Differences in HIV-related knowledge, attitudes, and behaviors among men who have sex with men (MSM): comparison between HIV-positive and HIV-negative college students

Zhengwei Jing¹Wenhui Chang²Hongyuan Wang³Chao Zhou⁴Tao Cui³Shiyao Xu³Peng Liao⁵Fei Li³Therese Hesketh^1,6Yan Ning^7*Zhifeng Wang^3,8*

• ¹Hangzhou Medical College, Hangzhou, China
• ²Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, China
• ³Peking University School of Public Health, Beijing, China
• ⁴Chongqing Center for Disease Control and Prevention, Chongqing, China
• ⁵Fudan University School of Public Health, Shanghai, China
• ⁶University College London Institute for Global Health, London, United Kingdom
• ⁷Chinese Center for Health Education, Beijing, China
• ⁸Peking University Health Science Center Center for Health Policy and Technology Assessment, Beijing, China

Objective: This study aimed to compare HIV-related knowledge, attitudes, sexual behaviors, and social networking between MSM college students with and without HIV infection, and to identify associated factors sustaining the high HIV prevalence in this population. Methods: A cross-sectional survey was conducted among 686 HIV-positive and HIV-negative MSM college students recruited from Guangdong, Chongqing, and Shaanxi provinces (January 2019–March 2021) via local Centers for Disease Control institutions and Non-Governmental Organizations. Data were collected through structured face-to-face interviews assessing sociodemographic, HIV knowledge sexual practices, and social behaviors. Comparative analyses utilized t-tests and Barnard/Fisher exact tests (significance: p < 0.05), reporting effect sizes. Results: HIV-positive students were significantly older (median: 23 vs. 22 years; p=0.007, δ=0.14) and more likely to engage in off-campus MSM networking (V=0.20, p<0.001). Overall HIV knowledge awareness was 75.4%. However, it was significantly deficient in recognizing the interconnected epidemic risk between sexually transmitted infections and HIV. HIV-negative students reported higher rates of sexual activity with peers (V=0.28, p < 0.001), favorable attitudes toward one-night stands (V=0.13, p=0.019), and stronger protective practices including disclosing HIV status pre-intercourse (25.2% vs. 9.1%; V=0.21, p < 0.001), consistent condom use with casual partners (87.6% vs. 68.0%; V=0.24, p < 0.001), and with partners met on-line (60.9% vs. 39.9%; V=0.21, p < 0.001). Only 50.6% of online partnerships involved condom consistency. Conclusion: Persisting high HIV incidence among Chinese MSM students suggests deficits in translating HIV knowledge into protective behaviors, notably in on-line partner-seeking contexts. Tailored interventions must address structural vulnerabilities through integrated campus health services and technology-enabled risk-reduction strategies.