Knowledge-Behavior Paradox - Highest Knowledge Contributes to Positive Attitude Toward People Living With HIV, But...

In Serbia, the highest incidence rates of sexually transmitted infections (STI) are recorded among young adults. Students enter medical studies with limited knowledge about STIs and HIV because there is an absence of reproductive health education in schools. The study aim was to evaluate the association of HIV and STI-related knowledge with attitudes toward people living with HIV and condom use among medical students.

This cross-sectional study was conducted in the spring of 2023. Medical students in the first and the fifth year at the Belgrade University completed an anonymous online questionnaire about knowledge of HIV/STIs, attitudes toward people living with HIV (PLWH) and condom use. Data were assessed using the adjusted linear, quantile, and logistic regression models.

Overall, 402 students responded (229 in the first and 173 in the fifth year). The total knowledge score was higher among older students (median 12 vs. 9 out of 14, p = 0.001), but no difference in attitudes toward PLWH was observed (12 vs. 12 out of 19, p = 0.128). Knowledge score only at the 90^th percentile was associated with stronger positive attitudes toward PLWH. No difference in condom use at last sexual intercourse was observed (62% in first year vs. 54% in fifth year, p = 0.184). Being female, not being partnered, not practicing anal sex, having some type of sex education, and not binge drinking were associated with condom use at last sexual intercourse.

Only students who had the highest level of knowledge on STIs and HIV were more likely to foster positive attitudes toward PLWH. However, neither high knowledge nor positive attitudes increased condom use. Condom use remains suboptimal among medical students. It is recommended that some forms of informal sex education be introduced to secondary and higher education institutions.