Acquired immunodeficiency syndrome (AIDS), caused by human immunodeficiency virus (HIV) infection, represents a chronic infectious disease with high mortality [1] that poses sustained challenges to public health systems globally. In recent years, China has witnessed concerning trends in HIV infections among young students, with annual increases in infection rates. Inadequate sexual health knowledge and limited HIV awareness constitute primary risk factors for elevated transmission risks [2]. Contemporary Chinese university students demonstrate increased sexual activity [3] alongside insufficient sexual health literacy [4], resulting in widespread deficits in HIV/AIDS knowledge [5][6].

Yunnan Province, designated as a priority region for HIV prevention and control in China, faces unique challenges in its border areas. Geographic remoteness, multicultural demographics, and inequitable health education resource distribution [7] render local university students particularly vulnerable populations in HIV prevention efforts. Previous research has documented low HIV knowledge awareness rates and weak risk prevention consciousness among this demographic [8], further intensifying regional prevention pressures. This study investigated HIV/AIDS knowledge and determinants among university students at a Yunnan border institution to establish current knowledge status and influencing factors, thereby providing scientific evidence for targeted HIV prevention education in border regions.

As a major global public health challenge, HIV/AIDS prevention effectiveness directly impacts population health and social stability, requiring coordinated societal participation. Our findings reveal that HIV/AIDS knowledge awareness among university students at this Yunnan border institution was 65.9%, with only 0.9% achieving perfect scores. This level falls below findings reported by Sun et al. [11]. and substantially short of requirements outlined in the “Implementation Plan for Curbing HIV Transmission (2019-2022)” [12], highlighting persistent educational gaps in border region universities requiring targeted enhancement.

Examining knowledge details, students demonstrated incomplete understanding of non-transmission routes, with only 73.6% awareness that “mosquito bites do not transmit HIV,” consistent with findings by Zhang et al. [13]. More concerning, awareness rates for critical items including “primary HIV transmission routes”, “World AIDS Day date”, and “absence of curative treatments in China” were merely 45.7%, 55.4%, and 57.0% respectively, revealing cognitive gaps in transmission mechanisms, prevention measures, and disease awareness. These findings suggest border universities should focus on these weak areas, optimizing educational priorities to enhance knowledge dissemination precision.

Univariate and multivariate analyses revealed key determinants of HIV/AIDS knowledge. Medical students’ higher awareness (69.1%) compared to non-medical students (62.5%) aligns with Tang’s findings [14], confirming the importance of professional background in disease knowledge acquisition. Second-year and above students’ significantly higher awareness (69.8%) versus freshmen (59.9%) likely reflects progressive HIV education enhancement through diverse educational formats [15], confirming university as a critical period for HIV health education providing systematic scientific knowledge support. Active HIV knowledge-seeking emerged as the strongest facilitating factor (OR = 4.48, 95% CI: 3.35 - 5.99). However, our study found only a minority of students obtained relevant knowledge through school channels, despite school education’s central role in HIV awareness enhancement [16][17], reflecting insufficient educational provision in border universities. Based on existing practices, schools could normalize HIV prevention education through promotional materials, classroom instruction, thematic activities, and peer education [18][19], providing knowledge support for students. Notably, multivariate analysis identified sexual experience as a barrier to knowledge (OR = 0.43, 95% CI: 0.27 - 0.68). This finding may stem from three factors: first, some students develop complacency after sexual debut, subconsciously believing HIV is irrelevant to them, losing motivation for active learning; second, insufficient pre-sexual HIV education without subsequent knowledge supplementation leads to cognitive lag; third, some students may deliberately avoid HIV knowledge due to guilt or wishful thinking regarding sexual behavior, unwilling to confront potential risks. These findings suggest targeted educational interventions are needed for sexually active students to break psychological barriers and strengthen risk awareness. To further elucidate the psychological mechanisms linking sexual behavior to knowledge awareness, future studies could utilize qualitative interviews or focus group discussions. This approach would enable a comprehensive examination of the population’s knowledge needs following sexual activity, attitudes towards information access, psychological defense mechanisms, and willingness to engage with education. The insights gained will inform the development of more targeted educational interventions, facilitating the overcoming of psychological barriers and enhancing risk prevention awareness.

In summary, college students in Yunnan’s border regions exhibit low awareness of HIV/AIDS knowledge [20], insufficient mastery of core concepts [21][22], and weak prevention awareness, indicating that related prevention and control efforts still face significant challenges [23]. Based on research findings and practical experience, three optimization measures are recommended: First, implement targeted knowledge dissemination by focusing on weak knowledge areas such as transmission routes [24] and preventive measures; Second, establish an educational model featuring “multi-party collaboration, multi-course co-education, and multi-teacher co-guidance” [25]. “Multi-party collaboration” should encompass internal university departments (e.g., Student Affairs Office, University Health Center, Youth League Committee, Mental Health Center) and external institutions (e.g., local CDC, community health centers, NGOs like AIDS prevention associations) to form a synergistic educational force; Prioritize key populations including non-medical majors, first-year students, and ethnic minority students. Third, refine the integrated prevention system encompassing “school-society-nation” [26][27], pooling on- and off-campus resources to stimulate students’ intrinsic motivation for knowledge acquisition through diverse approaches. This will comprehensively enhance HIV prevention awareness and self-protection capabilities among university students in border regions.

University Student Research Fund Project of Dali University in 2024 (KYSX2024040).

*These authors contributed equally to this work as co-first authors.

^#Corresponding author.