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Effectiveness of a Structured HIV Health Education Talk on
Knowledge, Attitude, Risky Behaviours, and Preventive Measures
Among Malaysian University Students
Joemmaicca Augustta Anak Joggery
1
, Siti Fatimah Md Shariff
2*
Open University Malaysia
*Corresponding Author
DOI:
https://dx.doi.org/10.47772/IJRISS.2025.91100451
Received: 14 November 2025; Accepted: 23 November 2025; Published: 16 December 2025
ABSRTRACT
HIV remains a persistent public health threat among Malaysian university students, with rising infection rates
attributed to misconceptions, limited awareness, and engagement in risky sexual behaviors. Despite ongoing
national prevention initiatives, gaps in knowledge and behavioral practices continue to place young adults at
heightened risk. This concept paper proposes a structured four-hour HIV health education talk as an evidence-
informed approach to strengthen HIV literacy, reshape risk perceptions, and promote preventive behaviors
among university students. Guided by the Knowledge–Attitude–Practice (KAP) Model and the Health Belief
Model (HBM), the proposed intervention integrates interactive teaching, myth correction, risk-reduction
counselling, and practical preventive strategies. The concept highlights the theoretical foundation, relevance,
and potential impact of implementing structured, student-centered HIV education in higher learning institutions.
It also underscores how such interventions could support national public health goals and inform future program
development aimed at reducing HIV transmission among youth. This paper serves as a basis for designing a
comprehensive educational initiative tailored to university settings in Malaysia.
HIV awareness, university students, health education, behavioral prevention, concept paper
INTRODUCTION
Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) continue to pose
significant global public health challenges, particularly among young people aged 15 to 24. Guided by ambitious
global targets such as the United Nations Program on HIV/AIDS (UNAIDS) 95–95–95 strategy and national
public health frameworks, countries worldwide have intensified their efforts to reduce HIV prevalence, expand
access to testing and treatment, and promote preventive behaviors especially among youth populations [17]. In
alignment with these global initiatives, the Centers for Disease Control and Prevention (CDC) in the United
States aims to reduce new HIV infections by 75% by 2025 and 90% by 2030 through enhanced testing, early
treatment, and comprehensive prevention campaigns [26].
In Malaysia, the Ministry of Health (MOH), in collaboration with the Malaysian AIDS Foundation (MAF) and
other key organizations, has implemented extensive HIV prevention, treatment, and care programs. These
include the provision of free first-line antiretroviral therapy (ART), Voluntary Counselling and Testing (VCT),
and Provider-Initiated Testing and Counselling (PITC) services available across 1,039 government clinics and
141 hospitals nationwide [4]. All initiatives are anchored under the National Strategic Plan for Ending AIDS
(NSPEA) 2016–2030, which aligns with the UNAIDS vision of eliminating AIDS as a public health threat by
2030 through expanded access to care, stigma reduction, and evidence-based prevention interventions [4].
Despite these national and international commitments, Malaysia has witnessed a worrying resurgence of HIV
infections among young adults, particularly those enrolled in higher education institutions. National surveillance
data indicate that the majority of new HIV cases occur among males aged 20–29 years, the demographic most
represented in universities [33]. Between 2020 and 2024, more than 1,000 Malaysian university students tested
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positive for HIV, including 222 new cases reported in 2024 alone, highlighting a persistent gap between
awareness and behavioral practice [1]. According to Dr. Zaiton Yahaya of the Malaysian AIDS Foundation,
sexual activity remains the primary mode of transmission among students, with limited awareness of risks and
inconsistent use of protection serving as major contributors to this surge [32].
Recognizing the growing concern about rising HIV cases among youth, the Ministry of Health (MOH) has
continued to strengthen its national response through increased resource allocation and policy support. In 2025,
an additional RM1 million allocation was announced for the Differentiated HIV Services for Key Populations
(DHSKP) program, raising the total annual funding to RM8 million. According to Health Minister Datuk Seri
Dr. Dzulkefly Ahmad, this expanded funding is intended to enhance prevention, screening, and treatment
services nationwide while intensifying outreach and education among key and youth populations in educational
institutions [23]. This renewed investment underscores Malaysia’s commitment to curbing new infections,
improving service accessibility, and enhancing the quality of life for people living with HIV (PLHIV).
