HIV/AIDS Knowledge, Attitudes, and Behaviors among Students Men Who Have Sex with Men in Chongqing Universities: A Cross-Sectional Study and Health Education Model Development

HIV/AIDS Knowledge, Attitudes, and Behaviors among Students Men Who Have Sex with Men in Chongqing Universities: A Cross-Sectional Study and Health Education Model Development | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article HIV/AIDS Knowledge, Attitudes, and Behaviors among Students Men Who Have Sex with Men in Chongqing Universities: A Cross-Sectional Study and Health Education Model Development Jingzhi Li, Ju Yan, Yundan Cheng, Xiaoxia Jiang, Jing Zhou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9112875/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : The rising HIV infection rate among Chinese college students, particularly men who have sex with men ( MSM ), is a critical public health concern. University MSM students, with their dual identities as both students and sexual minorities, may have unique cognitive, behavioral, and service needs inadequately addressed by general interventions. This study, conducted in 2025, investigated HIV/AIDS-related knowledge, attitudes, and behaviors ( KAB ) among this population in Chongqing, China, aiming to develop a targeted health education model for university settings. Methods : A cross-sectional survey was conducted with 1,400 MSM students recruited via snowball sampling through online platforms and community-based organizations. An anonymous online questionnaire assessed demographics, HIV/AIDS-related knowledge (13 items), attitudes (13 items), behaviors (3 items), and health education needs (6 items). Chi-square tests, logistic regression, and path analysis were performed. Results : The overall awareness rate of basic HIV knowledge was 78.50%, positive attitudes 49.93%, and high-risk sexual behaviors 64.79%. Misconceptions about non-transmission routes ( e.g., mosquito bites ) were common (~ 70% awareness ). Multivariate analysis identified lower education level, arts/sports majors, non-participation in health education, and reliance on traditional media as significant risk factors for poorer KAB outcomes ( P < 0.05 ). Path analysis validated the knowledge-attitude-behavior model, demonstrating that knowledge reduces high-risk behavior both directly and indirectly through attitudes. Students expressed strong demand for practical prevention information and favored interactive, structured educational formats. Conclusions : High-risk behaviors are prevalent among university MSM students, driven by identifiable and potentially modifiable factors. The validated KAB model provides a theoretical foundation for intervention. We propose a structured, multi-component health education model targeting specific subgroups ( e.g., arts/sports majors ) and integrating digital and formal curricula. Policy Implications : These findings underscore the need for precision health education strategies in university settings. Policymakers should prioritize resource allocation toward high-risk subgroups, mandate structured HIV education within formal curricula, and leverage digital platforms to enhance reach and engagement. Such targeted approaches are essential for reducing HIV transmission among MSM students and achieving national prevention goals. MSM University students HIV/AIDS Knowledge-Attitude-Behavior model Health education Path analysis Targeted intervention Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction HIV/AIDS continues to pose a major global public health challenge [ 1 , 2 ] . In 2022, young people aged 15–24 accounted for approximately one-quarter of new HIV infections in the Asia-Pacific region [ 3 ] . Globally, an estimated 3.1 million adolescents and young people ( 15–24 years ) were living with HIV by 2023 [ 4 ] . Among this age group, MSM are disproportionately affected, exhibiting a notably higher risk of infection [ 5 ] . Surveillance data from 2019 further indicate that MSM represented nearly one-quarter ( 23% ) of all new adult HIV infections worldwide [ 6 ] . Chongqing, a university-dense region in western China, reported a high proportion of MSM among student HIV infections in 2023, with a trend toward younger ages-a pattern underscoring escalating transmission risks in academic settings [ 7 , 8 ] . University students are typically in a sexually active phase, yet often exhibit limited social experience, increasingly open sexual attitudes, and inadequate protective awareness, making them a key population for targeted HIV prevention [ 9 , 10 ] . While substantial research exists on HIV interventions for MSM in the general population, studies focusing specifically on the unique context of university students and developing tailored intervention models remain scarce globally. University-based MSM students occupy dual identities—as both students navigating a formative life stage and as sexual minorities facing potential stigma. This duality may shape distinct cognitive, behavioral, and service-related needs that differ from the general MSM population or non-MSM students. Consequently, there is a pressing need to develop health education strategies that are more targeted, confidential, and accessible for this specific group. Chongqing, a major urban center in western China with a high concentration of universities, provides a valuable setting to investigate these issues and generate insights potentially relevant to similar populations elsewhere. Therefore, this study focuses on MSM students in Chongqing universities. It aims to systematically assess their current HIV/AIDS-related knowledge, attitudes, and behaviors. The study also analyzes the associated influencing factors, identifies gaps and unmet needs in existing health education. Ultimately, it seeks to develop a precision health education model tailored to the university environment. The findings are intended to provide an evidence-based foundation for optimizing HIV prevention strategies for this population, with potential implications for analogous settings. 1. Methods 1.1 Participants The study included 1,400 MSM students in Chongqing universities. Inclusion criteria were: ( 1 ) current enrollment in associate's, bachelor's, master's, and doctoral programs, and ( 2 ) a history of male-to-male sexual activity within the past year. 1.2 Study variables and measurements A self-administered anonymous online questionnaire was distributed via the Wenjuanxing platform ( https://www.wjx.cn ). The questionnaire was piloted and demonstrated good reliability and validity ( Cronbach’s α = 0.728, KMO = 0.719, Bartlett’s test of sphericity P < 0.001 ). It consisted of five domains. These included demographic characteristics, HIV/AIDS-related knowledge ( 13 items ), attitudes ( 13 items ), behaviors ( 3 items ), and health education needs ( 6 items ). Detailed items are listed in Table 1 . Participants scoring ≥ 80% on the knowledge or attitude sections were classified as “knowledgeable” or “holding positive attitudes,” respectively. Those reporting no HIV-related high-risk sexual behavior in the preceding 6 months were defined as having “healthy behavior.” Snowball sampling was used for recruitment, primarily through online social platforms and in collaboration with the community-based organization “Chongqing Yilu Tongxing Working Group” at their VCT sites. All participants completed the questionnaire independently online. Table 1 HIV/AIDS knowledge, attitude, and behavior items among MSM students in Chongqing Domain Item Question HIV/AIDS Knowledge 1 Can AIDS be cured? 2 Can an HIV-infected person be identified by appearance? 3 Does male-to-male sexual behavior increase the risk of HIV transmission? 4 Does having another sexually transmitted infection increase the risk of HIV infection? 5 Does using new-type drugs ( e.g., methamphetamine, ecstasy, ketamine ) increase the risk of HIV infection? 6 Can HIV be transmitted through handshakes? 7 Can HIV be transmitted through hugging? 8 Can HIV be transmitted through mosquito bites? 9 Can HIV be transmitted through social kissing? 10 Can HIV be transmitted through sharing meals? 