Acquired Immunodeficiency Syndrome (AIDS) is a global public health concern that poses a significant threat to human health, thereby impacting social stability and economic development. According to worldwide prevention and treatment data, the proportion of newly infected adolescents aged 15-24 years is 32.7%, of whom 91.5% are infected through sexual transmission [1] . China’s AIDS epidemic is marked by a notable increase in cases among the youth demographic. From 2017 to 2022, the average annual growth rate of AIDS cases in the student population was 13.4%, accompanied by the emergence of issues such as early sexual debut and inadequate condom use [2] . The western border region of Yunnan, due to its unique geographic location, experiences an average daily cross-border flow of 28,000 people [3] . This context, characterized by multicultural intertwining, poses a risk of high-risk sexual behaviors, particularly in light of the local ethnic minority characteristics of social activities, such as group gatherings and festive socializing [4] . Furthermore, students from cross-border families constitute a proportion of the university student population in the region. Some of these students are influenced by multicultural practices and differences in the acceptance of sexual health knowledge, which further exacerbates the risk of HIV transmission.

The health of university students is a significant factor in the broader context of national development, as they represent the core talent pool. However, the findings of this study indicate that the physiological and psychological development of this group is not yet fully mature, the knowledge system of sexual health is insufficient, and the awareness of self-protection is weak. This combination of factors renders them vulnerable to the threat of AIDS. The emergence of HIV cases within higher education institutions has been shown to have a significant impact on individuals, families, and public health and safety measures on campus [5] - [7] . Despite the explicit emphasis in the “Healthy China 2030” Planning Outline on the imperative to strengthen HIV prevention interventions for key populations [8] , the practice of HIV prevention in institutions of higher education is beset by numerous challenges. These include the limited efficacy of conventional lecture-based education, the inadequacy of new media resources regarding educational effectiveness [9] , an absence of sufficient collaboration between on-campus and off-campus prevention and control resources, and the ineffectiveness of the HIV testing and referral mechanism [10] . In this context, an in-depth analysis of the characteristics of the student population in colleges and universities in the western border of Yunnan Province is imperative. This analysis should include the influence of demographic characteristics such as ethnic composition (e.g., the percentage of Dai and Jingpo minority students) and family residence on health behaviours. It should also include targeted AIDS health education and the evaluation of its effectiveness. This will optimise the strategy for the prevention and control of HIV in regional colleges and universities, improve the prevention and control ability of students, and prevent the spread of AIDS on campuses. It is imperative that the prevention strategy of regional colleges and universities is optimised in order to address the pressing issue of HIV/AIDS on campus. This necessitates enhancing students’ competencies in the prevention and control of HIV/AIDS, thereby disrupting the transmission chain within educational institutions.

AIDS health education has significantly enhanced the knowledge level of students in colleges and universities in western Yunnan. By comparing the knowledge rate of students, it is found that the students’ mastery of key knowledge about the transmission channels and preventive measures of AIDS has increased significantly after the intervention, such as the proportion of students who know that “it is impossible to judge whether a person is infected with AIDS by his/her appearance”, “sharing toilets and baths with HIV-infected people does not spread AIDS”, etc. This is in agreement with the findings of Zhang Wanqing and Jiang Feng [13] [14] , whose study showed that health education conducted by different dominant actors had a positive impact on the change of newborns’ HIV knowledge acquisition. This shows that health education plays an important role in increasing students’ knowledge of AIDS, helping them to understand AIDS more accurately, and laying the foundation for them to form a scientific concept of prevention and treatment. However, despite significant progress, further efforts are needed to ensure that all students achieve the desired level of cognition.

Health education effectively improved positive attitudes toward HIV among students in colleges and universities in western Yunnan. The results of the study showed that students’ attitudes toward people living with HIV were more positive and tolerant, such as an increase in the percentage of those who were willing to continue to associate with people living with HIV and live on the same campus, and a change in the support for the idea of disclosing information about people living with HIV and schools refusing to enroll people living with HIV, which was similar to the results of the study conducted by Schengenzler [15] . This shows that health education not only improves students’ knowledge, but also eliminates, to a certain extent, their discrimination and prejudice against AIDS patients, promotes their understanding and acceptance of the AIDS community, and is conducive to the creation of a more harmonious and inclusive campus environment. However, attitude change is a long-term process that requires continuous education and guidance. Differences in HIV knowledge and attitudes among students with different characteristics suggest the need for targeted health education. It was found [16] that there were some differences in HIV knowledge and attitudes among students of different genders, places of residence, majors, and grades, such as freshmen’s knowledge enhancement and attitudinal change were more obvious after the intervention. Cao Xuang [17] [18] also pointed out that the knowledge of AIDS-related knowledge of new students in colleges and universities in border areas still needs to be improved, and there are differences in knowledge and health education needs among students with different characteristics. This suggests that when carrying out AIDS health education, students’ individual characteristics and differences in needs should be fully considered, and more targeted education strategies and contents should be developed to improve the effectiveness and coverage of health education, to ensure that all students can benefit from health education, and that they can jointly enhance their awareness and ability to prevent and control AIDS [19] . Future research and practice should further explore how to better meet the needs of different student groups.

This study has several methodological and design constraints. First, the sample was predominantly from a single medical school (91.0% medical majors) with an overrepresentation of Han Chinese students (81.1%), potentially limiting the generalizability of findings to non-medical institutions and ethnic minority populations in borderland multi-ethnic communities. Second, the single-group pretest-posttest design and short-term intervention evaluation (one semester) cannot fully exclude confounding factors or verify long-term effect sustainability. Third, the questionnaire lacked systematic integration of culturally sensitive indicators, such as the moderating role of cross-border family backgrounds (present in a proportion of students) on sexual health knowledge acquisition, nor did it examine correlations between ethnic-specific social activities (e.g., festival gatherings) and high-risk behaviors, potentially limiting the applicability of intervention strategies in unique borderland cultural contexts. Finally, the study did not elucidate the mediating mechanisms underlying attitude-behavior transformation nor quantify the synergistic effects between new media and traditional educational approaches, restricting the precise optimization of intervention strategies.

This research was Supported by the following grants: School-level Project of Western Yunnan University of Applied Sciences (2023XJKY002).

Kena Liu: Writing—original draft, Design questionnaire, Funding. Xuang Cao: Writing—original draft. Siliu Dai: Writing—original draft. Yixuan Huang: Completing the on-site questionnaire. Yun Zhou: Writing—review & editing, Writing—original draft, Formal analysis, Data curation.

*First author.

^#Corresponding author.