Factors associated with risk sexual behaviors among sexually active college students in Sichuan, China: a cross- sectional survey

Abstract Background Males account for a significant share of new infections among young people in China. This study aimed to identify the factors associated with risk sexual behaviours, and provide evidence of leverage for effective interventions among male college students. Methods The cross-sectional study was conducted from December 2020 to December 2021 in 16 colleges, located in Sichuan Province, one of the high-risk areas in China. Overall 1640 male college students who reported sexually experienced were analyzed in this study. Multivariable logistic regression analysis was applied to determine factors associated with risk sexual behaviours. Results The average age of included male students was 19.95 ± 1.56. Of them, 27.74% initiated sexual behavior early, and 16.52% did not use condoms at the latest sexual intercourse. Students who were older (age 20-21, AOR=0.43, 95%CI: 0.33-0.55; age≥22, AOR=0.13, 95%CI: 0.08-0.21) (versus age ≤ 19) were less likely to have early sexual debut. The likelihood of engaging in condomless sex at the latest sexual intercourse was lower among male college students who had a senior high school educated mother (vs junior high school and below, AOR=0.47, 95%CI: 0.28-0.80), were knowledgeable about sex and reproductive health (vs unknowledgeable, AOR=0.48, 95%CI: 0.27-0.85), and held a higher level of condom use efficacy confident vs unconfident, AOR=0.50, 95%CI: 0.35-0.71; very confident vs unconfident, AOR=0.26, 95%CI: 0.16-0.42). The odds of condomless sex at the latest sexual intercourse increased among participants reporting perceived risk of HIV infection (vs no, AOR=1.96, 95%CI: 1.27-3.03) and early sexual debut (vs no, AOR=1.61, 95%CI: 1.12-2.32). Conclusion Comprehensive sex education curricula might be an effective approach by emphasizing fundamental sex and reproductive information and empowering students with assertiveness and negotiation skills with regard to condom use during or before college.