However, despite these ongoing efforts, behavioral and educational gaps remain prominent, particularly among
university students. Evidence indicates that knowledge alone does not always lead to safer sexual practices.
Studies among Malaysian undergraduates, including those from health science programs, reveal persistent
misconceptions about HIV transmission, prevention, and treatment [8]. Many students remain unaware that
asymptomatic individuals can transmit HIV or that consistent condom use and regular testing are essential
preventive measures. Furthermore, cultural and religious sensitivities often limit open conversations about sexual
health, perpetuating stigma and discrimination toward PLHIV. These social barriers discourage students from
accessing HIV testing, attending awareness programs, or engaging in preventive practices. Such misconceptions
are particularly concerning among nursing and healthcare students, whose professional roles require not only
accurate knowledge but also the ability to educate others and advocate for HIV awareness within clinical and
community settings.
These challenges are not unique to Malaysia but reflect a broader global pattern. Studies in Kenya, South Africa,
and China show that university students, despite having moderate levels of HIV knowledge, continue to engage
in high-risk sexual behaviors due to peer influence, negative attitudes, misinformation, and a perceived sense of
invulnerability [2, 24]. Similarly, research across Asia and Africa indicates that while awareness campaigns
improve general knowledge, they often fail to produce lasting behavioral change without structured, evidence-
based educational approaches that address both cognitive understanding and motivational factors [30, 11].
In Malaysia, many university-based HIV campaigns tend to be short-term, lecture-style, and unstructured, often
lacking systematic evaluation to measure their effectiveness. Consequently, students may acquire factual
information without translating it into meaningful behavioral outcomes. This gap underscores the need for
targeted, structured HIV health education programs that are interactive, student-centered, and grounded in
established behavioral theories.
To address this issue, the present study proposes evaluating the effectiveness of a four-hour structured HIV
health education talk, conducted by the researcher, a nursing academic and health educator, designed to improve
students’ HIV-related knowledge, reduce risky behaviors, and enhance engagement in preventive measures. The
intervention adopts a student-centered, interactive approach that bridges the gap between awareness and practice,
guided by the Knowledge–Attitude–Practice (KAP) Model and the Health Belief Model (HBM). By integrating
these frameworks, the study aims to demonstrate how well-designed educational interventions can enhance HIV
literacy, reshape risk perceptions, and promote sustained preventive behaviors among Malaysian university
students.
Definition And Concept Clarification
Understanding HIV-related behavior among Malaysian university students requires a clear conceptual
foundation. For this concept paper, the Knowledge, Attitude, and Practice (KAP) model serves as the primary
framework for examining how students acquire HIV-related information, interpret it through emotional and
cultural lenses, and ultimately translate it into behavioral choices. This model is widely used in public health to
investigate behavioral determinants and guide health education interventions across various populations [14,3].
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Knowledge refers to students’ factual understanding of HIV transmission routes, symptoms, risk factors,
preventive methods, and available treatment. This cognitive domain forms the basis of risk recognition and
informed decision-making. However, evidence consistently demonstrates that high levels of knowledge do not
automatically lead to behavior change, particularly in contexts where misinformation, cultural sensitivity, or
social stigma prevail. Studies among university populations in Africa and Asia show that students may possess
adequate knowledge yet continue engaging in unsafe sexual practices due to conflicting beliefs or low perceived
vulnerability [2, 24].
Attitudes encompass beliefs, perceptions, emotional responses, and moral judgments related to HIV and people
living with HIV (PLHIV). In Malaysian university settings, attitudes are shaped by cultural expectations,
religious influence, peer norms, and societal stigma. These affect students’ willingness to undergo HIV testing,
discuss sexual health, purchase condoms, or engage in preventive behaviors. Negative attitudes such as fear,
shame, and judgment have been shown to limit participation in HIV programs and increase the likelihood of
secrecy around sexual behavior [8].
Practices represent the behavioral manifestation of students’ knowledge and attitudes. For this study, practices
are categorized into two domains:
1 Risky behaviors such as unprotected sex, multiple partners, and substance use before sexual activity.
2 Preventive measures including condom use, HIV testing, risk reduction, and consistent engagement with
sexual health information.
These behaviors indicate whether existing knowledge and attitudes are being translated into protective action.