11 Can correct condom use reduce the risk of HIV infection? 12 Should one seek HIV testing and counseling after engaging in high-risk sexual behavior? 13 Is intentional transmission of AIDS legally punishable? Positive HIV/AIDS Attitudes 1 Is homosexual behavior driven by emotion? 2 Is homosexual behavior driven by curiosity? 3 Is homosexual behavior driven by coercion? 4 Is homosexual behavior driven by seduction? 5 Is it acceptable to have multiple sexual partners at the same time? 6 Would you use apps to find sexual partners? 7 Would you fear and avoid people living with HIV? 8 Would you worry about being infected by people living with HIV? 9 Would you express care for people living with HIV? 10 If you were diagnosed with HIV, would you accept treatment? 11 If you were infected, would you inform your sexual partner? 12 Should condoms be used during every sexual act? 13 Is an HIV test necessary before first sexual intercourse with a new partner? HIV High-Risk Sexual Behaviors 1 In the past six months, have you had multiple sexual partners and not used condoms every time? 2 In the past six months, during male-to-male sexual activity, have you not used condoms every time? 3 In the past six months, have you engaged in commercial sex and not used condoms every time? 1.3 Statistical Analysis Data were entered and managed in Excel 2019 and analyzed using SPSS 23.0. Categorical variables are presented as frequencies and percentages ( % ). Group comparisons were performed with the χ² test. Variables with P < 0.05 in univariate analyses were entered into a multivariate logistic regression model to identify independent influencing factors and key intervention targets. The results were visualized using forest plots and heatmaps. Path analysis was further employed to examine the relationships and pathways among knowledge, attitude, and behavior. This allowed us to test the “knowledge-attitude-behavior” theoretical framework. 2. Results 2.1 Knowledge, Attitudes, and Behaviors A total of 1,515 questionnaires were distributed. 1,400 valid responses were returned, corresponding to an effective response rate of 92.41%. The overall awareness rate of basic HIV/AIDS knowledge among MSM students in Chongqing universities was 78.50% ( 1,099/1,400 ). Respondents demonstrated high awareness (≥ 97% ) of core transmission routes, such as the protective effect of correct condom use and the importance of post-exposure testing. Nevertheless, notable misconceptions persisted regarding non-transmission routes. Specifically, only 77.71% of respondents knew that HIV is not transmitted via mosquito bites, and 79.14% recognized that sharing meals does not transmit HIV ( Fig. 1 ). The overall proportion of respondents holding positive HIV/AIDS-related attitudes was 49.93% ( 699/1,400 ). While the vast majority (≥ 87% ) acknowledged the necessity of condom use and HIV testing, attitudes reflected a pattern of “cognitive-affective dissociation.” Despite clear behavioral intentions, widespread discrimination and fear toward people living with HIV were evident. 63.36% of respondents stated they would not express care for persons with HIV, and 80.64% reported fearing infection from them. Additionally, nearly 90% of respondents attributed homosexual behavior to external factors such as coercion or seduction rather than to emotional or autonomous choice ( 52.79% ) ( Fig. 2 ). The overall incidence of high-risk sexual behaviors was 64.79% ( 907/1,400 ). 55.64% reported having multiple sexual partners without consistent condom use in the past six months, and 53.57% reported not using condoms throughout male-to-male sexual encounters. The incidence of commercial sex was relatively low ( 5.00% ) ( Fig. 3 ). 2.2 Univariate Analysis The χ² test indicated significant differences in HIV/AIDS knowledge awareness rates across educational level, major, grade, monthly expenditure, participation in health education courses, and channels of knowledge acquisition ( P < 0.05 ). Significant variations in positive attitude rates were observed according to educational level, major, participation in health education courses, and HIV/AIDS knowledge level ( P < 0.05 ). Similarly, the incidence of high-risk sexual behavior differed significantly by educational level, major, parental marital status before age 15, participation in health education courses, channels of knowledge acquisition, knowledge awareness, and positive attitude ( P < 0.05 ) ( Fig. 4 ). 2.3 Multivariate Analysis Multiple logistic regression analysis further clarified the independent effects of each factor. Knowledge awareness was positively associated with higher education level ( bachelor’s degree or above, OR = 2.763–4.481 ), participation in health education courses ( OR = 1.519 ), and acquiring HIV-related information through the internet ( OR = 6.635 ), friends/relatives ( OR = 8.607 ), or school courses ( OR = 8.958 ). In contrast, majoring in arts/sports ( OR = 0.053 ) was inversely associated with knowledge awareness compared with medical majors ( Fig. 5 ). Figure 5 Forest plot of multivariate logistic regression analysis of factors associated with HIV/AIDS knowledge awareness Positive attitudes were significantly predicted by knowledge awareness ( OR = 4.319 ), participation in health education courses ( OR = 1.867 ), and acquiring knowledge through school courses ( OR = 6.950 ), whereas arts/sports majors ( OR = 0.405 ) showed lower odds of holding positive attitudes ( Fig. 6 ). Figure 7 Forest plot of multivariate logistic regression analysis of factors associated with HIV/AIDS-related high-risk sexual behaviors 2.4 Path Relationships Based on the “knowledge-attitude-behavior” framework, the path model ( Fig. 8 ) indicated that knowledge exerted both a direct negative effect on high-risk sexual behavior ( β = -0.220, P < 0.01 ) and an indirect effect mediated through positive attitudes. Specifically, each one-standard-deviation increase in knowledge level was associated with a 0.276-standard-deviation rise in positive attitude score. And each one-standard-deviation increase in positive attitude corresponded to a 0.154-standard-deviation decrease in high-risk behavior incidence. These findings confirm that knowledge serves as a key driver for fostering positive attitudes and, in turn, promoting behavioral change. Footnote: ** P < 0.01 Figure 8 Path diagram of HIV/AIDS knowledge, attitudes, and high-risk sexual behaviors 2.5 Status and Needs of Health Education Regarding the perceived reasons for the rising HIV infection rate, several key factors were identified. 70.71% of respondents attributed it to a “lack of sexual health knowledge and insufficient self-protection awareness.” Additionally, 69.93% pointed to “increased unprotected sexual behavior,” while 59.50% cited “complacency or a belief that they would not be infected.” Existing promotional materials were viewed as inadequate primarily because they “reached too limited an audience” ( 59.64% ), “lacked targeting” ( 55.21% ), and “used outdated formats” ( 55.21% ). In terms of knowledge needs, respondents expressed the strongest interest in learning about “methods to prevent infection” ( 82.43% ), “high-risk behaviors associated with HIV transmission” ( 77.71% ), and “information on VCT” ( 70.93% ). With respect to delivery formats, “specialized lectures” ( 59.21% ), “social practice activities ( e.g., animations, short films )” ( 54.07% ), and “compulsory courses” ( 50.21% ) were the most preferred options. Detailed results are presented in Table 2 . Table 2 Current status and needs of HIV/AIDS-related health education among MSM students in Chongqing universities. Item/Category n % Reasons perceived for rising HIV infection rate ( multiple choice ) Some negative external influences 680 48.57 Lack of sexual knowledge and self-protection skills 990 70.71 Lack of awareness about HIV infection risks 971 69.36 Increase in unprotected sexual behavior 979 69.93 Inadequate sexuality and HIV/AIDS education 746 53.29 Non-targeted publicity and education 609 43.50 Complacency ( belief that one will not be infected ) 833 59.50 Poor accessibility of preventive tools ( e.g., condoms, PrEP/PEP ) 581 41.50 