What psychosocial factors shape HIV testing willingness among Chinese college students? A cross-sectional survey integrating PLS-SEM and fsQCA

Background HIV/AIDS remains a major global health issue, and young students are a key affected group. Conventional interventions have overlooked students’ psychological and behavioural differences, reducing their impact. This study will identify specific psychosocial factors that drive college students to get HIV testing. Methods We surveyed 4451 college students in various regions in China from December 2022 to March 2023. Analysis occurred in two steps. First, we used partial least squares structural equation modelling (PLS-SEM) to test linear causal relationships among psychosocial constructs. Second, we used fuzzy set qualitative comparative analysis (fsQCA) to pinpoint combinations leading to high willingness for HIV testing. Results In PLS-SEM, lower HIV stigma (β=0.352, 95% CI 0.311 to 0.391) and higher condom-use self-efficacy (β=0.087, 95% CI 0.056 to 0.120) were associated with stronger safe-sex intention, which was associated with higher testing willingness (β=0.067, 95% CI 0.053 to 0.081). FsQCA identified five distinct pathways leading to high HIV testing willingness (coverage=0.788, consistency=0.790). The main types were (1) students with strong condom use intention; (2) students with low HIV stigma and supportive environments; (3) students with high risk perception and preventive actions; (4) students with high self-efficacy and HIV knowledge and (5) students confident in risk management and willing to test despite risk. These findings show there are multiple clear ways students reach a high willingness for HIV testing. Conclusion Using a dual analytic approach, we found that lower HIV stigma and higher condom-use self-efficacy were associated with greater safe-sex intention, which in turn was associated with higher HIV testing willingness. fsQCA further suggested multiple psychosocial configurations linked to high willingness. These findings may inform a combined universal-plus-tailored approach to campus HIV testing promotion, while longitudinal and intervention studies are needed to test causality.