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Picture Courtesy: PIB

Context:

World AIDS Day, observed annually on December 1, invites the world to reflect on the HIV/AIDS epidemic while recommitting to equity-driven, resilient health systems. Initiated in 1988 by WHO, the observance has evolved into a global platform for solidarity, remembrance, and advocacy.

What is AIDS?

AIDS (Acquired Immunodeficiency Syndrome) is the final and most severe stage of infection caused by the HIV virus, where the body’s defence system becomes so weak that it cannot fight even common germs or simple infections.

• HIV enters the body and keeps silently damaging the immune system, especially CD4 cells (the “commanders” of immunity).
• AIDS happens when this defence system collapses because too many CD4 cells are destroyed.

How HIV spreads?

HIV spreads when infected body fluids enter another person’s bloodstream. The main body fluids that carry HIV are blood, semen, vaginal fluids, rectal fluids, and breast milk.

• Unprotected sexual intercourse – HIV enters through tiny tears in genital or anal tissues.
• Sharing infected needles or syringes – Particularly among people who inject drugs or reuse needles in unsafe medical settings.
• From mother to child – During pregnancy, childbirth, or breastfeeding if the mother is not on treatment.
• Contaminated blood transfusion or unsafe medical practices – Rare in India today due to strict screening.

Not transmitted through

• Touching, hugging
• Sharing food, water, utensils
• Mosquitoes
• Using the same toilet or clothes
• Sweat, tears, or saliva (unless blood is present)

Picture Courtesy: PIB

What are the symptoms of AIDS?

• Early HIV Infection (2–6 weeks after exposure): Many people have no symptoms, but some may experience Fever, Sore throat, Swollen lymph nodes, Skin rash, Body pain and Fatigue
• Long Asymptomatic Phase: This is the longest stage, lasting 8–10 years or more without treatment. The virus is quietly multiplying and attacking CD4 immune cells.
• Symptomatic Phase (Immune system gets weaker): Gradual appearance of illnesses that a healthy immune system normally controls like Persistent fever, Weight loss, Recurrent oral or genital infections, Tuberculosis (very common in India), Chronic diarrhoea, Skin problems and Night sweats
• AIDS Stage (Advanced Immune Collapse): When CD4 count becomes extremely low and serious infections appear like Pneumonia, Brain infections, Severe TB, Certain cancers (e.g., lymphomas, Kaposi’s sarcoma).

Picture Courtesy: PIB

Current Status of AIDS in India:

• As of 2023, around 54 million people in India are estimated to be living with HIV. (Source: PIB)
• New HIV infections in India have declined significantly: by about 44% since 2010.
• Legal protections and social policies (like under HIV/AIDS (Prevention and Control) Act, 2017) help reduce stigma and discrimination, encouraging more people to seek testing and treatment.
• Higher-burden states: Maharashtra, Andhra Pradesh, Karnataka, Telangana, Tamil Nadu, and parts of the Northeast.
• AIDS-related deaths reduced: AIDS-related mortality declined by 66% from 2010 to 2023 due to wider access to ART.

Picture Courtesy: PIB

What are the challenges associated in reducing the AIDS burden in India?

Persistent stigma and discrimination: Despite legal protections, stigma prevents people from getting tested or continuing treatment. NACO’s Stigma Index Surveys show 1 in 4 people living with HIV. In some districts of Uttar Pradesh and Bihar, ASHA workers reported families refusing home-based testing due to fear of being “labelled”.

Higher burden in specific regions: The epidemic is unevenly distributed, requiring localised strategies. Northeast states show HIV concentration among people who inject drugs (PWID), driven by cross-border drug trade with Myanmar.

Late diagnosis and long asymptomatic phase: HIV remains silent for years — people feel healthy but the virus keeps damaging immunity. Around 30–40% of PLHIV in India are diagnosed late (with already low CD4 counts).

Treatment interruptions: Missing Antiretroviral Therapy (ART) doses leads to rebound in viral load and greater transmission. Between 2018–20, nearly 2 lakh PLHIV were labelled as “lost to follow-up”. 

Government initiatives to reduce HIV/AIDS burden in India:

National AIDS and STD Control Programme (NACP I–V)

• Backbone of India’s AIDS response.
• Expanded from awareness (Phase I) to comprehensive prevention–testing–treatment–care–viral load suppression model (Phase V).

Picture Courtesy: PIB

“Test and Treat” Policy (2017)

• All HIV-diagnosed individuals receive immediate ART, regardless of CD4 count.
• Result: ART coverage increased to 82% of diagnosed individuals. 

HIV/AIDS (Prevention & Control) Act, 2017

• First rights-based HIV law in South Asia.
• Prohibits discrimination in employment, education, housing, healthcare.
• Mandates confidentiality, informed consent, grievance redressal through Ombudsmen. 

Mission Sampark

• Tracks and re-engages PLHIV who dropped out of treatment (“lost-to-follow-up”).
• In states like Maharashtra, brought >25,000 persons back into ART.

PMTCT Programme (Prevention of Mother-to-Child Transmission)

• Routine testing for all pregnant women.
• MTCT rate reduced to below 3% in several states → major success in Tamil Nadu, Kerala, Maharashtra. 

Way Forward:

Shift from a “Medicalised HIV Response” to Strong Community-Led Systems: Global evidence shows that community-led HIV services reduce new infections by 25–30%, so India must expand structured roles for NGOs, youth groups, peer educators, and PLHIV networks to ensure last-mile outreach, stigma reduction, and early detection, especially in high-burden districts.

Institutionalise Universal Annual HIV Screening in High-Risk Districts: High-incidence zones such as the Northeast, metropolitan slums, long-distance transport hubs, and migrant belts should adopt compulsory annual screening, following the example of Thailand, where mandatory annual testing contributed to a 40% decline in late-stage diagnoses, thereby ensuring timely treatment initiation.

Integrate HIV Services with TB, NCDs, and Mental Health Care: Since 60–70% of AIDS-related deaths in India involve TB co-infection, HIV treatment centres must be fully integrated with TB screening, diabetes/hypertension management, and mental-health counselling to reduce patient travel burdens and improve treatment continuity, as evidenced by district-level integrated centres in Maharashtra that significantly cut follow-up losses.

Strengthen Youth-Focused Prevention and Sexual Health Literacy: With 65% of India’s population under 35, expanding comprehensive sexuality education, campus-based condom access, and digital behaviour-change campaigns is essential, and Kerala’s Red Ribbon Club model — which demonstrated measurable reductions in risky sexual behaviour among college students — provides a scalable national blueprint. 

Conclusion:

India’s fight against HIV/AIDS demonstrates a remarkable blend of science, community action, and strong public policy, reflected in a sustained decline in new infections and expanded access to life-saving ART. Yet the epidemic persists in pockets shaped by inequality, migration, stigma, and co-infections like TB, demanding a shift from a purely medical programme to a people-centred, community-led, technology-enabled response. By strengthening prevention for youth, ensuring uninterrupted treatment, expanding testing innovations, and addressing social determinants, India can convert its progress into a decisive push toward the national goal of ending AIDS as a public-health threat by 2030. 

Source: PIB