Prioritizing sexual pleasure over safety 595 42.50 Engagement in sex work for profit 354 25.29 Perceived shortcomings in current publicity materials ( multiple choice ) Insufficient quantity distributed 664 47.43 Limited reach within the target population 835 59.64 Not sufficiently targeted 773 55.21 Unattractive or outdated format 773 55.21 Limited variety of materials 514 36.71 Inappropriate delivery formats 621 44.36 Superficial content, lacks depth 635 45.36 Knowledge areas respondents wish to learn ( multiple choice ) Voluntary Counseling and Testing ( VCT ) 993 70.93 Methods to prevent STI/HIV infection 1154 82.43 High-risk behaviors for HIV infection 1088 77.71 Indications for STI ( including HIV ) testing 893 63.79 Sexual and reproductive health knowledge 908 64.86 Correct condom use skills 684 48.86 Preferred on-campus publicity formats ( multiple choice ) Special lectures / invited talks 829 59.21 Compulsory courses 703 50.21 Elective courses 620 44.29 Social practice activities ( e.g., animations, short films ) 757 54.07 Peer education 621 44.36 WeChat/QQ groups 523 37.36 Exhibitions ( posters, display windows, website features ) 596 42.57 Hotline counseling 453 32.36 Social media ( Douyin, Kuaishou, Weibo, Xiaohongshu, etc. ) 571 40.79 3. Discussion This study provides a comprehensive assessment of HIV/AIDS-related knowledge, attitudes, and behaviors among MSM students in Chongqing universities, revealing critical gaps and modifiable determinants that inform targeted intervention design. The overall HIV knowledge awareness rate of 78.50%, while comparable to figures from Hunan (76.8%) and a U.S. city (77.2%) [ 11 , 12 ] , remains substantially below the national target of 95% [ 13 , 14 ] . Persistent misconceptions about non-transmission routes—such as mosquito bites (77.71%) and shared meals (79.14%)—highlight the need for more precise health messaging, consistent with findings from other regions [ 15 , 16 ] . The rate of positive attitudes was only 49.93%, with notable internal contradictions. While most participants acknowledged the importance of condom use and testing, over 60% expressed unwillingness to show support for people living with HIV, and nearly 80% feared infection from them. This "cognitive-affective dissociation" reflects deep-seated stigma [ 17 , 18 ] that must be addressed alongside knowledge deficits. The high incidence of high-risk sexual behaviors (64.79%), closely linked to inconsistent condom use with multiple partners [ 19 ] , underscores a persistent knowledge-attitude-behavior gap that urgently requires intervention [ 20 , 21 ] . Multivariate analysis identified several modifiable determinants of KAB outcomes. Lower education level, arts/sports majors, non-participation in health education, and reliance on traditional media were consistently associated with poorer knowledge, less positive attitudes, and higher risk behaviors [ 22 – 24 ] . Notably, students in associate degree programs exhibited particularly low knowledge and attitude scores, likely due to limited exposure to structured health education [ 25 ] . Arts/sports majors emerged as a distinct high-risk subgroup, potentially due to higher sexual activity levels and less systematic health curricula compared to medical students, whose training provides comprehensive understanding of disease mechanisms [ 26 , 27 ] . Students from remarried families also showed elevated risk, suggesting that family structure may influence behavioral patterns. This finding warrants further qualitative investigation. Grade-level differences were also evident. First-year students demonstrated significantly lower knowledge than upper-year counterparts, reflecting fewer opportunities for campus-based HIV education. This finding underscores the importance of sustained health promotion during key educational transitions, including junior high, senior high, and university entry [ 27 , 28 ] . Encouragingly, participation in health education courses was associated with significantly higher knowledge and more positive attitudes [ 22 , 29 ] , confirming the value of structured programs in shaping KAB outcomes. Path analysis validated the knowledge-attitude-behavior model in this population, demonstrating that knowledge exerts both direct and indirect effects—mediated by attitude—on reducing high-risk behavior [ 30 – 32 ] . This theoretical confirmation implies that interventions must go beyond information dissemination to actively shape attitudes if behavioral change is to be achieved. The model's applicability suggests that strategies effective in this context may be transferable to similar populations elsewhere. Students' perceptions of existing health education further inform intervention design. Most attributed rising infection rates to knowledge deficits and unprotected sex, and nearly 60% cited complacency. This recognition aligns with Bandura's social cognitive theory linking knowledge, self-efficacy, and behavior [ 33 ] . Current materials were criticized for limited reach, lack of targeting, and outdated formats, pointing to the need for improved accessibility and presentation. Content preferences centered on practical prevention methods, high-risk behaviors, and VCT services, indicating a demand for actionable information. Delivery format preferences—special lectures, social practice activities (e.g., animations, short films), and compulsory courses—reflect an inclination toward interactive, experiential, and structured learning. While this contrasts with some studies favoring purely online information seeking [ 34 ] , it highlights a desire for credible, systematic education within the university environment. Accordingly, a blended model integrating formal curricula with digital platforms and peer-led activities is recommended [ 23 ] . This study has several limitations. Data on sensitive behaviors were collected retrospectively and may be subject to recall bias. The cross-sectional design precludes causal inferences, and the single-region focus limits generalizability, though the identified risk patterns and theoretical framework may offer insights for analogous settings. 4. Conclusions In summary, this study provides a comprehensive analysis of the HIV/AIDS-related knowledge, attitudes, and behaviors among a large sample of MSM students in Chongqing universities, revealing a significant prevalence of high-risk behaviors and distinct gaps in the KAB continuum. The empirical validation of the KAB model and the identification of specific, high-priority subgroups—arts/sports majors, students from remarried families, and those with lower education levels—provide a strong theoretical and practical foundation for precision intervention. We propose implementing a structured, multi-component health education model that is: (1) targeted, focusing on the unique needs and risk profiles of identified subgroups; (2) blended, integrating formal curricula with digital platforms and experiential activities; and (3) action-oriented, explicitly aiming to improve condom accessibility, usage skills, and consistent adherence. While derived from a single region, the conceptual framework and identified risk patterns hold potential relevance for university settings globally seeking to enhance HIV prevention for MSM students. Future research should explore the transferability of this model and delve deeper into the sociocultural drivers of risk in different contexts. Declarations Funding This study was funded by the 2023 Banan District Science and Health Joint Medical Research Project ( Grant No. BNWJ202300130 ). The funding bodies had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Competing interests The authors declare that they have no competing interests. Availability of data and material The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Code availability Not applicable. Ethics approval and consent to participate This study was approved by the Institutional Review Board of the Banan District Center for Disease Control and Prevention ( Chongqing, China ). This study was conducted in accordance with the Declaration of Helsinki. The first page of the online questionnaire clearly explained the purpose and procedures of the study, the potential benefits and risks for participants, and their right to decline participation. Submission of the completed online questionnaire was therefore regarded as providing informed consent. The Institutional Review Board approved this procedure of assumed consent upon receipt of the questionnaires. To ensure data confidentiality, a confidentiality agreement was signed between the principal investigators and the platform provider, Wenjuanxing, to protect all online data. Consent for publication Not applicable. This manuscript does not contain any individual person's data in any form (including individual details, images, or videos). Author Contribution LJZ, YJ, and CYD were responsible for the study conception, design, and funding acquisition. LJZ and CYD contributed to data collection. LJZ, JXX, and ZJ performed the data analysis. LJZ, CYD, JXX, and ZJ drafted the manuscript. YJ reviewed and revised the manuscript. All authors read and approved the final manuscript. References Thornton, J. (2022). Botswana's HIV/AIDS success. Lancet , 400 (10351), 480–481. Dwyer-Lindgren, L., Cork, M. A., Sligar, A., Steuben, K. M., et al. (2019). 