In India, significant strides have been made in the fight against AIDS. New HIV cases and AIDS related deaths have decreased since 2010. As part of its national programme to control the disease, multiple campaigns to help curb the stigma and discrimination associated with the disease in the country were also run.

However, progress has not been uniform across the country, with certain states in the North-eastern regions of the country and Punjab seeing up to six times increase in new infections in recent times, and deep-seated bias continuing to impact people living with HIV in the country. The situation is further complicated by rising intravenous drug usage in some parts and a lack of sex education that speaks about sexually transmitted diseases and safe sex practices.

“We have the power to transform lives and end AIDS once and for all.”

— On Monday’s #WorldAIDSDay, @antonioguterres calls for investing in prevention and expanding access to treatment to #endAIDS as a public health threat by 2030.https://t.co/x2RMZL9UKS pic.twitter.com/ZHzJo4aCNZ

— United Nations (@UN) December 1, 2025

What is HIV/AIDS and how does it spread?

Acquired Immunodeficiency Syndrome (AIDS) is a chronic condition caused by the Human Immunodeficiency Virus (HIV). HIV attacks and damages the immune system, weakening the body’s ability to fight infections and disease. Untreated HIV can progressively destroy immune function, ultimately leading to AIDS over several years.

Following primary infection is the clinical latent phase, also referred to as chronic HIV infection. During this period, the virus continues to reside in the body and affects white blood cells of the immune system, but many people do not exhibit symptoms. This phase can last for several years in individuals who are not on antiretroviral therapy (ART), though some may experience symptoms or develop more severe illness sooner.

As the infection progresses, individuals may enter symptomatic HIV infection. In this stage, the virus actively multiplies and destroys immune cells, leading to signs such as persistent fever, fatigue, swollen lymph glands, diarrhoea, weight loss, oral yeast infections (thrush), shingles (herpes zoster), and pneumonia. If left untreated, HIV usually progresses to AIDS in about eight to ten years. At this point, the immune system is severely weakened, making individuals highly susceptible to opportunistic infections and certain cancers that healthy immune systems can normally resist. Symptoms of these complications may include recurring fever, chills, ongoing diarrhoea, constant fatigue, rapid weight loss, skin rashes or bumps, and persistent white spots or lesions in the mouth.

HIV is transmitted through contact with infected bodily fluids such as blood, semen, vaginal fluids, and breast milk; primarily through sexual contact, sharing of needles or syringes, and contact with infected blood. Transmission can also occur from parent to child during pregnancy, childbirth, or breastfeeding, although effective treatment can significantly reduce this risk. It is important to note that HIV is not spread through casual contact, air, water, insect bites, hugging, kissing, dancing, shaking hands, or donating blood.

While there is no cure for HIV/AIDS, antiviral treatments (antiretroviral therapy or ART) can effectively control the infection, prevent progression to AIDS, and reduce transmission risk. Access to ART has dramatically reduced HIV-related deaths worldwide and enables people living with HIV to lead near-normal, healthy lives.

Globally, HIV remains a significant public health challenge. According to the World Health Organization (WHO), HIV has claimed an estimated 4.41 crore lives to date, with transmission ongoing in all countries. In 2024 alone, approximately 13 lakh people were newly infected with HIV, and an estimated 6.3 lakh died from HIV-related causes.

What progress has India made in its fight against HIV and AIDS?

India, however, has made progress in controlling HIV, even as challenges remain. The prevalence of HIV has decreased from 0.33 per cent in 2010 to 0.20 per cent in 2024—significantly lower than the global prevalence rate of 0.7 per cent. New infections have seen “a steeper decline” of 49 per cent during this period. While there were 1.25 lakh new HIV infections reported in 2010, only 64,500 such new cases were reported in 2024.

“This surpasses the global reduction rate of 40% over the same period,” (sic.) the government said in its release, while adding that in absolute numbers, India only represented 5 per cent of the global new infections in 2024.

