Separation between cognition of knowledge and sexual behaviors and influencing factors of PrEP among college students with multiple sexual partners in Nanning

Objective To understand the situation of the separation between cognition of knowledge and sexual behaviors regarding HIV Pre-Exposure Prophylaxis (PrEP) among college students in Nanning, Guangxi, and to analyze its influencing factors.Methods A cross-sectional survey was conducted in Nanning from November 19 to December 4, 2023. Using a multi-stage stratified cluster sampling method, young college students in Guangxi, who had at least one sexual partner in the past six months, were recruited to investigate their PrEP-related knowledge and usage behaviors. A multivariate logistic regression model was used to analyze the influencing factors of separation between cognition of knowledge and sexual behaviors.Results A total of 5,630 college students were surveyed, of whom 4,494 (79.8%) had one sexual partner, 572 (10.2%) had 2-3 sexual partners, and 564 (10.0%) had four or more sexual partners. Among the students with one sexual partner, 1,558 (34.7%) experienced separation between cognition of knowledge and sexual behaviors regarding PrEP usage. Among those with 2-3 sexual partners, 201 (35.1%) experienced this separation, and among those with four or more sexual partners, 144 (25.5%) experienced it. Multivariate logistic regression analysis showed that students identifying as homosexual or bisexual (OR=1.436, 95%CI: 1.150-1.793), those with an HIV testing frequency of less than 6 months (OR=1.423, 95%CI: 1.198-1.691), and those with an HIV testing frequency of more than 6 months (OR=1.386, 95%CI: 1.113-1.725), as well as students unwilling or uncertain about using PrEP (OR=2.322, 95%CI: 2.046-2.635), were significant influencing factors of the separation between cognition of knowledge and sexual behaviors regarding PrEP.Conclusion College students in Nanning with multiple sexual partners exhibit significant separation between cognition of knowledge and sexual behaviors regarding PrEP. In PrEP education efforts, special attention should be given to homosexuals, HIV testing behavior, and the lack of willingness to use PrEP. It is essential to improve the willingness to use PrEP and facilitate its adoption to reduce the occurrence of this separation.