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9112875","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617339954,"identity":"80f83aa7-eae7-437f-b2f1-6a7515a31808","order_by":0,"name":"Jingzhi Li","email":"","orcid":"","institution":"Department of Disease Prevention and Control Center, Chongqing Banan District","correspondingAuthor":false,"prefix":"","firstName":"Jingzhi","middleName":"","lastName":"Li","suffix":""},{"id":617339962,"identity":"0e064641-d525-41ec-a1f8-50e937765c40","order_by":1,"name":"Ju Yan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYBACfmbmgw8SDP7x8LM3EKlFsp0t2eBDwQEZyZ4DRGoxOM9jJjnjwwEbgxsJxNrSzGNszGNwh8fg5uONNxhqbKIJauFnZit8zGPwjEfydlqxBcOxtNwGwrYwbwbawszDdzvHTIKx4TBhLQaHGcykQVoYbp4hWgsL0PsGh3kEbvAQqUWyGRTIBmk8kj1AvyQQ4xd+/sPAqPxjY8/PfnjjjQ81NoS1oDhSIoEU5RAtpOoYBaNgFIyCkQEAexw+VlDs1rkAAAAASUVORK5CYII=","orcid":"","institution":"Department of Disease Prevention and Control Center, Chongqing Banan District","correspondingAuthor":true,"prefix":"","firstName":"Ju","middleName":"","lastName":"Yan","suffix":""},{"id":617339969,"identity":"56191eae-b85e-428e-91aa-f4e350dbc6df","order_by":2,"name":"Yundan Cheng","email":"","orcid":"","institution":"Department of Disease Prevention and Control Center, Chongqing Banan District","correspondingAuthor":false,"prefix":"","firstName":"Yundan","middleName":"","lastName":"Cheng","suffix":""},{"id":617339970,"identity":"22af83b8-2541-47ba-a535-797211f5cdca","order_by":3,"name":"Xiaoxia Jiang","email":"","orcid":"","institution":"Department of Disease Prevention and Control Center, Chongqing Banan District","correspondingAuthor":false,"prefix":"","firstName":"Xiaoxia","middleName":"","lastName":"Jiang","suffix":""},{"id":617339977,"identity":"89dd17f8-e516-4705-9627-e8dee3656a25","order_by":4,"name":"Jing Zhou","email":"","orcid":"","institution":"Department of Disease Prevention and Control Center, Chongqing Banan District","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2026-03-13 09:24:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9112875/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9112875/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106746468,"identity":"914f667a-b9e6-4f1a-9238-2d75647dd353","added_by":"auto","created_at":"2026-04-13 05:46:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23708,"visible":true,"origin":"","legend":"\u003cp\u003eHIV/AIDS knowledge awareness rate among participants\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-9112875/v1/85df34825c7c7c41eccd67d5.png"},{"id":106746474,"identity":"102a730c-f637-4e81-957c-c328a82faf07","added_by":"auto","created_at":"2026-04-13 05:46:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23607,"visible":true,"origin":"","legend":"\u003cp\u003ePositive attitude rate towards HIV/AIDS among participants\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-9112875/v1/827e1301034110d7296f6c6a.png"},{"id":106746469,"identity":"5841bf05-fb17-4767-8c12-c4781dbc0889","added_by":"auto","created_at":"2026-04-13 05:46:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":9647,"visible":true,"origin":"","legend":"\u003cp\u003eIncidence rate of high-risk sexual behaviors related to HIV/AIDS among participants\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-9112875/v1/2e76f3b3fc78a5dbe54f1c6a.png"},{"id":106959934,"identity":"516921a0-b226-4756-ab2f-7e67ffd96c5e","added_by":"auto","created_at":"2026-04-15 09:17:15","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":40694,"visible":true,"origin":"","legend":"\u003cp\u003eHeatmap of univariate analysis for factors associated with knowledge, attitudes, and behaviors\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-9112875/v1/210696ca43a372e6b8e877f2.png"},{"id":106993971,"identity":"13bb9de9-c946-40b4-a0c4-976f0ab2dd85","added_by":"auto","created_at":"2026-04-15 15:01:17","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":77070,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of multivariate logistic regression analysis\u003c/p\u003e\n\u003cp\u003eof factors associated with HIV/AIDS knowledge awareness\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-9112875/v1/70cbedc627059050baa28478.png"},{"id":106746472,"identity":"7e9d60d6-c827-4a94-83c4-53edc0117e02","added_by":"auto","created_at":"2026-04-13 05:46:44","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":66812,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of multivariate logistic regression analysis of factors associated with positive attitudes towards HIV/AIDS\u003c/p\u003e","description":"","filename":"image6.png","url":"https://assets-eu.researchsquare.com/files/rs-9112875/v1/b22709a2892afa68e1630ecc.png"},{"id":106746473,"identity":"006e28d6-e8e3-418a-ab8c-ec43e075726f","added_by":"auto","created_at":"2026-04-13 05:46:44","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":84021,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of multivariate logistic regression analysis of\u003c/p\u003e\n\u003cp\u003efactors associated with HIV/AIDS-related high-risk sexual behaviors\u003c/p\u003e","description":"","filename":"image7.png","url":"https://assets-eu.researchsquare.com/files/rs-9112875/v1/4409271748bf5b3d9e0d389e.png"},{"id":106996794,"identity":"9058213e-f9ac-4aa6-bee9-d91b77132e58","added_by":"auto","created_at":"2026-04-15 15:31:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":992652,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9112875/v1/87cfda3f-6a9e-4f6a-9331-db543a9ae98c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"HIV/AIDS Knowledge, Attitudes, and Behaviors among Students Men Who Have Sex with Men in Chongqing Universities: A Cross-Sectional Study and Health Education Model Development","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHIV/AIDS continues to pose a major global public health challenge\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. In 2022, young people aged 15\u0026ndash;24 accounted for approximately one-quarter of new HIV infections in the Asia-Pacific region\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Globally, an estimated 3.1\u0026nbsp;million adolescents and young people ( 15\u0026ndash;24 years ) were living with HIV by 2023\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Among this age group, MSM are disproportionately affected, exhibiting a notably higher risk of infection\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Surveillance data from 2019 further indicate that MSM represented nearly one-quarter ( 23% ) of all new adult HIV infections worldwide\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Chongqing, a university-dense region in western China, reported a high proportion of MSM among student HIV infections in 2023, with a trend toward younger ages-a pattern underscoring escalating transmission risks in academic settings\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. University students are typically in a sexually active phase, yet often exhibit limited social experience, increasingly open sexual attitudes, and inadequate protective awareness, making them a key population for targeted HIV prevention\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. While substantial research exists on HIV interventions for MSM in the general population, studies focusing specifically on the unique context of university students and developing tailored intervention models remain scarce globally. University-based MSM students occupy dual identities\u0026mdash;as both students navigating a formative life stage and as sexual minorities facing potential stigma. This duality may shape distinct cognitive, behavioral, and service-related needs that differ from the general MSM population or non-MSM students. Consequently, there is a pressing need to develop health education strategies that are more targeted, confidential, and accessible for this specific group. Chongqing, a major urban center in western China with a high concentration of universities, provides a valuable setting to investigate these issues and generate insights potentially relevant to similar populations elsewhere.