Abstract
BackgroundAdolescent sexual debut and non-consensual sex have been linked to higher sexual risk and STI infection in adulthood among men who have sex with men (MSM) in high-income countries. This study aimed to examine adolescent and non-consensual anal sexual debut among Chinese MSM and to evaluate factors associated with adolescent sexual debut and non-consensual anal sex.MethodsA cross-sectional study was conducted recently among Chinese men assigned male sex at birth, ≥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. Factors associated with an adolescent sexual debut (< 18 years old) and non-consensual sex at sexual debut were evaluated. We defined adolescent sexual debut as having anal sex with another man at 17 years old or younger, and the participants were asked whether their first male-to-male anal sex was non-consensual.ResultsOverall, 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 adolescent sexual debut, and 5.0% (101/2031) reported a non-consensual sexual debut. The adolescent 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 the last three months (AOR = 1.71, 95% CI 1.34–2.18). 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 adolescent sexual debut (AOR = 2.72, 95% CI 1.75–4.21).ConclusionsMany Chinese MSM reported adolescent 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 designing tailored interventions for MSM who experienced adolescent sexual debut and non-consensual sex at debut.
Highlights
Adolescent sexual debut and non-consensual sex have been linked to higher sexual risk and sexually transmitted infection (STI) infection in adulthood among men who have sex with men (MSM) in high-income countries
Most research on sexual debut and non-consensual sex among MSM has been focused on high-income countries [1, 7], and less is known about these phenomena in low- and middle-income countries where social taboos regarding same-sex behaviors are strongly endorsed but with limited denunciation of non-consensual sex [3]
This study aimed to examine adolescent and nonconsensual sexual debut among Chinese MSM and to evaluate factors associated with adolescent sexual debut and non-consensual anal sex
Summary
Adolescent sexual debut and non-consensual sex have been linked to higher sexual risk and STI infection in adulthood among men who have sex with men (MSM) in high-income countries. Though non-consensual sex in MSM has been explored, [8, 9] limited studies to date have assessed this issue in the context of adolescent sexual debut The intersection of these two factors is important because trauma related to early sexual experiences can lead to high-risk sexual behaviors in adulthood [1, 3]. Due to social and cultural pressures of the local environment, MSM in China are often subject to stigma and social discrimination [10, 11] As a result, they receive limited sexual health education from guardians or in schools, potentially leaving them with limited knowledge of safer sex practices [12, 13]. The studies on adolescent sexual debut and non-consensual sex among Chinese MSM are very limited [3, 14], and knowing these may guide the designing of future sexual health education and interventions for Chinese MSM
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