Background Unprotected anal sex among men who have sex with men (MSM) has a high probability of transmission of HIV, but using water-based lubricants along with condoms can significantly reduce HIV risk. We examined the prevalence and type of rectal lubricants use, and factors associated with exclusive use of water-based lubricants among MSM using data from a large-scale cross-sectional survey conducted in 2009–2010 in three Indian states.

Methods Using time-location cluster sampling, 3,880 MSM were recruited from cruising sites such as parks and local train stations. Behavioral data were collected using a structured questionnaire, and blood and urine samples were tested for HIV and STIs. We used binary logistic regression to assess the association between type of lubricants used and socio-demographic and programmatic indicators.

Results Of the total, a majority reported using lubricants (64%) and more than half (53%) exclusively used water-based lubricants. Less than one-tenth (7.6%) reported exclusive use of oil-based lubricants and nearly 40% of the MSM were mixed users (using both water and oil-based lubricants). Characteristics associated with increased odds for exclusive use of water-based lubricants taking non-users as reference were: exposure to HIV prevention interventions (AOR: 6.18, 95% CI 4.82–7.92), self-identity as kothis (AOR: 2.56, 95% CI 2.12–3.10), and consumption of alcohol (AOR: 1.28, 95% CI 1.07–1.53). When adjusted for socio-demographic and other contextual factors such as exposure and consumption of alcohol, HIV and STI prevalence did not have a statistically significant association.

Conclusion Targeted HIV interventions among MSM need to promote and distribute condom-compatible lubricants during anal sex and educate them not to use oil-based lubricants with condoms. Reaching and promoting condom-compatible lubricant use among all subgroups of MSM, irrespective of their presumed or stated sexual role in anal sex, will help in increasing the use of lubricants during anal sex and decreasing HIV transmission.