Barriers to sexual and reproductive health services among Albanian university students

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.