Background Men who have sex with men (MSM) in India are most-at-risk of HIV infection, with HIV prevalence almost 20 times higher than that in the general population. We describe the relationship between frequency of alcohol use and HIV-related risk behaviours among Indian MSM to develop strategies for addressing alcohol use within HIV interventions.

Methods Data for this analysis were drawn from a cross-sectional bio-behavioural survey (2009–2010) conducted in the states of Maharashtra, Tamil Nadu and Andhra Pradesh. 3,880 MSM were recruited from cruising sites using time-location cluster sampling. Binary logistic regression was carried out to assess relationships between frequent alcohol use and other sexual risk behaviours

Results We categorised those who reported consuming alcohol daily or at least once a week as ‘frequent’ drinkers (40% of the sample) and the remaining as ‘infrequent’ drinkers. Among frequent drinkers, majority were above 24 years (66%), literate (85%), self-identified as Kothis[feminine and receptive partner] (53%), had paying male partners (65%) and were exposed to HIV prevention interventions (78%). Multivariate analysis showed that frequent alcohol drinkers were more likely to be above 24 years (adjusted odds ratio [AOR] 1.37, p < 0.05) and employed (AOR 1.54, p < 0.05). Frequent alcohol drinkers were less likely than infrequent drinkers to report consistent condom use with paying male partners (AOR 0.75, p < 0.05), consistent condom use with regular male partner (AOR 0.74, p < 0.05), being community group member (AOR 0.84, p < 0.05), and self-identified as Kothi MSM (AOR 0.75, p < 0.05).

Conclusions Frequent alcohol drinking was more common among kothi-identified MSM and was significantly associated with inconsistent condom use with paying male partners and regular male partners. HIV prevention programmes need to be address alcohol consumption with better systematic screening counselling and referral to dependence treatment programme for men who have sex with men in India.