The cross-sectional study, led by Fang Pei of the Civil Aviation Flight University of China and colleagues, enrolled 4,133 students from 10 universities in Sichuan Province between October and December 2020. All of the participating institutions were located in Sichuan, which carries the highest burden of HIV infection of any province in China. According to the Chinese Center for Disease Control and Prevention, the number of newly diagnosed college students nationwide has been growing at an annual rate of 30 to 50 percent over the past several years, a trajectory that transforms the dense, socially dynamic environment of a university campus into a critical setting for infectious disease preparedness.

Participants, aged 16 to 28 with a mean age of 19.45 years, completed a standardized self-administered questionnaire covering demographics, HIV knowledge, HIV stigma, self-esteem, sexual behavior, and testing history. The survey achieved a 99 percent response rate. HIV knowledge was assessed with eight items developed by the National Center for AIDS/STD Control and Prevention of the China CDC, with students answering more than six items correctly classified as having a high knowledge level. Stigma was measured with the Chinese version of Zelaya’s HIV-related stigma scale, which probes four distinct dimensions: fear of casual transmission, moral judgment, personal stigma, and perceived community stigma. Self-esteem was evaluated with the Rosenberg self-esteem scale.

The headline knowledge figure of 74.2 percent conceals significant gaps in understanding. The highest awareness rate, 92.4 percent, was for the item stating that after high-risk behavior one should actively seek AIDS counseling and testing. The lowest, 62.8 percent, concerned the recognition that the main mode of HIV transmission among China’s students is male homosexual sex. Only 69.3 percent knew that HIV is a serious incurable infectious disease, and 74.3 percent understood that an HIV-infected person cannot be identified from appearance. Notably, 92.6 percent of participants had never been tested for HIV, and only 15.2 percent were aware of the HIV/AIDS epidemic in their own region, indicating that even free testing services available as part of China’s prevention campaign are reaching only a small fraction of the student population.

Stigma proved even more widespread than knowledge deficits. Fear of casual transmission was reported by 79.8 percent of respondents, moral judgment by 71.1 percent, personal stigma by 72.2 percent, and perceived community stigma by 71.8 percent. In practical terms, this means that most students surveyed either feared that HIV could be spread through everyday contact, held negative moral views about people living with HIV, personally endorsed discriminatory attitudes, or believed their community would stigmatize those with the virus. Previous research has consistently linked HIV-related stigma to decreased testing uptake and reduced efficacy of preventive behaviors such as condom use, making these attitudes a direct barrier to the very interventions that campus prevention strategies depend upon.

To untangle the factors driving both knowledge and stigma, the researchers applied multivariate logistic regression, calculating adjusted odds ratios with 95 percent confidence intervals. Six variables emerged as significantly associated with HIV knowledge: gender, ethnicity, grade, sexual orientation, awareness of the regional HIV/AIDS epidemic, and self-esteem. Female students had 0.85 times the odds of high knowledge compared to males, while students of non-Han ethnicity had 0.71 times the odds. Non-freshmen showed 1.37 times the odds of high knowledge relative to freshmen, and students aware of the regional epidemic had 1.76 times the odds. Those with high self-esteem showed 1.41 times the odds of robust HIV knowledge, a finding that underscores the psychological dimension of health literacy.

When the analysis turned to stigma, the most striking result was the consistency of the knowledge effect. Students with high HIV knowledge had significantly lower stigma across all four dimensions, with adjusted odds ratios of 0.50 for fear of casual transmission, 0.61 for moral judgment, 0.37 for personal stigma, and 0.43 for perceived community stigma, all statistically significant at the p < 0.001 level. This uniform association suggests that closing knowledge gaps could yield broad reductions in discriminatory attitudes, though the researchers caution that knowledge alone may not ultimately change risky behavior or prevention strategy utilization.

Beyond knowledge, seven variables played differentiated roles across the stigma dimensions. Female students showed less discriminatory attitudes than males in three dimensions, with adjusted odds ratios of 0.58 for moral judgment, 0.77 for personal stigma, and 0.65 for perceived community stigma, a pattern the researchers attribute partly to gender roles and increased compassion. Students of non-Han ethnicity expressed more fear of casual transmission, more negative judgment, and more personal stigma than Han students. Non-freshmen consistently showed higher stigma across fear, personal, and community dimensions than freshmen, possibly because older undergraduates are more likely to engage in unsafe sex despite their greater knowledge and may express stigma as a way of reducing discomfort associated with their own behavior. Non-heterosexual students showed less moral judgment, which the researchers suggest may reflect intersectional connections with HIV infection in social identification.

Self-esteem emerged as a powerful protective factor. Students with high self-esteem had lower stigma in three dimensions, with adjusted odds ratios of 0.81 for fear of casual transmission, 0.79 for personal stigma, and 0.62 for perceived community stigma. Being an only child also reduced personal stigma, with an adjusted odds ratio of 0.82, a surprising finding the researchers explain by noting that only children typically have higher self-ratings, which may result in more accurate perception of personal risk. Awareness of the regional HIV/AIDS epidemic reduced fear of casual transmission and perceived community stigma, consistent with the knowledge-attitude-belief-practice model, which holds that increased knowledge and self-esteem can reduce misunderstandings about transmission and ultimately diminish stigma.

The researchers conclude that college students in southwest China have a low level of HIV knowledge and a high degree of HIV stigma, characteristics that directly compromise institutional capacity for effective infectious disease emergency management. They argue that addressing HIV on campuses must incorporate deliberate efforts to reduce stigma, and that the four dimensions of stigma, being influenced by different factors, should be addressed independently when developing new interventions. For emergency preparedness, the study underscores the necessity of integrating stigma-reduction strategies into institutional plans, since stigma acts as a barrier to risk communication, intervention uptake, and response efficacy during public health emergencies. The researchers call for multilayered interventions at the individual, interpersonal, community, institutional, and structural levels, along with targeted learning and practice opportunities to improve student self-esteem, as personal self-esteem heavily influenced both HIV knowledge and stigma. Further studies, they note, are required to identify effective ways to raise knowledge levels and decrease stigma among college students if the global goal of ending the AIDS epidemic by 2030 is to be achieved.

Subject of Research: Fundamental data regarding the emergency management of infectious diseases in higher education institutions: HIV knowledge and stigma among college students in Southwest China

Article Title: Fundamental data regarding the emergency management of infectious diseases in higher education institutions: HIV knowledge and stigma among college students in Southwest China

Article References: Pei, F., Li, X., Yao, H., & Pei, R. (2026). Fundamental data regarding the emergency management of infectious diseases in higher education institutions: HIV knowledge and stigma among college students in Southwest China. Frontiers in Public Health, 14, Article 1970246. https://doi.org/10.3389/fpubh.2026.1970246

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1970246

Keywords: Fundamental, data, regarding, emergency, management, infectious, diseases, higher, education, institutions, knowledge, stigma