BackgroundCollege students in China are emerging as one of the most vulnerable groups to contract HIV, because they are in a sexually active age group and also because of their open attitude toward sex and high risk sexual behaviors. This study aimed to explore the prevalence of willingness among college students to utilize HIV testing and counseling (HTC) service and the factors that may affect willingness, including predisposing, enabling and need factors, based on the Andersen’s behavioral model.MethodsA cross-sectional study was conducted from October 6, 2016 to December 31, 2016 in Hubei University of Science and Technology in China. After signing informed consent, college students completed a self-designed online questionnaire distributed via https://www.wjx.cn/ voluntarily, anonymously and confidentially. Pearson’s chi-square test and Logistic regression models were chosen to analyze the factors associated with willingness to utilize HTC service.ResultsOut of 3314 college students in the sample, 2583 (77.9%) expressed their willingness to utilize HTC service. After adjustment, those with low levels of discrimination towards people living with HIV (PLHIV) (OR = 1.41, 95%CI:1.17–1.68), being more knowledgeable about free HTC service centers (OR = 1.44, 95%CI:1.17–1.77), having recognized the necessity to provide HTC service in the local university (OR = 2.20, 95%CI:1.73–2.80), and having a higher HIV risk perception (OR = 1.64, 95%CI:1.37–1.95) were more willing to utilize HTC service, compared with their respective counterparts.ConclusionsIn order to improve their willingness to utilize HTC service and finally to achieve the goal of zero-AIDS, a comprehensive intervention measure should be taken to publicize HTC service, eliminate stigma and discrimination against PLHIV, recruit and train peer volunteers to serve in the local university, and increase self-perceived risk of HIV infection.

Background Since pre-exposure prophylaxis (PrEP) is mainly prescribed to high-risk uninfected individuals, consistent condom use (CCU) continues to be recommended as an inexpensive, feasible, practical and acceptable way to prevent the general population from acquiring and transmitting HIV through sexual intercourse. The objective of this cross-sectional study was to compare the relative importance of various determinants of CCU among sexually experienced undergraduates in mainland China so as to assess and subsequently to suggest ways to eliminate inequities in its use. Method From September 10, 2018, to January 9, 2019, an anonymous self-administered online questionnaire was voluntarily completed by 12,750 participants distributed across 30 provinces in mainland China (except for Tibet). The present analysis was restricted to 2054 sexually experienced undergraduates. Pearson’s chi-square test and Logistic regression models were chosen to analyze the factors associated with CCU. Results The overall rate of CCU was 61.3% [95% confidence interval (CI) = 59.2–63.4%]. CCU was inequitably distributed since enabling factors exerted greater effects than predisposing and need variables. Compared with heterosexual men, heterosexual women [adjusted odds ratio (AOR) = 0.78, 95% confidence interval (CI):0.64–0.96)], non-heterosexuals men (AOR = 0.64, 95% CI:0.45–0.92) and women (AOR = 0.68, 95% CI:0.47–0.99) were less prone to using condoms consistently. Those with more resources [i.e., higher levels of self- efficacy for condom use (AOR = 2.86, 95% CI:2.35–3.49) and being knowledgeable of the national AIDS policy (AOR = 1.50, 95% CI:1.23–1.82)], and those with lower need for condoms [i.e., late initiation of sexual activity (AOR = 1.34, 95% CI:1.09–1.64) and single sexual partner (AOR = 1.68,95% CI:1.21–2.33)] were more likely to be consistent condom users. Conclusions In order to increase consistency of condom use and simultaneously reduce the remaining inequities, a comprehensive intervention measure should be taken to target heterosexual women, non-heterosexual men and women, and those with higher need for condoms, improve their condom use self- efficacy and raise their awareness of the national AIDS policy.

