Background In 2008, the HIV prevalence among men having sex with men (MSM) in Manipur state, India was 17.21%. Project ORCHID is an Indian HIV prevention project funded by Avahan India, which supports local partner NGOs to deliver a range of harm reduction interventions targeting injecting drug users, men having sex with men and female sex workers. It reaches up to 1450 MSM in two districts of Manipur and Nagaland. To measure HIV risk behaviour among this group, a census survey was carried out in 2010.

Methods Male sex workers (n = 1446) enrolled in the targeted intervention programme were interviewed through questionnaires. Peer educators and community volunteers met MSMs individually and administered the questionnaires. Variables were analysed using multivariate linear regression.

Results 1407 MSM returned valid responses regarding their sexual behaviour, out of whom 62.2% (n = 899) reported unsafe anal sex in the previous week. Out of the 1446 interviewed 61% (n = 858) reported alcohol consumption at the most recent sexual encounter with another MSM.

Variables including age, identity, literacy, marital status, number of partners, and alcohol consumption were tested for association with unsafe anal sex by bivariate analysis, and only number of partners, identity and consumption of alcohol at last sex were found significant and were included in the regression model. Age, although not significant, was also included.

Linear regression analysis (n = 1407) showed that identity, having more partners, and consumption of alcohol at the time of the most recent sex act were all significantly associated with higher rates of unsafe sex.

Conclusion HIV prevention programmes among MSM in India need to address issues of alcohol use and design appropriate interventions to reduce vulnerabilities of MSM in this regard. Interventions should also consider the particular risks and needs of those with sexual identities associated with more ano-receptive sex and high volume of partners.