The prevalence of and factors associated with willingness to utilize HTC service among college students in China

Abstract

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.

Applying the health belief model to identify predictors of self-perceived risk of HIV infection among undergraduates in mainland China

“…Based on a review of prior studies and measures of HBM constructs, twelve independent variables hypothesized to in uence self-perception of HIV risk were identi ed and tested in this study, as illustrated in Figure 1. Consistent with previous studies [20,24,25], a combination of perceived susceptibility to HIV infection (e.g., "A healthy looking person can be HIV positive" [16,20,24]), perceived severity of HIV infection (e.g., "HIV is a highly contagious, incurable disease [16,24,25]), and perceived bene ts of health promoting behaviors (e.g., "Correct and consistent use of condoms during sexual intercourse could reduce the risk of HIV transmission" [16,24,25]) has been termed "HIV-related knowledge", which is measured by the 12-item scale of Yes/No/I do not know questions [24,25]. Stigma and discrimination against people living with HIV, which has been identi ed as a major barrier to HIV prevention, diagnose, care and treatment, was based on the Chinese version of Zelaya's 24-item scale of Yes/No/It depends on the situation statements [24,25].…”

“…The outcome variable for this study is self-perception of HIV risk, measured by asking undergraduates to estimate their risk of acquiring HIV and ve choices were provided: 1=no risk at all, 2=uncertainty, 3=small risk, 4=moderate risk, and 5=high risk [11,24]. Consistent with our previous studies [24,25], perceived risk was treated as a dichotomous variable, which is equal to 0 if undergraduates perceived themselves to have no risk of acquiring HIV infection, and is 1 otherwise.…”

Application of the Chinese version of Zelaya's HIV-related stigma scale to undergraduates in mainland China

“…As described in the background section ( Figure 1), eleven factors previously shown to be associated with stigmatizing attitudes were taken as independent variables. Consistent with our previous study [36], a 12-item scale of Yes/No/I do not know questions (α = 0.75) was used to measure HIV-related knowledge and also dichotomized into high and low based on its median value (median 10 scores).…”

“…Those who answered "yes" were then required to provide information about their unsafe sexual behaviors. In this study, unsafe sex was treated as a dummy variable, which was equal to 1 if respondents had more than two sexual partners (multiple partners) within the past 6 months [36], or had ever had sex with a casual or commercial sex partner [36], or failed to use condoms consistently in every act of sexual intercourse [36], and was 0 otherwise. The respondents were asked for their age, but they were provided with four possible choices:① younger than 18 years old; ②18-25 years old; ③26-29 years old; ④30 years or older.…”

“…While the CVZHSS has been tested and validated successfully for medical college students in Zhejiang province of China and also applied to undergraduates majoring in nursing, medicine and education, its reliability and validity among general college students (including but not limited to college students majoring in medicine, nursing and education) throughout mainland China had not been fully tested prior to the current research. Moreover, eleven factors (See Figure 1), including five socialdemographic characteristics {gender [19], residential areas [19], major [24], age [38], and sexual orientation [38]}, HIV-related knowledge [19], awareness of the national AIDS policy [36], risky sexual behaviors [37], three preventive practices [37] such as having ever being tested for HIV [43], willingness to utilize HIV testing and counselling (HTC) service [37] and perception of HIV risk [36], have previously been studied as correlates of HIV-related stigma. However, these studies usually used bivariate analyses that did not take into account the effects of potential confounders.…”