However, evidence shows that practices are heavily influenced by personal, social, and structural factors such
as peer pressure, cultural norms, perceived stigma, and access barriers [6, 18].
Although KAP components are distinct, they are interconnected. Knowledge often shapes attitudes, and attitudes
influence practices, but the process is not linear. Students may know the facts yet continue unsafe behavior due
to embarrassment, denial, low self-efficacy, or perceived invulnerability. Therefore, KAP is best understood as
a dynamic construct shaped by context and moderated by psychosocial influences commonly faced by university
students in Malaysia.
It is important to distinguish KAP from related constructs. Health literacy involves the broader ability to seek,
understand, and apply health information; risk perception concerns subjective vulnerability; and behavioral
intention reflects motivational readiness often described in the Theory of Planned Behavior. Although these
interact with KAP, they do not capture the integrated cognitive–emotional–behavioral continuum that the KAP
model embodies.
Figure 1 below illustrates the concept of the KAP model and its roles in shaping HIV-related behavior among
university students.
Figure 1: Concept of KAP Model
Theoretical Foundations Related to HIV
To strengthen the conceptual grounding of this study, the Health Belief Model (HBM) is integrated alongside
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the KAP model. While KAP outlines the cognitive and behavioural progression of knowledge influencing
attitudes and practices, the HBM explains the psychological factors that determine whether an individual will
act on that knowledge. This dual approach is essential given the persistent behavioural gap documented among
Malaysian university students, where rising HIV infections occur despite increased national prevention efforts.
Within the KAP framework, knowledge encompasses students’ understanding of HIV transmission, prevention,
and treatment; attitudes reflect beliefs and emotional responses toward HIV and PLHIV; and practices include
risk-taking and preventive behaviours. Malaysian evidence indicates that misconceptions such as believing HIV
can spread through casual contact or that symptoms are always visible persist despite widespread educational
campaigns. These knowledge gaps are compounded by stigma, moral judgments, and limited sexual health
education, which collectively influence attitudes and deter preventive action [13].
The HBM complements the KAP model by addressing the internal motivations and perceived barriers that shape
health behaviour. Its six core constructs are:
• Perceived susceptibility – students’ beliefs about their likelihood of contracting HIV.
• Perceived severity – beliefs about the seriousness of HIV infection.
• Perceived benefits – beliefs that preventive actions (e.g., condom use, testing) will reduce risk.
• Perceived barriers – obstacles such as stigma, embarrassment, cultural taboos, or access issues
• Cues to action – triggers that prompt behavioural change such as educational talks, peer discussions, or digital
reminders.
• Self-efficacy – confidence in one’s ability to adopt preventive behaviours.
These constructs explain why students who possess accurate HIV knowledge may still avoid testing or fail to
use condoms consistently. For instance, a student may understand HIV risks but feel embarrassed buying
condoms (a perceived barrier), or believe that HIV “won’t happen to them” (low perceived susceptibility). These
psychological factors are critical in shaping HIV-related practices among young adults.
In the context of this concept paper, the structured 4-hour HIV health education talk serves as a targeted cue to
action intended to:
1. Increase perceived susceptibility and severity
2. Strengthen perceived benefits of preventive behaviour
3. Reduce barriers by addressing stigma and misconceptions
4. Enhance self-efficacy through interactive learning and discussion
In doing so, the intervention bridges the gap between knowledge and practice, an essential step identified in the
uploaded study background and national HIV statistics.
Figure 2 illustrates how the KAP model applies to HIV behaviour among university students.
Figure 2: KAP Model Related to HIV
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Integration of Kap Model and Health Belief Model
The integration of KAP and HBM strengthens the theoretical foundation of this concept paper by combining
both cognitive–behavioural and psychological determinants of HIV-related behaviour. The KAP model provides
a natural sequence, knowledge shaping attitudes, which influence practices while the HBM adds depth by
explaining why individuals may or may not take preventive actions, even when they are knowledgeable.
Among Malaysian university students, this dual framework is highly applicable. Young adults are at a
developmental stage where increased autonomy, peer influence, sociocultural expectations, and reduced parental
monitoring intersect. At the same time, many are constrained by religious conservatism, stigma surrounding
sexual health, and limited access to comprehensive sexual education. These competing dynamics may lead to
inconsistencies between what students know and what they do. For example, a student may understand HIV risk
yet continue unprotected sex due to peer pressure, romantic dynamics, or embarrassment discussing condom
use.
