An analysis of HIV-related behaviors and attitudes among college students in eastern China: A cross-sectional study

Recently, human immunodeficiency virus (HIV) infection among young university students has garnered significant global attention. This study aimed to compare the demographics, behaviors, and knowledge of male and female college students, in addition to investigating the self-reported HIV-related behaviors and attitudes of sexually active college students in Zhejiang Province, eastern China. This cross-sectional study was conducted using stratified cluster sampling. A self-developed web-based questionnaire was used to collect demographic and sexual behavior data, and those only sexually active students were analyzed. The χ2 test was then used to compare the characteristics of the participants across different genders. A total of 3873 students who reported engaging in sexual activity were evaluated in this study, representing 12.2% of the total student population. Among them, 2734 were men, accounting for 19.1% of all male students (2734/14,320). Sexually active college students had an average age of 20.18 ± 1.37 years. Significant statistical differences were found between male and female students about age, grade, place of household registration, monthly living cost, family relationships, acquired immunodeficiency syndrome-themed lectures or health education courses, HIV testing publicity, HIV risk self-assessment, voluntary counseling and testing for HIV, acceptance of one-night stands and commercial sex, condom use self-efficacy, and casual sex. The findings highlight significant gender disparities in sexual behaviors and HIV-related awareness among sexually active students, suggesting the need for gender-tailored sexual health education programs that address socioeconomic factors (e.g., household registration disparities) while strengthening condom use self-efficacy interventions, particularly for male students exhibiting higher-risk sexual practices. Sexually active college students displayed high levels of sexual openness and knowledge regarding HIV testing, but low testing rates, condom use, and condom use self-efficacy. In addition, a higher proportion of male students engaged in casual sex.