Abstract: Objective To understand the acceptability of early initiation of antiretroviral therapy (ART) among HIV positive men who have sex with men (MSM) and sero-discordant couples in Hangzhou and explore the influencing factors on early initiation of ART. Methods The questionnaire survey was conducted among the patients met the inclusion criteria. Results Totally 235 valid questionnaires were collected, in which 159 said yes to accept early initiation of ART, accounting for 67.66%. The proportions of HIV positive MSM and sero-discordant couples who would like to receive ART were 65.63% and 76.74% respectively, the difference had no statistical significance (2=1.99,P=0.16). The positive factors on ART acceptability included the thoughts that ART would delay the progress to AIDS and drug resistance would develop due to late ART, and the negative factors included the thought that HIV infection status might be exposed if receiving ART and higher education level. Conclusion In order to promote the early initiation of ART and prevent the spread of AIDS, it is necessary to conduct active health education to improve the awareness of early ART importance among HIV infected persons and decrease the discrimination to HIV infected persons.