Jonila Gabrani, Lumturi Merkuri, Iva Rugia, Rovena Kushta, Kristi Cela

Background: Understanding sexual health inequalities among university students is essential to inform targeted public health interventions. Previous studies show that knowledge, attitudes, and behaviors differ based on sociodemographic variables such as gender, age, and level of education. Objective: This study aims to assess how gender, age, and SRH education influence knowledge, behaviors, and use of sexual and reproductive health (SRH) services among Albanian university students. Methods: A cross-sectional survey was conducted with 7,679 university students in public and private institutions across Albania. A structured questionnaire assessed SRH knowledge, STI prevention behaviors, and access to healthcare services. Statistical analyses included chi-square tests and logistic regression to examine relationships between sociodemographic variables and SRH outcomes. Results: Female students reported higher engagement in preventive practices such as gynecological visits and Pap tests (p < 0.001), while male students reported earlier sexual debut and less consistent condom use. Prior SRH education significantly increased the likelihood of STI/HIV testing (p < 0.001). Age was positively associated with STI awareness but not necessarily with service use. Only 11.4% of respondents reported STI testing, and 7.6% had been tested for HIV, while 53.8% were unaware of available testing services. Conclusion: This study highlights disparities in SRH knowledge and service utilization driven by gender, age, and educational exposure. Tailored public health programs that integrate SRH into university curricula and emphasize outreach to young men and underserved populations are needed to reduce inequities and promote preventive behaviors.