Educational interventions must therefore go beyond delivering information. They need to reshape attitudes,
challenge stigma, address perceived barriers, and build confidence in adopting preventive behaviours. A
structured, interactive HIV education talk can effectively serve this role by functioning as both a knowledge-
enhancing mechanism (KAP) and a cue-to-action plus motivation-enhancer (HBM).
Figure 3 presents key HBM constructs relevant to HIV prevention.
Figure 3: Health Belief Model
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Figure 4 demonstrates the integrated theoretical framework guiding this concept paper.
Figure 4: Integrated KAP–HBM Framework Related to HIV
Research Objectives
General Objective
To evaluate the effectiveness of a structured HIV health education, talk in improving HIV-related knowledge,
reducing risky behaviors, and enhancing preventive measures among Malaysian university students.
Specific Objectives
1. To assess baseline levels of HIV-related knowledge, attitude, risky behaviors, and preventive
measures among Malaysian university students.
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2. To evaluate post-session levels of HIV-related knowledge, attitude, risky behaviors, and preventive
measures among students who receive the structured HIV health education talk.
3. To compare post-session scores between the intervention and control groups to determine the
effectiveness of the educational talk.
4. To examine associations between socio-demographic factors and students’ baseline levels of HIV-
related knowledge, attitude, risky behaviors, and preventive measures.
Research Questions
1. What are the baseline levels of HIV-related knowledge, attitude, risky behaviors, and preventive
measures among Malaysian university students?
2. How do post-session scores of HIV-related knowledge, attitude, risky behaviors, and preventive
measures differ among students who receive the structured HIV health education talk?
3. Is there a significant difference in post-session outcomes between the intervention and control
groups?
4. What associations exist between socio-demographic factors and baseline scores on HIV-related
knowledge, attitude, risky behaviors, and preventive measures?
Significance of the Study
Students
University students are at a formative stage of life where their sexual health decisions carry long-term
consequences. By participating in this study, students gain reliable and practical knowledge on HIV transmission
and prevention. The structured session will empower them to make safer choices, recognize personal risk, and
engage in preventive behaviors such as consistent condom use and voluntary testing. Furthermore, the session
encourages open dialogue and peer awareness, fostering a culture of responsibility and compassion toward
people living with HIV.
Universities
The findings will provide universities with evidence-based insights into the current state of students’ HIV
knowledge and behavioral risk factors. Institutions can use these results to design targeted campus health
programs and integrate short, structured health education modules into orientation or health-week activities.
Conducting sessions led by qualified health professionals ensures accuracy, credibility, and impact in student
learning outcomes.
Public Health Policymakers
The study contributes to Malaysia’s efforts to achieve the UNAIDS 95–95–95 goals by offering practical data
on the effectiveness of short-duration, structured interventions in university settings. The results can inform
policy formulation under the Ministry of Health Malaysia’s National Strategic Plan to End AIDS, highlighting
how targeted educational interventions can reduce new infections among youth, a group that accounted for over
20% of recent HIV cases nationwide [1, 33].
Future Research
Few Malaysian studies have evaluated HIV prevention education using a quasi-experimental design. This
research therefore adds to the limited body of evidence on the measurable impact of brief educational
interventions. The findings can serve as a foundation for future longitudinal or cross-institutional studies
examining sustained behavioral change, stigma reduction, and the long-term effects of similar programs among
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young adults.
Empirical Evidence and Literature Review
A growing body of empirical literature has examined HIV-related knowledge, attitudes, risky behaviours, and
preventive measures among youth and young adults across global, regional, and national contexts. While general
awareness of HIV and AIDS tends to be high among university students, deeper analysis consistently reveals
substantial gaps in knowledge accuracy, perception of risk, and engagement in safe sexual practices. These
shortcomings are often influenced by cultural taboos, stigma, misinformation, and limited access to youth-
friendly and confidential health services, which collectively undermine the effectiveness of existing HIV
prevention strategies.
Globally, numerous studies highlight the prevalence of the knowledge-behaviour gap among youth. In Uganda,
Akello et al. reported that while 80% of students had heard of HIV or AIDS, only 53% correctly understood key
modes of transmission and prevention [2]. In Ghana, Arhin and Gyimah found that first-year university students
generally supported HIV testing but demonstrated low awareness of asymptomatic infection and treatment
adherence [3]. These findings suggest that superficial awareness is insufficient to change behaviour unless
supported by deeper cognitive and attitudinal shifts.
