Background: HIV/ AIDS is a global pandemic. Sub-Saharan Africa accounts two- thirds of the newly HIV infected cases in the world. Similarly, the prevalence of HIV infections among Ethiopian university students has also increased, as HIV prevention was not sufficiently prioritized. In order to decrease the surge of the HIV pandemic, prevention messages that encourage individuals to reduce sexual and risk behaviors still remain a key intervention strategy. Besides this, the behavioral response to HIV prevention messages among Ethiopian universities is not well studied.

Objective: To assess students’ behavioral response to HIV/AIDS prevention messages in selected universities of the Amhara region using Extended Parallel Process Model (EPPM), 2019.

Methods: A facility-based cross-sectional study was employed among 423 eligible students from January to February, 2019 using stratified sampling technique. The dependent variable is response to HIV/AIDS prevention messages (danger control and fear control) which is addressed by EPPM. The model explains the components of threat (perceived susceptibility and perceived severity) and efficacy (response efficacy, self-efficacy).   Subtracting wings of threat component score from efficacy wings score gives the critical value.  If the critical value had positive scores, it shows responses of danger control; if the critical value is negative, it shows response of fear control.  A logistic regression model was fitted to assess the association between the dependent and independent variables.

Result: The response rate of this study is 94.6%.  Among 400 respondents, 263(65.8%) with 95% CI (61,70) of them were in danger control response whereas 137(34.2%) with 95% CI (30, 39) were in fear control response. Moreover, 200(50%) of the participants had adequate knowledge and 180(45%) had a favorable attitude towards HIV/AIDS prevention messages. Danger control response for HIV prevention messages were higher among first-year students [AOR=5.5; 95% CI (1.5, 19)] and third year students [AOR= 3.9; 95% CI (2, 14)] as compared with fifth-year students. Similarly, those students who reside on the campus were 60% times less likely to develop danger control when compared with students who live within their family [AOR= 0.4; 95% CI (0.2, 0.9)]. Besides this, students who had adequate knowledge [AOR= 2.6; 95% CI (1.5, 4.5)] and students who receive fear-inducer messages [AOR= 4.5; 95% CI (3, 25)] were more likely to develop danger control responses.

Conclusion and recommendation: Nearly 2/3 of the participants were in danger control response.  Year of study, with whom students currently live, type of message they received, and the knowledge level of respondents were the factors associated with students’ response to HIV/AIDS prevention messages. Therefore, the messages must aim on enhancing threat components perception with appropriate efficacy messages to control danger and promote behavioral change.