HIV and STI Knowledge, Sexual Health Education, and HIV-Related Stigma Among Spanish University Students: A Cross-Sectional Study.

Despite substantial advances in HIV prevention and treatment, sexually transmitted infections (STIs) remain an increasing public health concern among young people, while stigma toward people living with HIV (PLHIV) continues to represent a major psychosocial barrier. This study examined whether knowledge about HIV and other STIs, compared with self-reported exposure to sexual health education, was associated with stigma toward PLHIV among Spanish university students. A cross-sectional study was conducted with 728 university students from several Spanish universities. Participants completed an anonymous self-administered questionnaire assessing sociodemographic characteristics, exposure to sexual health education, knowledge of HIV and other STIs, and stigma toward PLHIV. Descriptive analyses, correlation analyses, nonparametric group comparisons, and hierarchical linear regression models were performed. A Poisson regression model was also estimated as a sensitivity analysis. Participants demonstrated good knowledge of the main routes of HIV transmission but showed substantial gaps regarding the HIV window period and several aspects of STI transmission and treatment. Although stigma was generally low in everyday social interactions, it remained high in situations involving intimacy and close physical contact. Knowledge of HIV and other STIs was moderately and negatively associated with stigma (r = - .46, p < .001). Students exposed to sexual health education demonstrated higher levels of knowledge but did not differ in stigma from those who had not received such education. In the hierarchical regression analyses, knowledge emerged as the strongest predictor of stigma, explaining an additional 14.5% of the variance beyond sociodemographic characteristics and exposure to sexual health education. The Poisson regression model yielded consistent results. Greater knowledge about HIV and other STIs was independently associated with lower stigma toward PLHIV, whereas exposure to sexual health education was not associated with stigmatizing attitudes. These findings highlight the need for educational interventions that not only provide accurate and comprehensive sexual health information but also explicitly address HIV-related stigma, misconceptions about transmission, and attitudes toward intimacy and close physical contact with PLHIV.