Social inequalities in sexual health: gender, age, and education on university students in Albania

Abstract Background Disparities in sexual and reproductive health (SRH) knowledge, behaviours, and healthcare access persist among young adults in Albania. Gender, age, and prior SRH education significantly influence preventive behaviours and healthcare utilization. Understanding these factors is critical for designing targeted interventions to improve health outcomes. Methods A cross-sectional study was conducted among 7,679 university students across Albania using a structured survey to assess SRH knowledge, STI prevention behaviours, and access to healthcare services. Statistical analyses, including chi-square tests and logistic regression, were performed to examine differences in SRH outcomes based on gender, age, prior SRH education, and university type. Results Female students were more likely to engage in routine gynaecological visits (p < 0.001) and Pap testing (p < 0.001), while male students exhibited earlier sexual debut and lower condom use consistency. Older students showed greater STI prevention awareness but did not necessarily seek healthcare services more frequently. Previous exposure to sexual and reproductive health (SRH) education emerged as a strong predictor of engagement in preventive healthcare. Students who had received formal SRH instruction were significantly more likely to undergo STI and HIV testing (p < 0.001). The overall uptake of testing services remained critically low-only 11.4% had been screened for STIs, and a mere 7.6% had received HIV testing. Conclusions This study underscores the impact of gender, age, and SRH education in shaping SRH knowledge, preventive behaviours, and healthcare access among young adults. While minor differences exist between public and private university students, larger disparities are driven by educational background and gender norms. Key messages • Female students engage more in preventive healthcare, while male students report riskier sexual behaviors. Formal SRH education significantly increases STI/HIV testing rates. • Over half of the students don’t know where to get tested. Despite slightly higher awareness among public university students, testing rates remain critically low.