In Southeast Asia, similar trends have been documented. Fana reported common misconceptions about non-
sexual transmission, such as HIV spreading through casual contact, reinforcing stigma and fear [14]. A national
study in Thailand by Liu et al. found that even among educated populations, HIV-related stigma persisted and
remained a major barrier to voluntary testing [24]. Students’ attitudes were shaped by religious teachings, moral
judgments, and gender norms, influencing perceptions of risk and decisions about prevention [24].
In Malaysia, empirical data underscore the urgency of addressing HIV risk among university students.
Surveillance reports show that from 2020–2024, over 1,000 university students tested positive for HIV, with 222
cases reported in 2024 alone [1]. Most occurred among males aged 20–29, the demographic most represented in
universities [33]. The main mode of transmission continues to be unprotected sexual activity involving
inconsistent condom use and low uptake of testing services [32, 20].
Studies conducted in Malaysian universities further support these concerns. Fatimah Sham et al. found that only
61% of undergraduates knew HIV is not transmitted through sharing utensils, revealing gaps in fundamental
knowledge [13]. Fewer than half reported regular condom use. Che Hashim et al. found ongoing reluctance to
undergo testing due to fear of judgment and confidentiality concerns [8]. These patterns indicate that knowledge
acquisition has not translated into consistent protective behaviour.
Stigmatizing attitudes also continue to be a major barrier. JadKarim et al. demonstrated that negative attitudes
toward PLHIV were associated with lower intentions to use condoms and avoid testing [20]. Moral or religious
beliefs often contributed to the perception that HIV infection is a result of immoral behaviour, reinforcing silence
and denial.
Behaviourally, many studies have documented risky sexual practices among students, even among those exposed
to HIV education. Calderón et al. explained that knowledge alone does not change behaviour unless accompanied
by self-efficacy, access, and social support [6]. This finding is consistent with Malaysian studies such as Chong
et al., which found avoidance of testing despite understanding its importance [9].
Educational interventions have shown mixed outcomes. Peer-led programs improved knowledge and attitudes
but had modest effects on behaviour change [9]. Digital interventions expanded access but often lacked
emotional and motivational engagement.
There is increasing recognition that HIV prevention programs for university students must go beyond
information-only approaches and adopt holistic, theory-driven interventions. Programs must consider not only
what students know, but how they feel, how they perceive their vulnerability, and what real-world barriers they
face. This study responds to that need by integrating the Knowledge–Attitude–Practice (KAP) model and the
Health Belief Model (HBM) into a structured educational intervention tailored specifically to Malaysian
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university students.
TABLE I
Theoretical
Framework
Associated Authors
Study Focus Cluster
Knowledge, Attitude,
and Practice (KAP)
Model
Akello et al. (2023), Arhin and
Gyimah (2021)
Global HIV awareness among youth
Fana (2021), Liu et al. (2022)
HIV knowledge and stigma in Southeast Asia
Fatimah Sham et al. (2020), Che
Hashim et al. (2024)
HIV knowledge and behavior in Malaysian
universities
Chong et al. (2021)
Peer education impact on knowledge and
attitudes
Health Belief Model
(HBM)
Jad Karim et al. (2023)
HIV testing reluctance due to stigma and risk
perception
Calderón et al. (2015), Chong et
al. (2021)
Risky behavior despite HIV knowledge
Current Study (Concept Paper
Proposal)
Justification for structured intervention
RESEARCH METHODOLOGY
Research Design
The study will employ a quasi-experimental pre-test and post-test design with a control group to assess the
effectiveness of the intervention. Both groups will complete validated questionnaires before and two weeks after
the intervention. The design enables comparison of changes within and between groups, identifying measurable
improvements attributable to the educational session.
Participants
A total of 100 Malaysian university students, aged 18 to 30 years, will be recruited through purposive sampling.
Participants will be equally divided into two groups:
• Intervention Group (n = 50): Will attend the structured HIV health education talk.
• Control Group (n = 50): Will not receive the intervention during the study period but will complete the same
pre- and post-assessments.