\u003c/p\u003e \u003cp\u003eTherefore, this study focuses on MSM students in Chongqing universities. It aims to systematically assess their current HIV/AIDS-related knowledge, attitudes, and behaviors. The study also analyzes the associated influencing factors, identifies gaps and unmet needs in existing health education. Ultimately, it seeks to develop a precision health education model tailored to the university environment. The findings are intended to provide an evidence-based foundation for optimizing HIV prevention strategies for this population, with potential implications for analogous settings.\u003c/p\u003e"},{"header":"1. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Participants\u003c/h2\u003e \u003cp\u003eThe study included 1,400 MSM students in Chongqing universities. Inclusion criteria were: ( 1 ) current enrollment in associate's, bachelor's, master's, and doctoral programs, and ( 2 ) a history of male-to-male sexual activity within the past year.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Study variables and measurements\u003c/h2\u003e \u003cp\u003eA self-administered anonymous online questionnaire was distributed via the Wenjuanxing platform ( \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wjx.cn\u003c/span\u003e\u003cspan address=\"https://www.wjx.cn\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e ). The questionnaire was piloted and demonstrated good reliability and validity ( Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.728, KMO\u0026thinsp;=\u0026thinsp;0.719, Bartlett\u0026rsquo;s test of sphericity \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 ). It consisted of five domains. These included demographic characteristics, HIV/AIDS-related knowledge ( 13 items ), attitudes ( 13 items ), behaviors ( 3 items ), and health education needs ( 6 items ). Detailed items are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Participants scoring\u0026thinsp;\u0026ge;\u0026thinsp;80% on the knowledge or attitude sections were classified as \u0026ldquo;knowledgeable\u0026rdquo; or \u0026ldquo;holding positive attitudes,\u0026rdquo; respectively. Those reporting no HIV-related high-risk sexual behavior in the preceding 6 months were defined as having \u0026ldquo;healthy behavior.\u0026rdquo;\u003c/p\u003e \u003cp\u003eSnowball sampling was used for recruitment, primarily through online social platforms and in collaboration with the community-based organization \u0026ldquo;Chongqing Yilu Tongxing Working Group\u0026rdquo; at their VCT sites. All participants completed the questionnaire independently online.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHIV/AIDS knowledge, attitude, and behavior items among MSM students in Chongqing\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV/AIDS Knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCan AIDS be cured?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCan an HIV-infected person be identified by appearance?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoes male-to-male sexual behavior increase the risk of HIV transmission?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoes having another sexually transmitted infection increase the risk of HIV infection?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoes using new-type drugs ( e.g., methamphetamine, ecstasy, ketamine ) increase the risk of HIV infection?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCan HIV be transmitted through handshakes?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCan HIV be transmitted through hugging?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCan HIV be transmitted through mosquito bites?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCan HIV be transmitted through social kissing?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCan HIV be transmitted through sharing meals?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCan correct condom use reduce the risk of\u0026nbsp; HIV infection?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eShould one seek HIV testing and counseling after engaging in high-risk sexual behavior?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIs intentional transmission of AIDS legally punishable?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive HIV/AIDS Attitudes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIs homosexual behavior driven by emotion?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIs homosexual behavior driven by curiosity?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIs homosexual behavior driven by coercion?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIs homosexual behavior driven by seduction?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIs it acceptable to have multiple sexual partners at the same time?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWould you use apps to find sexual partners?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWould you fear and avoid people living with HIV?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWould you worry about being infected by people living with HIV?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWould you express care for people living with HIV?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIf you were diagnosed with HIV, would you accept treatment?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIf you were infected, would you inform your sexual partner?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eShould condoms be used during every sexual act?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIs an HIV test necessary before first sexual intercourse with a new partner?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV High-Risk Sexual Behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn the past six months, have you had multiple sexual partners and not used condoms every time?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn the past six months, during male-to-male sexual activity, have you not used condoms every time?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn the past six months, have you engaged in commercial sex and not used condoms every time?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Statistical Analysis\u003c/h2\u003e \u003cp\u003eData were entered and managed in Excel 2019 and analyzed using SPSS 23.0. Categorical variables are presented as frequencies and percentages ( % ). Group comparisons were performed with the χ\u0026sup2; test. Variables with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in univariate analyses were entered into a multivariate logistic regression model to identify independent influencing factors and key intervention targets. The results were visualized using forest plots and heatmaps. Path analysis was further employed to examine the relationships and pathways among knowledge, attitude, and behavior. This allowed us to test the \u0026ldquo;knowledge-attitude-behavior\u0026rdquo; theoretical framework.