Early and non-consensual sexual debut among Chinese men who have sex with men: a cross-sectional study

Abstract Background Early sexual debut and non-consensual sex have been linked to higher sexual risk and STI infection among men who have sex with men (MSM) in high-income countries. This study aimed to examine early and non-consensual sexual debut among Chinese MSM and to evaluate factors associated with early sexual debut and non-consensual sex. Methods A cross-sectional study was conducted in 2016 among Chinese men born biologically male, ≥ 18 years old, and who had ever engaged in anal sex with a man. Participants answered questions regarding socio-demographics, condomless sex, age at anal sexual debut with a man, and whether the first anal sex was consensual sex. Factors associated with an early sexual debut (< 18 years old) and non-consensual sex at sexual debut were evaluated. Results Overall, 2031 eligible men completed the survey. The mean age of sexual debut was 20.7 (SD = 4.3) years old. 17.6% (358/2031) of men reported early sexual debut, and 5.0% (101/2031) reported a non-consensual sexual debut. Early sexual debut was associated with having more male sexual partners (adjusted OR 1.10, 95% CI 1.06–1.15) and condomless anal sex in last three months (AOR = 1.71, 95% CI 1.34–2.18) in last three months. MSM whose sexual debut was non-consensual were more likely to have condomless anal sex (AOR = 1.76, 95% CI 1.17–2.66), and to have reported an early sexual debut (AOR = 2.72, 95% CI 1.75–4.21). Conclusions Many Chinese MSM reported early sexual debut and non-consensual sex, both of which are associated with sexual risk behaviors and drive STI transmission. These findings highlight the need for improving sexual health education among young people.