Approximately 50% of the 1,744 students in this study lived in rural areas, which may reflects the current situation of students in western China. The main subjects of this survey were junior college students, who may have a relatively high HIV infection rate ; therefore, it was important to understand the AIDS-related knowledge-attitude-practice among students for a more effective AIDS health education.
Analysis on the level of knowledge about AIDS
The study found that most of participants had a good understanding of the knowledge that condoms can reduce the spread of AIDS and the need for counseling and testing after high-risk behaviors; this shows that young people in the region have a certain awareness of AIDS prevention and control. However, some studies have shown that most students evade HIV screening after high-risk behaviors due to fear of testing positive, and considering that HIV testing and counseling are neither necessary nor important . This reveals that students' awareness of AIDS risks was inaccurate and their AIDS risk identification ability should be improved . Our study found that students had the lowest awareness rate of PEP. It implied that students lack of comprehensive and up-dated AIDS-related knowledge, and AIDS health education needs to keep pace with the progress of AIDS research and treatment.
The results showed that females have a lower awareness rate of AIDS knowledge than males. In most developing countries, women are less educated and their access to sexual health education was often more limited than males, therefore they have little knowledge of AIDS and high susceptibility. In the United States, women account for approximately one-fifth of new HIV infections and 22% females expressed worry about HIV , which suggested that females should be more important targets for education and help. In different majors, the awareness rate of medical students was the highest , which may be related to the medical students' learning about AIDS in school. The awareness rate of AIDS among the senior students was higher than that among the junior students . With the growth of grades, access to AIDS knowledge and the probability of AIDS awareness rate will also increase. This suggests that medical students may be developed as AIDS health education educators; the junior students should focus on AIDS health education.
Attitude of AIDS discrimination
The main reason for people's discrimination against AIDS is fear of HIV infection; however, the reason for people's fear of HIV is the lack of understanding of the essence of AIDS infection . We should strengthen AIDS health education and inform people who are exposed to HIV in their daily lives that they will not be infected and that the HIV load in saliva and urine is very low ; thus reducing the fear of AIDS among students. Colins' study showed that AIDS knowledge is positively correlated with attitudes, and knowledge has a positive effect on attitudes . However, our study showed that the influence of the awareness rate of AIDS knowledge on the score of AIDS discrimination was not statistically significant. This shows that AIDS knowledge alone may not affect students' discriminatory attitudes towards AIDS, and some more effective strategies are needed to change their attitudes.
In this study, females' discrimination against AIDS was less than males', which might relate to the fact that females were more tolerant than males . Therefore, anti-discrimination education strategies should be developed in light of students' psychological characteristics of gender differences. Among different majors, medical students have the lowest score of HIV/AIDS discrimination, which may be related to the particularity of medical specialty. Medical students have more opportunities to contact HIV/AIDS patients, which could reduce discrimination towards HIV/AIDS . Therefore, frequent contact with people living with AIDS may help reduce discrimination against AIDS.
Analysis of AIDS-related sexual behavior
Results of this study showed that 235 (13.5%) students reported having sex, which was lower than that of Western countries，such as the United States [13-14]. The occurrence of sexual behavior may be related to the cultural differences in different countries. This study found that more than 50% of students who had sex did not insist on the use of condoms; actually, the correct use of condoms is one of the main ways to reduce the spread of AIDS . However, young people use condoms more to prevent pregnancies than to prevent STD . It reveals that students have a low awareness of the risk of AIDS infection. It is necessary to strengthen the correct application of condoms among young people to change the dangerous sexual behaviors of students and reduce the spread of AIDS.
The Internet was a platform for expanding contact with different sexual partners, which increases probability of sexual activity between strangers and the likelihood of unsafe sex, which leads to the transmission of sexually transmitted diseases to sexual partners [31,32]. In this study, 125 (7.2%) students sought sexual partners through social networks, which revealed that the Internet has become a popular way for young people to seek sexual partners in China. It suggests that the intervention of young people's network behavior is an important content of AIDS education. At the same time, the mode of AIDS health education should not be limited to the traditional mode; network education and prevention should be given more attention, which conforms to the characteristics of students.
AIDS health education for males is crucial. The males’ sexual behavior was 3.824 times higher than that of females; and the males tend to have commercial or temporary sexual partners. It reveals that males were more active in sexual attitude and behavior; and the probability of high-risk behaviors was higher. The researchers found that males with knowledge of sexual and reproductive health reported that the age of first sexual intercourse may be delayed or contraceptive use increase during sexual intercourse . This showed that AIDS health education has a positive impact on males.
The incidence of sexual behavior of senior students was higher than that of junior students; and the awareness rate of AIDS knowledge of senior students was higher than that of junior students; resulting in the separation of knowledge and behavior, which brought challenges to the prevention and control of AIDS among students. It revealed that AIDS knowledge among students was not sufficient to affect the change of behavior. So, the best educational methods should be explored according to their respective characteristics.
Research Limitations and Recommendations
The scope of this study is limited to west of China. We have not investigated other regions; and the study may not be representative beyond this area. It suggests that the scope of the study should be expanded, and a multi-center study should be conducted to improve the scientific nature of the study. The multivariate linear regression model of AIDS discrimination has a low coefficient of determination, which indicated that the main factors affecting AIDS discrimination have not been found. This study involves the privacy issues related to sexual behavior; there may be retrospective information bias or avoidance awareness.