Deaths have seen a far more dramatic decline, of 81.4 per cent, from 1.73 lakh in 2010 to 32,200 in 2024. “This decline is fueled by the expansion of free ART to over 18 million people living with HIV (PLHIV) by 2025, achieving 94 per cent ART retention and 97 per cent viral suppression rates-key factors in preventing progression from HIV to AIDS,” (sic.) according to the government’s own figures.

India also accounts for only about 5 per cent of the global burden as well when it comes to AIDS related deaths. “This disparity highlights India’s superior outcomes, driven by affordable generic drug production (supplying 70% of global ART) and community engagement, exceeding global reduction trends and aligning with UNAIDS 95-95-95 targets,” it said, referring to the ambitious global goals to “end” the AIDS epidemic by 2030, by increasing detection, access to treatment, and viral suppression. According to this, 95 per cent of people living with HIV should know of their HIV status, 95 per cent of those diagnosed should get treatment, and 95 per cent of those receiving treatment should achieve viral suppression.

India’s framework to combat HIV/AIDS 

According to the Ministry of Health and Family Welfare press release, the National AIDS Control Organization (NACO) runs nationwide campaigns through multimedia, outdoor media, and digital platforms to engage diverse audiences. At the community level, awareness is promoted through training programs for Self-Help Groups, Anganwadi Workers, ASHAs, and Panchayati Raj members, fostering behavioural change and supportive environments.

High-risk groups, including Female Sex Workers, Men who have Sex with Men, People Who Inject Drugs, Transgender individuals, truck drivers, and migrants, are addressed through 1,619 Targeted Intervention projects to ensure access to prevention, testing, treatment, and care services. NACO aims to eliminate stigma and expand access, “ultimately achieving the goal of ending the AIDS epidemic as a public health threat.”

Thematic campaigns also work to prevent discrimination against People Living with HIV (PLHIV), promoting inclusivity in workplaces, healthcare facilities, schools, and communities. In line with the HIV and AIDS (Prevention and Control) Act, 2017, Ombudsmen have been appointed in 34 States and Union Territories to address complaints of discrimination.

What are the challenges that remain in India’s fight against HIV and AIDS?

While India has made great strides, progress has not been made uniformly across states. State-wise data for 2024 was not readily available, but according to the 2023 data, most states have seen a decrease in annual new infections since 2010, including major states like Andhra Pradesh (-76 per cent), Maharashtra (-66.7 per cent), Karnataka (-70 per cent), and Kerala (-74 per cent).

However, some states, particularly in the North-East and Punjab, have witnessed significant increases. Tripura topped the chart with a 524 per cent increase in new infections in 2023, compared to 2010. Arunachal Pradesh (470 per cent increase), Meghalaya (125 per cent increase), and Punjab (116.7 per cent) follow and stand out with the highest rise in new HIV infections, highlighting regional disparities that need targeted interventions.

A 2019 study conducted across all 640 districts of India found that “sixty-three districts with consistently high HIV prevalence were clustered in the South and North-East regions of India.” It identified that population size, density, and urbanisation were positively associated with high HIV prevalence in these districts. Additionally, higher levels of literacy, better socio-economic status, a larger proportion of the population in the reproductive age group, and late marriages were also positively linked to high HIV prevalence in all regions except the Southern region. The study further noted that “higher levels of knowledge about the role of condoms in HIV prevention and condom use were associated with low HIV prevalence at the district level.”

How does the usage of drugs make the situation murkier?

In some states, experts also point to the use of contaminated shared syringes by drug users as a possible reason for the spike. Dolly Khurana, Assistant Director of the Surveillance and Information Division at the Punjab State AIDS Control Society, pointed out that the sharp rise in injection drug use is a major factor behind the increasing HIV burden in the state, describing the situation as an “IDU (injecting drug use) epidemic in Punjab.” She said that the estimated proportion of injection drug users in Punjab has risen significantly, “from 0.2 earlier to 0.42 as per 2023 data,” reflecting a worrying growth in injectable drug use across the state. She added that unsafe injection practices involving shared needles and syringes continue to be a primary driver of new HIV infections.