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Knowledge, Attitudes, and Behaviors\u003c/h2\u003e \u003cp\u003eA total of 1,515 questionnaires were distributed. 1,400 valid responses were returned, corresponding to an effective response rate of 92.41%. The overall awareness rate of basic HIV/AIDS knowledge among MSM students in Chongqing universities was 78.50% ( 1,099/1,400 ). Respondents demonstrated high awareness (\u0026ge;\u0026thinsp;97% ) of core transmission routes, such as the protective effect of correct condom use and the importance of post-exposure testing. Nevertheless, notable misconceptions persisted regarding non-transmission routes. Specifically, only 77.71% of respondents knew that HIV is not transmitted via mosquito bites, and 79.14% recognized that sharing meals does not transmit HIV ( Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e ).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe overall proportion of respondents holding positive HIV/AIDS-related attitudes was 49.93% ( 699/1,400 ). While the vast majority (\u0026ge;\u0026thinsp;87% ) acknowledged the necessity of condom use and HIV testing, attitudes reflected a pattern of \u0026ldquo;cognitive-affective dissociation.\u0026rdquo; Despite clear behavioral intentions, widespread discrimination and fear toward people living with HIV were evident. 63.36% of respondents stated they would not express care for persons with HIV, and 80.64% reported fearing infection from them. Additionally, nearly 90% of respondents attributed homosexual behavior to external factors such as coercion or seduction rather than to emotional or autonomous choice ( 52.79% ) ( Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e ).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe overall incidence of high-risk sexual behaviors was 64.79% ( 907/1,400 ). 55.64% reported having multiple sexual partners without consistent condom use in the past six months, and 53.57% reported not using condoms throughout male-to-male sexual encounters. The incidence of commercial sex was relatively low ( 5.00% ) ( Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e ).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Univariate Analysis\u003c/h2\u003e \u003cp\u003eThe χ\u0026sup2; test indicated significant differences in HIV/AIDS knowledge awareness rates across educational level, major, grade, monthly expenditure, participation in health education courses, and channels of knowledge acquisition ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ). Significant variations in positive attitude rates were observed according to educational level, major, participation in health education courses, and HIV/AIDS knowledge level ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ). Similarly, the incidence of high-risk sexual behavior differed significantly by educational level, major, parental marital status before age 15, participation in health education courses, channels of knowledge acquisition, knowledge awareness, and positive attitude ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ) ( Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e ).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Multivariate Analysis\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMultiple logistic regression analysis further clarified the independent effects of each factor. Knowledge awareness was positively associated with higher education level ( bachelor\u0026rsquo;s degree or above, OR\u0026thinsp;=\u0026thinsp;2.763\u0026ndash;4.481 ), participation in health education courses ( OR\u0026thinsp;=\u0026thinsp;1.519 ), and acquiring HIV-related information through the internet ( OR\u0026thinsp;=\u0026thinsp;6.635 ), friends/relatives ( OR\u0026thinsp;=\u0026thinsp;8.607 ), or school courses ( OR\u0026thinsp;=\u0026thinsp;8.958 ). In contrast, majoring in arts/sports ( OR\u0026thinsp;=\u0026thinsp;0.053 ) was inversely associated with knowledge awareness compared with medical majors ( Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e5\u003c/span\u003e ).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e5\u003c/span\u003e Forest plot of multivariate logistic regression analysis\u003c/p\u003e \u003cp\u003eof factors associated with HIV/AIDS knowledge awareness\u003c/p\u003e \u003cp\u003ePositive attitudes were significantly predicted by knowledge awareness ( OR\u0026thinsp;=\u0026thinsp;4.319 ), participation in health education courses ( OR\u0026thinsp;=\u0026thinsp;1.867 ), and acquiring knowledge through school courses ( OR\u0026thinsp;=\u0026thinsp;6.950 ), whereas arts/sports majors ( OR\u0026thinsp;=\u0026thinsp;0.405 ) showed lower odds of holding positive attitudes ( Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e6\u003c/span\u003e ).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e7\u003c/span\u003e Forest plot of multivariate logistic regression analysis of\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003efactors associated with HIV/AIDS-related high-risk sexual behaviors\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Path Relationships\u003c/h2\u003e \u003cp\u003eBased on the \u0026ldquo;knowledge-attitude-behavior\u0026rdquo; framework, the path model ( Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e8\u003c/span\u003e ) indicated that knowledge exerted both a direct negative effect on high-risk sexual behavior ( β = -0.220, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 ) and an indirect effect mediated through positive attitudes. Specifically, each one-standard-deviation increase in knowledge level was associated with a 0.276-standard-deviation rise in positive attitude score. And each one-standard-deviation increase in positive attitude corresponded to a 0.154-standard-deviation decrease in high-risk behavior incidence. These findings confirm that knowledge serves as a key driver for fostering positive attitudes and, in turn, promoting behavioral change.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFootnote: ** \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e8\u003c/span\u003e Path diagram of HIV/AIDS knowledge, attitudes, and high-risk sexual behaviors\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Status and Needs of Health Education\u003c/h2\u003e \u003cp\u003eRegarding the perceived reasons for the rising HIV infection rate, several key factors were identified. 70.71% of respondents attributed it to a \u0026ldquo;lack of sexual health knowledge and insufficient self-protection awareness.\u0026rdquo; Additionally, 69.93% pointed to \u0026ldquo;increased unprotected sexual behavior,\u0026rdquo; while 59.50% cited \u0026ldquo;complacency or a belief that they would not be infected.\u0026rdquo; Existing promotional materials were viewed as inadequate primarily because they \u0026ldquo;reached too limited an audience\u0026rdquo; ( 59.64% ), \u0026ldquo;lacked targeting\u0026rdquo; ( 55.21% ), and \u0026ldquo;used outdated formats\u0026rdquo; ( 55.21% ). In terms of knowledge needs, respondents expressed the strongest interest in learning about \u0026ldquo;methods to prevent infection\u0026rdquo; ( 82.43% ), \u0026ldquo;high-risk behaviors associated with HIV transmission\u0026rdquo; ( 77.71% ), and \u0026ldquo;information on VCT\u0026rdquo; ( 70.93% ). With respect to delivery formats, \u0026ldquo;specialized lectures\u0026rdquo; ( 59.21% ), \u0026ldquo;social practice activities ( e.g., animations, short films )\u0026rdquo; ( 54.07% ), and \u0026ldquo;compulsory courses\u0026rdquo; ( 50.21% ) were the most preferred options. Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026nbsp;Current status and needs of HIV/AIDS-related health education among MSM students in Chongqing universities.