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

BACKGROUND: HIV prevention, diagnosis, treatment and care services might be hampered by inaccurate risk assessment. This study aimed to investigate the extent of and factors associated with the discordance between perceived risk and actual risky sexual behaviors among undergraduates in mainland China, guided by the Anderson's behavioral model. METHODS: This study involved a secondary analysis of cross-sectional data collected during the fall semester of 2018–2019 academic year. The present analysis was restricted to 8808 undergraduates with low risk perception. Those who had low perceived risk but actually engaged in risky sexual behaviors were categorized as risk discordance (RD). Univariate and multivariate Logistic regression analyses were conducted to identify factors associated with RD. RESULTS: Overall, the discordance rate between perceived and actual risk was 8.5% (95% CI: 7.9%-9.1%). Multivariate Logistic regression analysis indicated that non-heterosexual women (AOR = 0.41, 95% CI:0.27–0.60), heterosexual men (AOR = 0.45, 95% CI:0.33–0.61) and women (AOR = 0.26, 95% CI:0.19–0.35) were less likely to exhibit RD, when compared with non- heterosexual men. Furthermore, non-freshmen (AOR = 1.57, 95% CI:1.30–1.90), early initiators of sexual intercourse (AOR = 5.82, 95% CI:4.10–8.26), and those who had lower levels of HIV knowledge (AOR = 1.28, 95% CI:1.08–1.51), displayed higher levels of stigma against PLHIV (AOR = 1.50, 95% CI:1.26–1.77) and had ever been tested for HIV (AOR = 1.36, 95% CI:1.04–1.77) were more prone to reporting RD. Those with more enabling resources [i.e., displaying high levels of condom use self-efficacy (AOR = 0.70, 95% CI:0.59–0.84) and being knowledge of local testing center (AOR = 0.71, 95% CI:0.60–0.83)] were less likely to report RD. However, spending more than 2000 Yuan a month on basic needs (AOR = 2.55, 95% CI:2.07–3.14), residing in urban areas (AOR = 1.35, 95% CI:1.15–1.59) and being knowledgeable of the national AIDS policy (AOR = 1.40,95% CI:1.18–1.66) increased the chance of exhibiting RD. CONCLUSIONS: Comprehensive interventions, including targeting students with high-risk characteristics, improving the acceptability of PrEP and PEP, conducting health education, enhancing self-efficacy for using condoms and making opt-out HIV testing routine in college campus, should be taken to reduce the discordance between perceived and actual HIV risk and finally to reach the goal of Zero AIDS.