HIV prevalence among pregnant women in Karnataka has risen for three consecutive surveillance rounds, reversing a trend that had held for nearly twenty years, according to the state’s own annual report for 2025-26 released by the Karnataka State AIDS Prevention Society (KSAPS).

The finding is significant because it comes from the HIV Sentinel Surveillance of pregnant women attending government health centres, a key tool used to monitor HIV trends in the general population rather than only among high-risk groups.

This survey shows that the prevalence in Karnataka fell steadily from 1.49% in 2005 to a low of 0.22% in 2018-19. Since then, the number has climbed in every round: from 0.29% in 2020-21 and to 0.57% in 2022-23.

This means prevalence among pregnant women in Karnataka has more than doubled from its lowest recorded point in under five years, even as the state’s own report describes the broader trend as one of decline, comparing 2022-23 only against the 2004 figure of 1.5%.

The rise places Karnataka among the states with the highest HIV burden in the country. 

According to the ANC HSS Plus 2023 Technical Report published by the National AIDS Control Organisation (NACO), the central body that runs India’s HIV response, Karnataka recorded the third highest prevalence among all states and union territories at 0.57%, behind only Mizoram at 0.63% and Meghalaya at 0.58%. 

The national average among pregnant women stood at 0.23%, less than half of Karnataka’s figure.

The same national report found that eight districts in Karnataka, Bagalkot, Bangalore, Belgaum, Hassan, Kodagu, Kolar, Koppal and Raichur, had sentinel sites recording HIV prevalence of 1%. or more. This was the highest number of such districts in any state in the country, ahead of Maharashtra, which had five.

Separately, Sankalak, NACO’s data booklet on the national AIDS response, estimated Karnataka’s overall adult HIV prevalence at 0.44% in 2024. This figure covers the general adult population and is a different, broader measure than the pregnant women survey mentioned above. 

It is still more than double the national adult prevalence of 0.20%. Only Andhra Pradesh, Nagaland and Mizoram recorded higher adult prevalence among states.

In absolute numbers, Karnataka had an estimated 2.91 lakh people living with HIV, referred to in official data as PLHIV, in 2024. This was the third largest such population among all states, after Maharashtra at 3.99 lakh and Andhra Pradesh at 3.10 lakh. 

The state also recorded an estimated 4,618 new HIV infections that year. 

Of Karnataka’s 31 districts, 24 have been classified as high priority districts under the national programme, a category assigned based on how high the prevalence is and how many people are infected.

The rise in new detections comes even as Karnataka’s treatment programme continues to expand. 

As per the KSAPS annual report, the state had 96 ART centres and 290 Link ART centres functioning in 2025-26. ART, or antiretroviral therapy, is the standard lifelong medication given to people with HIV to control the virus, and Link ART centres are smaller outreach points where patients can collect these medicines closer to home. 

Alongside these, the state had 442 stand-alone HIV testing centres and 2,926 facility-integrated testing centres, which offer testing as part of other routine health services.

Since the ART programme began, 4,15,199 people have been registered at treatment centres in Karnataka till March 2026. Of these, 3,43,103 had ever started antiretroviral therapy, but only 2,00,291 are currently alive and on treatment. 

The report records 1,18,027 people as having died while on the ART programme, and another 13,137 as lost to follow-up, meaning they stopped returning for treatment and their current status is not known to the health system.

Karnataka’s progress on the national 95-95-95 treatment targets also lags behind the national average on one count. These targets measure three things: how many people living with HIV know their status, how many of those diagnosed are on treatment, and how many of those on treatment have low enough virus levels in their blood to no longer transmit the infection, a state called viral suppression. 

As per Sankalak, 79.9% of people living with HIV in Karnataka knew their status in 2024-25, compared with the national figure of 83.9%. 

The state matched or nearly matched the national average on the other two counts, with 86.9% of those diagnosed on treatment and viral suppression at or above 95%.

Karnataka has been conducting HIV sentinel surveillance among antenatal clinic attendees since 1998, with the survey carried out once every two years. The next round, the 19th, was conducted in 2024-25, and its results are yet to be released as part of routine reporting. 

The state’s high-risk group surveillance, covering populations such as female sex workers, men who have sex with men and injecting drug users, is scheduled for 2025-26 and is currently in progress, according to the KSAPS report.

What do the doctors think?

Doctors cautioned against drawing early conclusions from Karnataka’s rising HIV prevalence figures, pointing instead to the need for sustained data before determining whether the trend reflected a genuine public health concern.

Dr Ravindra Zore, Critical Care Unit Intensivist at Zynova Shalby Hospital, Ghatkopar, Mumbai, said it was too early to tell whether the numbers pointed to a real rise in cases. 

“It will be difficult to tell whether the concerning surge in HIV cases is for real or if the COVID-era testing gaps are just distorting the numbers. At this stage, this trend should be observed with utmost caution. We will need more consistent data before jumping to any conclusions. So, instead of worrying, it is better to monitor the trend as of now,” he said.

The rise, Dr Zore said, could reflect improvements in the healthcare system rather than a worsening epidemic. “Increasing prevalence even after strong ART coverage may highlight the improved survival rates of those people living with HIV along with better detection with the help of advanced testing facilities,” he said.

The wide gap between those who ever started antiretroviral therapy and those still alive and on treatment, Zore explained, pointed to deaths accumulated over years of the programme. “A large gap may reflect cumulative mortality over time, mainly among those who start treatment late or have co-infections and comorbidities. It can also be driven by loss to follow-up because of various factors such as migration, stigma, treatment fatigue, or barriers when it comes to continuous care,” he added.

Patients often discontinued treatment for reasons unrelated to the medicine itself, Dr Zore added. 

“There are many patients who tend to drop out due to stigma, fear of disclosure, financial concern or work-related mobility that disrupts regular clinic visits. Even factors such as side effects, treatment fatigue, and long travel distances can also lead to discontinuation in treatment,” he said.

Zore struck a cautionary note on whether the rise from 0.22% to 0.57% constituted a meaningful public health trend. “It will be difficult at this stage to tell if it’s a concerning trend or a statistical margin of error. We will have to wait and watch. It will not be right to draw any conclusions at this stage,” he pointed out.

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