Associations among condom use, sexual behavior, and knowledge about HIV/AIDS. A study of 13,293 public school students

BACKGROUND: This school-based study explored associations between Mexican young people's condom use, other sexual behaviors, and HIV/AIDS knowledge. METHODS: Students (n=13,293, 11-24 years of age) from a random sample of public schools in the central Mexican state of Morelos completed a self-administered questionnaire. We performed logistic regression analysis of condom use and sexual behavior variables and a knowledge-based index on HIV/AIDS prevention and transmission. RESULTS: Average age at sexual debut was 13.6 +/- 1.9 years among young men and 14.2 +/- 2.2 years among young women; 34.5% of sample participants reported using condoms during their first sexual intercourse. More students had intermediate HIV/AIDS knowledge levels (46%, 95% confidence interval 95% CI], 45.2-46.9) than high levels (37%, 95% CI 36.2-37.8, p <0.01). Students knew more concerning HIV transmission than about prevention of HIV infection. Among young men, high levels of HIV/AIDS knowledge increased likelihood of condom use (odds ratio OR] 1.4, 95% CI, 1.1-1.7), while among young women high levels of knowledge decreased likelihood of using condoms (OR 0.7, 95% CI, 0.5-1.0). Young men with high levels of HIV/AIDS knowledge were more likely to have had three or more sexual partners (OR 1.7, 95% CI, 1.3-2.2), but young women with high knowledge levels were more likely to have only one lifetime sexual partner (OR 0.6, 95% CI, 0.4-0.9). CONCLUSIONS: As in previous studies in smaller samples, levels of knowledge with regard to HIV/AIDS were low in Mexican youth. HIV/AIDS education programs for Mexican students should focus on conveying knowledge on HIV prevention. Because apparently knowledge is not directly correlated with condom use among young women, prevention strategies that deal with social acceptability of condoms and social skills related with condom negotiation are also needed.