Abstract
BACKGROUND: Access to sexual and reproductive health (SRH) services remains limited among university students in Albania, despite global progress in HIV/STI prevention. Low awareness, stigma, and fragmented youth-friendly services continue to hinder preventive healthcare utilization. Understanding the factors shaping SRH-seeking behavior is essential for designing effective interventions. METHODS: A cross-sectional study was conducted among 7,679 students from public and private universities in Albania (2024-2025). A structured, validated questionnaire assessed SRH knowledge, awareness of testing locations, condom access, and use of preventive services. Descriptive statistics, chi-square tests, and multivariable logistic regression were performed to identify predictors of HIV/STI testing, guided by Andersen's Behavioral Model. RESULTS: SRH service utilization was low, with only 11.4% of students reporting STI screening and 7.6% HIV testing. Students who were aware of testing locations had significantly higher odds of ever being tested (OR = 7.52; 95% CI: 6.21-9.09). Gender differences were pronounced, female students were more likely to report condom non-use and uncertainty about access points. Although sexual health education was associated with testing in bivariate analyses, only parental communication remained significant in the adjusted model. CONCLUSIONS: Significant gaps in SRH awareness, access, and preventive healthcare engagement exist among Albanian university students. Enabling factors, particularly knowledge of service availability, play a greater role in influencing utilization than individual or predisposing characteristics, consistent with Andersen's Behavioral Model. Strengthening youth-friendly SRH services, increasing the visibility of testing sites, integrating SRH education into university programs, and addressing gender-specific barriers are essential to improve uptake of preventive SRH services in Albania.