Background Early sexual debut and non-consensual sex among men who have sex with men (MSM) may contribute to adult high-risk behaviors and STI transmission. Most knowledge about early MSM sex comes from high-income countries. This study examined the prevalence and factors associated with the early sexual debut and non-consensual sex at sexual debut among Chinese MSM.

Methods An online cross-sectional study was conducted among MSM who were born as a male, ≥16 years-old, and ever engaged in anal sex with a man in China in 2016. Participants answered questions regarding sociodemographics, condomless sex, and HIV testing history. Early sexual debut was defined as having anal sex before 18. Non-consensual sex was defined as “where a person do sexual things to you that you did not want them to do.” Multivariable logistic regression was used to identify factors associated with the early sexual debut and non-consensual sex.

Results Overall, 2105 men completed the survey. Among them, 85.9% were never married, and 35.4% had high school or less education. The mean age of sexual debut was 20.82 (SD=5.30) years. About one-fifth (20.1%, 424/2105) of men experienced early sexual debut, and 4.9% (104/2105) experience non-consensual sex at sexual debut. Results from multivariable logistic regression models showed that early sexual debut was associated with having more male partners in the last three months (adjusted OR 1.08 [95% CI 1.04–1.13]) and condomless sex in the last three months (1.49 [1.18–1.89]). MSM whose sexual debut was non-consensual were more likely to have tested for HIV (1.56 [1.01–2.42]), have had recent condomless sex (1.70 [1.13–2.56]), and to experience early sexual debut (2.54 [1.65–3.89]).

Conclusion Many Chinese MSM experience early sexual debut and non-consensual sex at sexual debut. Given the limited coverage of sexual health education in China, this has implications for expanding education and research about sexuality among youth.

Disclosure No significant relationships.