Safe Sex Practices and HIV-Related Cognitions Among University Students in Czechia and Estonia

The unique social and transitional life stages experienced by university students present both challenges and opportunities for targeted Human Immunodeficiency Virus (HIV) prevention initiatives. In Central and Eastern Europe, limited comparative evidence exists regarding HIV-related perceptions and preventive behaviours in this group. This study aimed to assess HIV-related awareness, attitudes, perceptions, and safe sex practices among university students in Czechia and Estonia, and to examine the sociodemographic and contextual factors associated with these outcomes. A cross-sectional study was conducted between October 2023 and March 2024 among students at Masaryk University (Czechia) and the University of Tartu (Estonia). Participants completed a self-administered digital questionnaire assessing HIV-related knowledge and attitudes toward people living with HIV (PLWH), perceived risk and testing behaviour, and condom use. Multiple regression and logistic regression analyses were used to identify predictors. Among 619 respondents (Czechia: 323; Estonia: 296), HIV-related awareness was higher in Czechia (mean 4.41/6) than in Estonia (3.68/6, p < 0.001). Men who have sex with men (MSM) and sexual minorities reported significantly higher awareness and testing rates compared to other participants. Overall, 36.5% had ever tested for HIV; condom use consistency was 40%. We found that higher awareness and positive attitudes were associated with safer sex practices and greater HIV testing. International students reported greater perceived risk but lower HIV-related awareness. Awareness and attitudes did not independently predict behavioural outcomes after adjustment. While students showed moderate knowledge and positive attitudes related to HIV, significant gaps persist, particularly among heterosexual and non-medical students. These findings support the need for inclusive, context-sensitive HIV prevention strategies in university settings that address both.