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem/Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eReasons perceived for rising HIV infection rate ( multiple choice )\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSome negative external influences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of sexual knowledge and self-protection skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of awareness about HIV infection risks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncrease in unprotected sexual behavior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate sexuality and HIV/AIDS education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-targeted publicity and education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplacency ( belief that one will not be infected )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor accessibility of preventive tools ( e.g., condoms, PrEP/PEP )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrioritizing sexual pleasure over safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEngagement in sex work for profit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePerceived shortcomings in current publicity materials ( multiple choice )\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient quantity distributed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimited reach within the target population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot sufficiently targeted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnattractive or outdated format\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimited variety of materials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInappropriate delivery formats\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperficial content, lacks depth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eKnowledge areas respondents wish to learn ( multiple choice )\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVoluntary Counseling and Testing ( VCT )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethods to prevent STI/HIV infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh-risk behaviors for HIV infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndications for STI ( including HIV ) testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual and reproductive health knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e908\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorrect condom use skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePreferred on-campus publicity formats ( multiple choice )\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecial lectures / invited talks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompulsory courses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElective courses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial practice activities ( e.g., animations, short films )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeer education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeChat/QQ groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExhibitions ( posters, display windows, website features )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHotline counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial media ( Douyin, Kuaishou, Weibo, Xiaohongshu, etc. )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThis study provides a comprehensive assessment of HIV/AIDS-related knowledge, attitudes, and behaviors among MSM students in Chongqing universities, revealing critical gaps and modifiable determinants that inform targeted intervention design. The overall HIV knowledge awareness rate of 78.50%, while comparable to figures from Hunan (76.8%) and a U.S. city (77.2%)\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, remains substantially below the national target of 95%\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Persistent misconceptions about non-transmission routes\u0026mdash;such as mosquito bites (77.71%) and shared meals (79.14%)\u0026mdash;highlight the need for more precise health messaging, consistent with findings from other regions\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe rate of positive attitudes was only 49.93%, with notable internal contradictions. While most participants acknowledged the importance of condom use and testing, over 60% expressed unwillingness to show support for people living with HIV, and nearly 80% feared infection from them. This \"cognitive-affective dissociation\" reflects deep-seated stigma\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e that must be addressed alongside knowledge deficits. The high incidence of high-risk sexual behaviors (64.79%), closely linked to inconsistent condom use with multiple partners\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, underscores a persistent knowledge-attitude-behavior gap that urgently requires intervention\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMultivariate analysis identified several modifiable determinants of KAB outcomes. Lower education level, arts/sports majors, non-participation in health education, and reliance on traditional media were consistently associated with poorer knowledge, less positive attitudes, and higher risk behaviors\u003csup\u003e[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Notably, students in associate degree programs exhibited particularly low knowledge and attitude scores, likely due to limited exposure to structured health education\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Arts/sports majors emerged as a distinct high-risk subgroup, potentially due to higher sexual activity levels and less systematic health curricula compared to medical students, whose training provides comprehensive understanding of disease mechanisms\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Students from remarried families also showed elevated risk, suggesting that family structure may influence behavioral patterns. This finding warrants further qualitative investigation.\u003c/p\u003e \u003cp\u003eGrade-level differences were also evident. First-year students demonstrated significantly lower knowledge than upper-year counterparts, reflecting fewer opportunities for campus-based HIV education. This finding underscores the importance of sustained health promotion during key educational transitions, including junior high, senior high, and university entry\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Encouragingly, participation in health education courses was associated with significantly higher knowledge and more positive attitudes\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e, confirming the value of structured programs in shaping KAB outcomes.\u003c/p\u003e \u003cp\u003ePath analysis validated the knowledge-attitude-behavior model in this population, demonstrating that knowledge exerts both direct and indirect effects\u0026mdash;mediated by attitude\u0026mdash;on reducing high-risk behavior\u003csup\u003e[\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. This theoretical confirmation implies that interventions must go beyond information dissemination to actively shape attitudes if behavioral change is to be achieved. The model's applicability suggests that strategies effective in this context may be transferable to similar populations elsewhere.\u003c/p\u003e \u003cp\u003eStudents' perceptions of existing health education further inform intervention design. Most attributed rising infection rates to knowledge deficits and unprotected sex, and nearly 60% cited complacency. This recognition aligns with Bandura's social cognitive theory linking knowledge, self-efficacy, and behavior\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. Current materials were criticized for limited reach, lack of targeting, and outdated formats, pointing to the need for improved accessibility and presentation. Content preferences centered on practical prevention methods, high-risk behaviors, and VCT services, indicating a demand for actionable information. Delivery format preferences\u0026mdash;special lectures, social practice activities (e.g., animations, short films), and compulsory courses\u0026mdash;reflect an inclination toward interactive, experiential, and structured learning. While this contrasts with some studies favoring purely online information seeking\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e, it highlights a desire for credible, systematic education within the university environment. Accordingly, a blended model integrating formal curricula with digital platforms and peer-led activities is recommended\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study has several limitations. Data on sensitive behaviors were collected retrospectively and may be subject to recall bias. The cross-sectional design precludes causal inferences, and the single-region focus limits generalizability, though the identified risk patterns and theoretical framework may offer insights for analogous settings.