Alcohol and Drug Use Surrounding Sex Among Men Who Have Sex with Men in India

Little is known about alcohol and drug use with sex among Indian men who have sex with men (MSM). Sexually active MSM across India, recruited via social media and MSM-specific mobile dating apps, completed an anonymous online survey in Hindi or English. We used multivariable modified Poisson regression to identify factors associated with (1) Alcohol use and (2) Drug use ± alcohol (chemsex) surrounding sex. Of the 4321 MSM included in this analysis, respondents came from all states and over 400 localities; median age was 26 years, 15 % lived in poverty, and 18 % had less than college education. Overall, 23 % (996) reported using alcohol whereas 5 % (226) reported having chemsex. In multivariable analysis, alcohol use was associated (p < .05) with lower education, older age, being ‘out’ to anyone about their sexuality, having a paid or casual male partner, being in a committed relationship with a female partner, and having > 6 sexual partners in the past six months. Chemsex was associated with lower education, being ‘out’ to anyone, having > 6 sexual partners in the past six months, having casual male partners, living with HIV, and having a STI diagnosis in the past year. This study found that alcohol use surrounding sex was more common than chemsex among a large national sample of Indian MSM. Differing characteristics were associated with either alcohol use or chemsex, which may be related to cultural and contextual factors. These findings indicate a need to further assess what impact alcohol and drug use surrounding sex may have on sexual risk behaviors, and what interventions are needed to mitigate such risks.