Ways of Knowledge Access and Risky Sexual Behaviors Among Young Students: Evidence from a Cross-sectional Study (Preprint)
Authors: Zhang Yun , Jin Jie , Cheng Feng , Zhang Xingliang , Xu Junfang 
Published: November 2024

BACKGROUND

Human Immunodeficiency Virus (HIV) infection continues to pose a significant challenge for young students in China, with most infections resulting from risky sexual behaviors. Transmitting HIV-related knowledge through various knowledge accesses is found to be critical in preventing risky sexual behaviors. Different HIV-related information sources exhibit their unique characteristics, assigning different labels to the nature of information that affects young adults' perception of HIV and sexual behaviors.

OBJECTIVE

This study aimed to examine the relationship between various knowledge accesses and risky behaviors, analyzing the mediating effects of HIV-related knowledge, which are expected to provide evidence for more effective HIV knowledge dissemination and the reduction of risky behaviors among youth.

METHODS

A questionnaire on HIV-related knowledge and behavior of young students was used to conduct the online survey. Knowledge access included school education, mass communication, and interpersonal communication. HIV-related knowledge was categorized into general and prevention knowledge. Risky behavior was defined as having multiple sexual partners or engaging in unprotected sex. Binary logistic regression was used to analyze the relationship between knowledge accesses, HIV-related knowledge and risky behaviors. Multiple mediation models constructed by Process4.1 program were conducted to determine whether the levels of HIV-related knowledge mediated the relationship between knowledge access and risky behavior.

RESULTS

A total of 20,602 young adult respondents participated in the survey, with 9,541 males (46.3%) and 11,061 females (53.7%), averaging 20.14±1.91 years. Mass communication reached 19,030 (92.37%) students; 17,949 (87.12%) participants acquired HIV-related knowledge from school education; 11,274 (54.72%) students accessed knowledge through interpersonal communication. Among the 2,423 students who had sex, 363 (14.98%) had multiple sexual partners and 830 (34.26%) engaged in unprotected sex. School education (OR=0.6, 95%Cl=0.46-0.78), mass communication (OR=0.64, 95%Cl=0.47-0.87) and HIV prevention knowledge (OR=0.79, 95%Cl=0.69-0.9) were negatively associated with multiple sexual partners, while interpersonal communication (OR=1.41, 95%Cl=1.13-1.75) was positively associated. School education (OR=0.75, 95%Cl=0.64-0.91) and HIV prevention knowledge (OR=0.81, 95%Cl=0.73-0.89) were negatively correlated with unprotected sexual behaviors, while interpersonal communication (OR=1.27, 95%Cl=1.09-1.46) and general HIV knowledge (OR=1.17, 95%Cl=1.08-1.28) were significantly positively correlated. The results of the multiple mediation models revealed that knowledge accesses had indirect effects on risky behaviors through prevention knowledge and general knowledge. School education had opposing indirect effects of -0.023 and 0.023 through prevention and general knowledge, leading to a non-significant overall indirect effect. Mass communication showed indirect effects of -0.044 and 0.012, while interpersonal communication demonstrated indirect effects of 0.007 and 0.005 through the same pathways.

CONCLUSIONS

Students who acquire HIV-related knowledge from school education and mass media are less likely to engage in risky behaviors, compared to those who acquire it through interpersonal communication. We should fully leverage the advantages of school education and mass communication, and an emphasis should be placed on prevention knowledge to promote changes in risky behavior. Knowledge access primarily influences risky behaviors by shaping cultural values and behavioral norms, rather than solely transmitting information. To effectively reduce risky behaviors through knowledge enhancement, non-mandatory, voluntary educational approaches are recommended.