptive and insertive10034.2 (28.9, 40.0)
    Homosexual sex partner number (past 12 months; n=292)
    116957.9 (52.0, 63.6)
    2–910034.2 (28.9, 40.0)
    10–237.9 (5.2, 11.7)
    Condom use with homosexual partner (past 12 months; n=292)
    None8930.5 (25.3, 36.2)
    Not consistent use6421.9 (17.4, 27.2)
    Consistent use13947.6 (41.8, 53.5)
    Any drug use before/during sex (past 12 months)
    Yes1092.4 (1.97, 2.9)
    No4,46497.6 (97.1, 98.0)
    HIV testing and counseling practices (n=1,106)
    Number of HIV tests taken
    174667.5 (64.6, 70.2)
    2–34431.1 (28.4, 33.9)
    10–50.5 (0.2, 1.1)
    20–111.0 (0.5, 1.8)
    The last HIV test was in the past
    6 months53148.0 (45.0, 51.0)
    7–12 months14813.4 (11.5, 15.6)
    1–2 years17716.0 (13.9, 18.3)
    ≥2 years25022.6 (20.2, 25.2)
    Ever had HIV self-testing
    Yes36132.6 (29.9, 35.5)
    No74567.4 (64.5, 70.1)
    Reason for not doing HIV self-testing (n=745)
    Unaware of where to obtain HIV self-testing kits
    Yes18625.0 (21.9, 28.3)
    No21328.6 (25.4, 32.0)
    No answer34646.4 (42.8, 50.1)
    Unsure about how to conduct HIV self-testing
    Yes13618.3 (15.6, 21.3)
    No26335.3 (31.9, 38.9)
    No answer34646.4 (42.8, 50.1)
    Distrustful of the result of HIV self-testing
    Yes557.4 (5.7, 9.6)
    No34446.2 (42.6, 49.8)
    No answer34646.4 (42.8, 50.1)
    Unsure about what to do after HIV self-testing
    Yes7510.1 (8.1, 12.5)
    No32443.5 (39.9, 47.1)
    No answer34646.4 (42.8, 50.1)
    Abbreviation: CI=confidence interval; HIV=human immunodeficiency virus.

    Table 3.  Sex experience and HIV testing among college students in 6 Chinese cities, 2021 (N=5,384).

    Among all respondents, 1,106 (2.0%, 1,106/54,052) reported ever having had an HIV test, with 67.5% (746/1,106) of them testing only once. Nearly half (48.0%, 531/1,106) had an HIV test in the past 6 months, and 32.6% (361/1,106) have had an HIVST. As for the major reasons for not using HIVST, 25.0% (186/745) did not know where to obtain HIVST kits and 18.3% (136/745) did not know how to conduct an HIVST.

    • The Implementation Plan for the Containment and Control of HIV/AIDS (2019–2022), jointly released by the National Health Commission and nine other ministries and commissions, defines the target HIV knowledge rate among college students at 95% (3). In this survey, some basic HIV knowledge questions scored as low as around 65% (Q4, Q5) and 71% (Q1). While the sample’s high proportion of freshmen may negatively affect HIV knowledge results, HIV knowledge among college students as a whole falls short in both structure and comprehensiveness, as seen in the low-scored questions above. Over 90% of respondents are open to taking PEP to prevent HIV infection after unprotected sex, however, the 64.7% awareness rate and the lack of knowledge of where to find it impede access to PEP. HIVST, given its convenience and confidentiality (4), has been proven as a preferred testing method by college students (5). Additionally, HIVST kits can often be obtained from campus vending machines or online shops (6-7). However, over half of the respondents have not heard of HIVST, suggesting the need for its more prominent role in college prevention education and health services.

      About 10% of respondents reported having had sexual experiences. The mean age for sexual debut was 18.39 years, which is consistent with the results of previous research (8). Among them, 22.3% reported first having sex at 17 or below and 33.2% reported having sex at the age of 18, mostly around a time before entering college or during the freshman year. Early sexual debut is associated with unintended pregnancy, more sexual partners, and unprotected sex (9). Future prevention education should therefore highlight preparedness before sexual debut. The correct condom use rate was low at first sex, and consistent condom use rates were low for sex in the past 12 months. In addition, 292 male respondents reported having sex with another male in the past 12 months, with a low rate of consistent condom use (47.6%). The risks of unprotected sex should thus be discussed in greater depth in prevention education, coupled with condom availability, including for men who have sex with men (MSM). In the present survey, 2.0% of respondents reported having had an HIV test. As voluntary HIV testing becomes a process of education and intervention, promoting HIV testing can add great value, especially for students with sexual experiences.

      The HIV knowledge rate was compared with a previous study conducted in Henan Province (10). The questions with low awareness rates were similar (Q1, Q4). Therefore, this survey can represent both the knowledge gaps of college students and where the gaps are.

      This study has several limitations. First, the self-reported data may lead to underreporting of “not-encouraged behaviors” (i.e., unprotected sex). Second, considering the cross-sectional study design, recall bias may exist on past events. Third, as students from lower grades were over represented, further analysis is needed to factor in grade levels.

      Overall, this survey provided empirical guidance on HIV education among students. First, as over half of respondents with sexual experience reported their first sex at or before age 18 and condom use rate was low, prevention education should begin no later than middle school. Second, the curriculum should be specific about risky sexual behaviors, including unprotected sex between males. Third, college HIV prevention must integrate education with access to services, including those on HIVST and PEP.

    • Dr. Hao Yang, Ms. Wang Xinlun, and Mr. Jacob Wood.

    • No conflicts of interest.

Reference (10)

Citation:

Catalog

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return