Abstract
Aim: To examine multilevel sexual-health vulnerability in higher education and distinguish evidence about knowledge, preventive behaviour, service use and infection-related outcomes. Subject and Methods: The authors conducted a structured critical review of a pre-existing 118-reference bibliography, retaining a publication boundary of 25 May 2026. The reference-based evidence map was documented on 8 October 2026. Sources were classified by population, design and relevance; 38 candidate reports received content-level assessment. Source-linked information and the availability of supporting material were recorded. The review was human-led, with artificial intelligence used as an assistive tool. Results: Thirty-three empirical higher-education reports were charted and 85 references retained as context. The mapped reports comprised 18 cross-sectional analyses, six randomised trials, five other intervention evaluations, three qualitative studies and one participatory mixed-methods study. They described gaps between knowledge and practice, uneven testing and vaccine uptake, and barriers involving confidentiality, stigma and service design. Digital interventions had outcome-specific findings: educational gains did not consistently translate into behaviour or vaccination. Companion reports and mixed denominators precluded summing participants. The documentation supporting many charted fields was limited to abstracts or excerpts. Conclusion: University prevention should connect education and behavioural capability with accessible testing, biomedical prevention and continuity of care. The proposed five-level framework is a service-design and research proposition, not a validated risk score. The bounded bibliography and uneven source documentation limit completeness and certainty.