We examined the prevalence and type of rectal lubricants use and factors associated with exclusive use of latex-condom compatible lubricants (water-based lubricants) among men who have sex with men (MSM) using data from a large-scale cross-sectional survey conducted in 2009/10 in three Indian states. Using time-location cluster sampling, 3880？MSM were recruited from cruising sites. We used multiple logistic regression to assess the association between type of lubricants used and sociodemographic and programmatic indicators. Among those who reported using lubricants (64%) more than half (53%) exclusively used water-based lubricants, less than one-tenth used exclusively oil-based lubricants, and nearly 40% used both water-based and oil-based lubricants. Factors associated with exclusive use of water-based lubricants were exposure to HIV prevention interventions (AOR: 6.18, 95% CI 4.82 to 7.92) and kothi-identified MSM—feminine/anal-receptive (AOR: 2.56, 95% CI 2.12 to 3.10). Targeted HIV interventions among MSM need to promote and distribute latex condom-compatible lubricants for use during anal sex—irrespective of their presumed or stated sexual role in anal sex, and educate them not to use oil-based lubricants with condoms. 1. Introduction Men who have sex with men (MSM) are a highly vulnerable population and substantially affected by the HIV epidemic worldwide [1]. In India, MSM have a very high HIV prevalence (7.4%) compared with the general population (0.31%). The National AIDS Control Organisation (NACO) has recognized MSM as a “key population” at risk for HIV and it funds targeted HIV interventions among MSM [2, 3]. Unprotected anal sex among MSM increases probability of transmission of HIV [4], but using water-based lubricants along with latex condoms can reduce HIV risk by reducing friction and condom damage [5]. Several studies [6–10] have documented that a significant proportion of MSM and hijras (male-to-female transgender people) in India use condoms inconsistently in anal sex acts and do not use latex condom compatible lubricants. In India, there is limited data on the use of lubricants along with condoms during anal sex by MSM. Understanding the extent and type of lubricants used by MSM will help policy-makers and program managers make evidence-informed decisions on promoting and distributing latex condom-compatible (water-based or silicone-based) lubricants along with condoms. We describe the prevalence and type of rectal lubricants use and factors associated with exclusive use of water-based lubricants among MSM in three southern states
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