Inequities in the utilization of HIV counseling and testing services among undergraduates in mainland China

Abstract

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.

Acceptance and associated factors of HIV testing among college students in China: A systematic review and meta-analysis

“…In our study, the finding might be explained by the high incidence of sexual behavior and unsafe sexual behavior among male students, and male students have a higher risk perception and behavior initiative [ 55 , 56 ]. Secondly, the medical students were related to higher willingness to HIV testing, which was similar to the other study [ 15 ]. Medical students have more opportunities to receive medical-related information, thereby developing stronger awareness of HIV prevention and treatment.…”

“…For example, a free HIV counseling and testing (HCT) and an anonymous urine self-collection for HIV self-testing (HIVST) are provided on college campuses [ 13 , 14 ]. Unfortunately, due to the lack of HIV testing knowledge, discriminatory attitudes and HIV-related stigma, the utilization rate of these services are low of Chinese college students [ 15 , 16 ].…”

Discordance between perceived risk and actual risky sexual behaviors among undergraduate university students in mainland China: a cross-sectional study

“…In addition, Wechat and Sina Weibo, as the largest social media platforms, were also used to distribute questionnaires to improve sample representativeness. A detailed description of the study design and settings was demonstrated in our previous publications [ 12 , 17 , 18 ].…”

“…The Anderson's Behavioural Model [ 11 ] has been adapted to elucidate the factors contributing to risk discordance. According to this model, the decision to undergo HIV testing is affected by three sets of factors: predisposing, enabling and need characteristics [ 12 ]. Predisposing characteristics include sociodemographics {e.g., gender [ 12 ], sexual orientation [ 12 ], major [ 12 ], grade/age [ 12 , 13 ], race [ 2 ], occupation [ 8 ], age at first sex [ 1 , 8 , 14 ]} and AIDS-related knowledge-attitude-belief -practice (KABP) such as knowledge of HIV transmission [ 1 , 12 ], stigma against people living with HIV (PLHIV) [ 12 ] and prior testing [ 1 ].…”

“…According to this model, the decision to undergo HIV testing is affected by three sets of factors: predisposing, enabling and need characteristics [ 12 ]. Predisposing characteristics include sociodemographics {e.g., gender [ 12 ], sexual orientation [ 12 ], major [ 12 ], grade/age [ 12 , 13 ], race [ 2 ], occupation [ 8 ], age at first sex [ 1 , 8 , 14 ]} and AIDS-related knowledge-attitude-belief -practice (KABP) such as knowledge of HIV transmission [ 1 , 12 ], stigma against people living with HIV (PLHIV) [ 12 ] and prior testing [ 1 ]. Enabling characteristics refer to peer, familial, and social networks and community resources such as condom use self-efficacy [ 15 ], family income [ 12 ], geographic region [ 1 , 14 ], urban or rural area of residence [ 12 , 14 ], availability of local testing center [ 12 , 14 ], and political commitment to HIV/AIDS control [ 14 , 16 ].…”