Inclusion Criteria:
Malaysian undergraduates (Diploma/Degree), aged 18–30, able to read English or Bahasa Malaysia, willing to
participate, and provide informed consent.
Exclusion Criteria:
Individuals previously diagnosed with HIV/AIDS, those who have attended similar HIV educational sessions in
the past six months, or who cannot complete both assessments.
Instrumentations
1. Brief HIV Knowledge Questionnaire (HIV-KQ-18) – Carey & Schroder (2002)
2. Attitudes towards HIV are measured using the HIV Attitudes Scale (HIV-AS) developed by Gómez-
Lugo et al. (2020).
3. HIV Risky Behaviour Questionnaire – Folasayo et al. (2017)
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4. HIV Preventive Measures Questionnaire – Folasayo et al. (2017)
Each instrument demonstrates strong reliability (Cronbach’s α ≥ 0.70). Instruments will be adapted for linguistic
and cultural appropriateness for Malaysian students.
Intervention
The intervention comprises a single 4-hour educational talk delivered by the researcher, who is a nursing
academic experienced in HIV education. The session will be conducted online via Google Meet, ensuring
accessibility for participants from various universities. The content is evidence-based and designed to promote
awareness, correct misconceptions, and empower behavioral change in line with the Health Belief Model such
as perceived risk, benefits, and barriers and the KAP framework that links knowledge to practice.
TABLE II
Time
Session Component
8:30 – 9:00 AM
Registration & Pre-Test
9:00 – 9:20 AM
Opening Remarks &
Introduction
9:20 – 10:00 AM
Session 1: Knowledge
(Transmission & Risk
Factors)
10:00 – 10:45 AM
Session 2: Attitudes
Exploring beliefs and stigma toward HIV and PLHIV,
personal values, and the importance of empathy and
support.
10:45 – 11:00 AM
Morning Break
11:00 – 11:45 AM
Session 3: Risky
Behaviours Among
Students
11:45 – 12:30 PM
Session 4: Preventive
Strategies
12:30 – 1:00 PM
Interactive Segment &
Q&A
1:00 – 1:15 PM
Conclusion & Summary
1:15 – 1:30 PM
Closing &
Acknowledgements
Data Collection Procedure
1. Pre-Test: Distributed via Google Form before the talk for both groups.
2. Intervention: Four-hour online session conducted by the researcher.
3. Post-Test: Two weeks after the session, the same questionnaires will be re-administered to both groups.
Data will be coded anonymously to maintain participant confidentiality.
Data Analysis
Data will be analyzed using IBM SPSS Version 26:
1. Descriptive statistics (frequencies, mean, SD) to summarize demographic data.
2. Paired sample t-tests/Wilcoxon signed-rank tests to measure pre- and post-test changes within groups.
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3. Independent sample t-tests/Mann–Whitney U tests to compare post-test outcomes between groups.
4. Chi-square and correlation analyses to examine relationships between socio-demographic factors and
baseline variables.
A significance level of p < 0.05 will be considered statistically significant.
Ethical Considerations
Ethical approval will be obtained from OUM ethical committee and the respective universities ethics committees
prior to data collection. All participants will provide informed consent, and anonymity will be maintained
throughout. Data will be stored securely in a password-protected database and used strictly for academic research
purposes.
CONCLUSIONS
This study aims to evaluate the effectiveness of a structured HIV health education talk in improving HIV-related
knowledge, reducing risky behaviours, and increasing preventive actions among Malaysian university students.
Using a quasi-experimental pre-test and post-test design, the research will provide valuable evidence on how
short, focused educational programs when facilitated by qualified health professionals can contribute to
behavioural change. The results will inform both campus-based initiatives and broader national strategies aimed
at curbing HIV transmission among young adults in Malaysia.
ACKNOWLEDGMENT
The I would like to express my sincere appreciation to everyone who contributed to the development of this
concept paper. My gratitude goes to Open University Malaysia for providing academic guidance and a
supportive learning environment. I am deeply thankful to my lecturers and supervisors for their constructive
feedback, encouragement, and expert insights throughout this process. I also extend heartfelt thanks to my
colleagues and peers for their continuous support and meaningful discussions that strengthened this work.
Finally, I acknowledge my family and friends for their patience, motivation, and unwavering belief in my
academic journey.
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