\u003c/p\u003e"},{"header":"4. Conclusions","content":"\u003cp\u003eIn summary, this study provides a comprehensive analysis of the HIV/AIDS-related knowledge, attitudes, and behaviors among a large sample of MSM students in Chongqing universities, revealing a significant prevalence of high-risk behaviors and distinct gaps in the KAB continuum. The empirical validation of the KAB model and the identification of specific, high-priority subgroups\u0026mdash;arts/sports majors, students from remarried families, and those with lower education levels\u0026mdash;provide a strong theoretical and practical foundation for precision intervention. We propose implementing a structured, multi-component health education model that is: (1) targeted, focusing on the unique needs and risk profiles of identified subgroups; (2) blended, integrating formal curricula with digital platforms and experiential activities; and (3) action-oriented, explicitly aiming to improve condom accessibility, usage skills, and consistent adherence. While derived from a single region, the conceptual framework and identified risk patterns hold potential relevance for university settings globally seeking to enhance HIV prevention for MSM students. Future research should explore the transferability of this model and delve deeper into the sociocultural drivers of risk in different contexts.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the 2023 Banan District Science and Health Joint Medical Research Project ( Grant No. BNWJ202300130 ). The funding bodies had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of the Banan District Center for Disease Control and Prevention ( Chongqing, China ). This study was conducted in accordance with the Declaration of Helsinki. The first page of the online questionnaire clearly explained the purpose and procedures of the study, the potential benefits and risks for participants, and their right to decline participation. Submission of the completed online questionnaire was therefore regarded as providing informed consent. The Institutional Review Board approved this procedure of assumed consent upon receipt of the questionnaires. To ensure data confidentiality, a confidentiality agreement was signed between the principal investigators and the platform provider, Wenjuanxing, to protect all online data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any individual person\u0026apos;s data in any form (including individual details, images, or videos).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLJZ, YJ, and CYD were responsible for the study conception, design, and funding acquisition. LJZ and CYD contributed to data collection. LJZ, JXX, and ZJ performed the data analysis. LJZ, CYD, JXX, and ZJ drafted the manuscript. YJ reviewed and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eThornton, J. (2022). Botswana's HIV/AIDS success. \u003cem\u003eLancet\u003c/em\u003e, \u003cem\u003e400\u003c/em\u003e(10351), 480\u0026ndash;481.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDwyer-Lindgren, L., Cork, M. A., Sligar, A., Steuben, K. M., et al. (2019). 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Q. (2025). Investigation on knowledge awareness rate and prevention needsof AIDS among 12 109 college students in Huizhou City 2021. \u003cem\u003eJ Prev Med Informat\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(12), 1611\u0026ndash;1620.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsegay, G., Edris, M., \u0026amp; Meseret, S. (2013). Assessment of voluntary counseling and testing service utilization and associated factors among Debre Markos University Students, North West Ethiopia: a cross-sectional survey in 2011. \u003cem\u003eBmc Public Health\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 243.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"MSM, University students, HIV/AIDS, Knowledge-Attitude-Behavior model, Health education, Path analysis, Targeted intervention","lastPublishedDoi":"10.21203/rs.3.rs-9112875/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9112875/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eIntroduction\u003c/b\u003e: The rising HIV infection rate among Chinese college students, particularly men who have sex with men ( MSM ), is a critical public health concern. University MSM students, with their dual identities as both students and sexual minorities, may have unique cognitive, behavioral, and service needs inadequately addressed by general interventions. This study, conducted in 2025, investigated HIV/AIDS-related knowledge, attitudes, and behaviors ( KAB ) among this population in Chongqing, China, aiming to develop a targeted health education model for university settings.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e: A cross-sectional survey was conducted with 1,400 MSM students recruited via snowball sampling through online platforms and community-based organizations. An anonymous online questionnaire assessed demographics, HIV/AIDS-related knowledge (13 items), attitudes (13 items), behaviors (3 items), and health education needs (6 items). Chi-square tests, logistic regression, and path analysis were performed.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e: The overall awareness rate of basic HIV knowledge was 78.50%, positive attitudes 49.93%, and high-risk sexual behaviors 64.79%. Misconceptions about non-transmission routes ( e.g., mosquito bites ) were common (~\u0026thinsp;70% awareness ). Multivariate analysis identified lower education level, arts/sports majors, non-participation in health education, and reliance on traditional media as significant risk factors for poorer KAB outcomes ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ). Path analysis validated the knowledge-attitude-behavior model, demonstrating that knowledge reduces high-risk behavior both directly and indirectly through attitudes. Students expressed strong demand for practical prevention information and favored interactive, structured educational formats.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions\u003c/b\u003e: High-risk behaviors are prevalent among university MSM students, driven by identifiable and potentially modifiable factors. The validated KAB model provides a theoretical foundation for intervention. We propose a structured, multi-component health education model targeting specific subgroups ( e.g., arts/sports majors ) and integrating digital and formal curricula.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePolicy Implications\u003c/b\u003e: These findings underscore the need for precision health education strategies in university settings. Policymakers should prioritize resource allocation toward high-risk subgroups, mandate structured HIV education within formal curricula, and leverage digital platforms to enhance reach and engagement. Such targeted approaches are essential for reducing HIV transmission among MSM students and achieving national prevention goals.\u003c/p\u003e","manuscriptTitle":"HIV/AIDS Knowledge, Attitudes, and Behaviors among Students Men Who Have Sex with Men in Chongqing Universities: A Cross-Sectional Study and Health Education Model Development","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-13 05:46:38","doi":"10.21203/rs.3.rs-9112875/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"13c2c365-4001-453e-80e2-41378ba2659b","owner":[],"postedDate":"April 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T05:46:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-13 05:46:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9112875","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9112875","identity":"rs-9112875","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}