HIV/AIDS knowledge and stigma attitudes among older men in Sichuan Province, Southwest China: a cross-sectional study.

BACKGROUND

In China, men aged 50 years and older face elevated HIV infection risks due to ongoing sexual activity and limited prevention knowledge. HIV/AIDS-related stigma exacerbates these risks through delayed testing and reduced prevention engagement, yet stigma attitudes toward people living with HIV remain poorly understood in this population in China. This study examined the associations between HIV/AIDS knowledge and stigma attitudes among older men in Sichuan.

METHODS

A cross-sectional study was conducted among 841 older men via multistage cluster sampling between July and August 2023. Validated questionnaires were used to assess HIV/AIDS knowledge, stigma attitudes, sociocultural factors (sexual attitudes, social support, and socioeconomic status), and the utilization of HIV/AIDS services. Multivariable logistic regression and propensity score matching (PSM) were employed to control for confounding variables and strengthen the association estimates.

RESULTS

Awareness of HIV/AIDS knowledge was associated with lower stigma attitudes (adjusted odds ratio [AOR] = 0.61, 95% CI 0.44-0.84), with PSM analyses confirming stronger effects (AOR = 0.51-0.53, 95% CI 0.37-0.72). High education level (junior high school and above: AOR = 0.38, 95% CI 0.21-0.70) and liberal sexual attitudes (AOR = 0.51, 95% CI 0.37-0.71) showed stronger inverse associations with stigma attitudes than knowledge did.

CONCLUSIONS

This study identifies a low-knowledge-high-stigma pattern among older men in Sichuan, Southwest China, which may be influenced by historical fear-based health messaging and conservative sociocultural norms. Although awareness of HIV/AIDS knowledge was associated with lower stigma attitudes, education level, and sexual attitudes demonstrated more potent effects. These findings underscore the need for integrated interventions that combine knowledge-based education with sociocultural approaches to mitigate stigma in this region.