The dissociation between condom use knowledge and actual behavior among college students in Guangzhou, China: a...

In the context of the progress made in HIV/AIDS prevention and treatment initiatives, the awareness of HIV/AIDS among Chinese adolescents has been on a steady upward trend. Nevertheless, the number of new HIV infections among college students keeps rising. In recent years, over 95% of newly diagnosed HIV/AIDS cases reported in China have been transmitted via sexual contact. In 2024, 100% of newly diagnosed HIV/AIDS cases in Guangzhou, China, have been sexually transmitted. One of the critical factors is the dissociation between condom use knowledge and actual behavior. That is to say, individuals have a comprehensive understanding of the transmission routes of AIDS, the infection modes, and the risks associated with unprotected sexual behavior, yet their actual sexual behavior goes against their awareness.

A comprehensive investigation was conducted to assess the current situation of the dissociation between condom use knowledge and actual behavior among college students. Moreover, relevant influencing factors were analyzed in great detail to lay a solid foundation for the exploration of highly effective intervention models.

In November 2024, a cross-sectional survey was conducted at 13 universities and colleges in Guangzhou, China. Statistical analyses were performed using SPSS (version 26). A chi-square test and bivariate logistic regression analysis were utilized to compare the differences among respondents with diverse characteristics, and multivariate logistic regression was employed to analyze the primary influencing factors regarding the dissociation between condom use knowledge and actual behavior among college students.

Among the 1,583 sexually experienced respondents, 14.66% utilized condoms. Regarding demographic characteristics, when compared with females who were 22 years old or above, of Han ethnicity, residing in student dormitories, or having average monthly living expenses ranging from 1,000 to 2,000 RMB, males [odds ratio (OR) = 1.525, 95% confidence intervals (CI): 1.131-2.056], individuals aged 18-21 years (OR = 4.199, 95% CI: 1.352-13.045), ethnic minorities (OR = 1.981, 95% CI: 1.179-3.330), those living independently or sharing accommodation with their families (OR = 1.995, 95% CI: 1.286-3.093), or those with average monthly living expenses exceeding 3,000 RMB (OR = 3.470, 95% CI: 1.910-6.305) were more likely to show a dissociation between condom use knowledge and actual behavior among college students. Regarding sexual activity, alcohol consumption, and drug use, comparisons were made with non-homosexual individuals, those who had their first sexual intercourse at an age above 18 years, those who used a condom during their first sexual encounter with someone else, those who had sexual intercourse with only one partner, those with no experience of forced sexual intercourse, those with no casual sexual activities in the past year, those with no commercial sexual intercourse in the past year, or those whose frequency of alcohol consumption in the past three months was less than once a week. Homosexuality (OR = 2.149, 95% CI: 1.077-4.286), an age at first sexual intercourse of 18 or younger (OR = 1.557, 95% CI: 1.106-2.191), failure to use a condom during the first sexual intercourse (OR = 5.257, 95% CI: 3.592-7.693), having a total number of sexual partners ranging from 2 to 5 (OR = 2.356, 95% CI: 1.102-5.036), forced sexual intercourse (OR = 2.307, 95% CI: 1.199-4.436), casual sexual intercourse in the past year (OR = 2.407, 95% CI: 1.631-3.552), commercial sexual intercourse in the past year (OR = 17.885, 95% CI: 5.248-60.952), an alcohol consumption frequency in the past 3 months of at least once a week (OR = 2.140, 95% CI: 1.225-3.727) were more likely to exhibit a dissociation between condom use knowledge and actual behavior among college students. "The object of the first sexual intercourse not being a lover" was an independent protective factor against the dissociation between condom use knowledge and actual behavior (OR = 0.407, 95% CI: 0.197-0.842). When it came to HIV risk perception, related services, and attitudes, compared with statements such as "I don't know anyone with HIV", "I haven't been tested for HIV", "I'll get an HIV test if I engage in risky sexual behaviors", and "I have a high level of HIV-related attitudes", those who say "I know people with HIV (OR = 6.077, 95% CI: 3.220 -11.468)", "I've been tested for HIV (OR = 2.840, 95% CI: 1.981-4.071)", "People who wouldn't or were unsure if they'd get an HIV test after risky sexual behaviors (OR = 2.250, 95% CI: 1.634-3.099)", and "Those with non-high HIV-related attitudes (OR = 1.698, 95% CI: 1.139-2.530)" are more likely to show a disconnect between condom use knowledge and behavior.

This study revealed that nearly 15% of sexually active college students had experiences related to condom use and identified the factors influencing the dissociation between condom use knowledge and actual behavior. It is highly recommended to implement a multi-level intervention strategy targeting high-risk AIDS-related behaviors in order to decrease the incidence of high-risk sexual behaviors among college students.