BackgroundThis cross-sectional study aims to validate the Chinese version of Zelaya’s HIV-related Stigma Scale (CVZHSS) among a large undergraduate sample in mainland China, and apply it to measure the level of different dimensions of stigma and their respective determinants.MethodsFrom September 10, 2018, to January 9, 2019, a total of 10,665 eligible undergraduates conveniently drawn from 30 provinces in mainland China (except for Tibet) completed the self-designed online questionnaire distributed via sojump.com voluntarily, anonymously and confidentially. Both exploratory and confirmatory factor analyses (EFA and CFA) were first performed to test its construct validity, Cronbach’s alpha was then used to assess its internal consistency, and Logistic regression analyses were finally carried out to identify predictors of various dimensions of stigma.ResultsAs expected from the original model, four factors (i.e., “fear of casual transmission”, “moral judgment”, “personal stigma” and “perceived community stigma”) were extracted using principal component analysis with varimax rotation, accounting for 63.26% of the total variance. The CFA further confirmed the four-factor construct (CFI = 0.92, GFI = 0.91, RMSEA = 0.07). In addition, all the four factors demonstrated acceptable internal consistency with Cronbach’s alpha ranging from 0.83 to 0.92. Stigma as measured by “fear of casual transmission” (74.4%), “moral judgement” (61.6%), “personal stigma” (79.0%) and “perceived community stigma”(36.5%) is highly prevalent among undergraduates. Except for non-freshmen, less knowledge about HIV and unsafe sex which were consistently associated with higher levels of stigma in all four dimensions, other eight variables including gender, residential area, major, sexual orientation, having ever being tested perception of HIV risk, willingness to utilize HTC service and awareness of the national AIDS policy played differential roles in affecting different dimensions of stigma.ConclusionsThe CVZHSS is a reliable and valid measurement tool and can be used to identify undergraduates with high levels of stigma. However, the four dimensions (Fear, moral judgement, personal stigma and perceived community stigma) were respectively influenced by different determinants, and thus should be treated independently when designing, implementing and evaluating stigma reduction programs.

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Background HIV counseling and testing (HCT) is provided free of charge on college campuses, but very few studies have examined whether HCT uptake is equitably distributed. This cross-sectional study aimed to compare the relative importance of various determinants of HCT uptake among undergraduates in mainland China so as to assess and subsequently to suggest ways to eliminate inequities in its use, guided by the Andersen’s behavioral model. Methods A total of 10,665 eligible undergraduates were conveniently selected to complete an online survey. Hierarchical logistic regression analyses were performed to identify the factors associated with HCT utilization. Results Only 7.7% of undergraduates had utilized HCT services. HCT uptake was inequitably distributed, since it was mainly determined by predisposing and enabling factors rather than by need factors. Further analysis indicated that HCT uptake was significantly related to two need factors, one enabling factor and six predisposing factors. Those with a higher need [i.e., perceiving themselves to be at higher risk of acquiring HIV infection (AOR = 2.76, 95% CI:2.02–3.78) and engaging in condomless sex (AOR = 1.29, 95% CI:1.00–1.67)] and those with more resources [i.e., being knowledgeable of local AIDS service organization (AOR = 1.59, 95% CI:1.37–1.85)] were more likely to utilize HCT services. Compared to non-heterosexual men, non-heterosexual women (AOR = 0.51, 95% CI:0.37–0.72), heterosexual men (AOR = 0.44, 95% CI:0.33–0.57) and women (AOR = 0.31, 95%CI: 0.24–0.41) were less likely to utilize HCT service. Furthermore, those with more knowledge (AOR = 0.80, 95% CI:0.69–0.94) and taking a positive attitude towards HCT services [i.e, expressing their willingness to utilize HCT services (AOR = 0.68, 95% CI:0.56–0.81) and having recognized the necessity to provide HTC services in the local university (AOR = 0.46, 95% CI:0.36–0.57)] were less likely to utilize HCT services. However, medical students (AOR = 1.34, 95% CI: 1.15–1.56) and non-freshmen (AOR = 1.22, 95% CI:1.03–1.45) were more likely to utilize HCT services. Conclusions To increase HCT uptake and simultaneously reduce the remaining inequities, a comprehensive intervention should be continued to target non-heterosexual men and non- freshmen and those with a higher need for HCT services, conduct health education, improve the availability and accessibility of HIV testing services.