A study in Punjab, which surveyed 1,155 injection drug users across five cities, including border districts Amritsar, Taran-Taran, and Batala, as well as Jalandhar and Ludhiana, corroborated this. It found that HIV and Hepatitis C antibody prevalences among such drug users were 29 per cent and 49 per cent, respectively. In multivariate analyses, the researchers found that “city of residence closer to the international border” and “more than one year of injecting drugs” were significantly associated with HIV and Hepatitis C positivity. Based on these findings, the study concluded that “alcohol and sexual risk reduction, strengthening of needle and syringe exchange programs, reducing injecting duration, and clinical management of HIV, HCV, and HIV/HCV co-infection appear as four core programme needs” for the region.

Explaining the rising positivity rates among injection drug users, she said that monthly data from Targeted Intervention centres show a clear pattern. “The people who come to TI centres for the first time and get tested are often found HIV positive,” Khurana explained. In contrast, those who are already registered at these centres mostly continue to test negative. “It is the new entrants in the IDU population who are largely driving the current increase in HIV cases,” she added.

Khurana explained that a major shift in policy in 2017 significantly changed the HIV treatment landscape in the state. “Under the test and treat policy, every person registered at ART centres is immediately started on treatment, regardless of their CD4 count (a medical parameter used for diagnosis and treatment decisions for HIV patients),” she said. This led to a substantial increase in the patient load at ART centres, particularly for the supply of medicines. At the same time, Punjab expanded its HIV testing infrastructure by setting up many new testing facilities.

She noted that access to testing has improved over the years. “In 2010, the number of confirmation sites was very limited. By 2023, we have 115 confirmation centres across Punjab,” she said. This expansion has made testing far more accessible, allowing people to either come voluntarily or be referred by doctors to Integrated Counselling and Testing Centres without having to travel long distances.

What can be done to reduce risk?

Dr Jayaprakash Muliyil, India’s top epidemiologist and former Principal of Christian Medical College, Vellore, explained that disease spread must always be understood through the lens of “ecology”, the environment in which a disease thrives or fails to thrive. “For HIV, the ecology is largely social, rather than biological,” he said.

Citing his own field research, Dr Muliyil said that exposure to commercial sex work among Indian men aged 18–40 was about 3 per cent, which he described as a key driver of HIV transmission. “The main trigger for HIV spread in India has been exposure to commercial sex work. Once the husband is infected, the spouse often gets it next,” he explained.

He pointed out that India’s traditional value system acted as a protective factor for many years. “There may be flirtation, but this kind of high-risk sexual behaviour is not commonly accepted in our society. That actually protected us from the runaway epidemic seen in many African countries,” he said, adding that India’s situation was very different from Western countries or South Africa.

He, however, flagged a major weakness – India’s discomfort in talking openly about sex. “We teach children how to wash their hands, but we never talk at home about sexuality. Even medical students often have a very primitive understanding of it,” he observed. According to him, knowledge is central to protection, especially for young people learning about healthy relationships.

Dr Muliyil cited Kerala again as an example where education and awareness improved preventive behaviour. “People were smart. Not necessarily more chaste, but they knew how to protect themselves. Condom use became widely accepted,” he said.

Discussing commercial sex workers, he stressed that they play a critical role in the transmission dynamics of HIV, yet remain socially marginalised. “Unless we learn to respect, protect, and empower them with health awareness, transmission will continue under the shadow of stigma,” he said.

On regional variations, he pointed out that the North-East has faced a different set of challenges, particularly linked to injecting drug use, which created a distinct HIV transmission pattern in that region.

Addressing long-term control, Dr Muliyil highlighted “the status of women” as a crucial determinant. He explained that Kerala’s better HIV control is also linked to women’s higher social status, measured through the female-to-male sex ratio. “In most states, the ratio favours men. In Kerala, women outnumber men. That reflects women’s value and rights in society,” he said.

“When women have higher status, they are better able to protect themselves and influence the transmission dynamics of diseases like HIV,” he concluded.

Also read: Beyond birth control: Why contraception matters for preventing HIV and STIs