Background HIV prevalence among female sex workers (FSW) is around eight times higher than general population in India. There is limited information on alcohol use and related risk factors among FSWs in the country. To inform HIV prevention interventions, we assessed the patterns of alcohol use among FSWs and its association with background characteristics and other risk behaviour using data from a bio-behavioural survey (2009–2010).

Methods 7,806 women aged 18 years or older who sold sex in exchange of cash at least once in past month were recruited from Andhra Pradesh, Tamil Nadu and Maharashtra states in India using two-stage time location cluster sampling. Behavioural information was collected through structured questionnaires, blood and urine specimens were tested for HIV and other STIs.

Results About one fourth (26%) of FSWs reported consuming alcohol daily or at least once a week, and termed as ‘frequent’ alcohol users. Among them, four-fifth were aged above 24 years, 68% illiterate, 63% currently married, 29% had experienced physical violence, 58% were in sex work profession for more than five years and 78% were using condom consistently with regular clients. The frequent alcohol users were more likely to be in sex work for five plus years (AOR: 1.42, p < 0.05), had 10 or more clients per week (AOR: 1.53, p < 0.05), experienced physical violence (AOR: 1.64, p < 0.05), were in-debt (AOR: 1.71, p < 0.05) and reported anal sex with clients (AOR: 1.81, p < 0.05). However, frequent alcohol use was not associated with increased STIs (NG/CT/Syphilis) and HIV prevalence.

Conclusion These findings suggest the frequent alcohol use is associated with other high risk behaviour that can increase vulnerabilities for HIV and STI. Therefore targeted interventions needs to address alcohol use and associated factors, which could positively impact HIV prevention interventions among FSWs in India.