World AIDS Day, 1 December 2025
A Beginning Shrouded in Fear (1986)
When India detected its first HIV cases among sex workers in Chennai in 1986, the country was unprepared. Public knowledge was minimal. Testing was rare. Stigma was overwhelming.
But the moment marked the start of one of the largest public health mobilisations in India’s history.
By the early 1990s, India had launched the National AIDS Control Programme (NACP) and set up NACO, laying the foundation for a long journey of surveillance, prevention, and care.¹–³
The Years of Rapid Expansion (1995–2010)
When Prevention Became a National Mission
Across the next decade, India transformed its response:
- Targeted Interventions for sex workers, MSM, transgender persons, truckers, and people who inject drugs
- Condom promotion and STI management in high-burden districts
- Widespread HIV testing
- Introduction of free ART in 2004, changing survival and dignity
Peer-reviewed studies document impressive results. Declines were seen in many sex worker groups, stabilisation among MSM in several states, and improved treatment access across the country.⁴–⁶
India’s epidemic—once feared to explode—began to turn.
The Indian HIV Story in Numbers (1986 → 2024)
Prevalence & Burden
India today has:
- 2.4–2.6 million people living with HIV¹
- Adult prevalence ~0.20%, among the lowest globally
Yet the absolute numbers remain high due to India’s large population.
New Infections
- 40–45% decline in new HIV infections since 2010¹
- greatest improvements in southern states after targeted scale-up
AIDS-Related Deaths
With wider ART access:
- Deaths have declined sharply
- Currently estimated at ~30,000–40,000 per year⁷⁻⁸
These are not just numbers—they reflect lives saved, families supported, and communities strengthened.
Inside the High-Risk Groups: The Heart of India’s Epidemic
India’s epidemic remains concentrated, and trends vary across groups.
People Who Inject Drugs (PWID)
- Pooled national prevalence ~6%
- Highest rates in northeast India⁹
- Strong links to harm-reduction coverage
Female Sex Workers (FSW)
- Downward trends in many states
- Community mobilisation, condoms, and STI management played a major role⁴⁻⁶
Men Who Have Sex with Men (MSM)
- Mixed patterns
- Some urban clusters still report ongoing high incidence¹⁰
Transgender Persons
- Consistently higher prevalence
- Require dedicated, stigma-free services
How India Funded the Fight: From Donor Reliance to National Ownership
NACP-I to NACP-V
India’s HIV programme evolved through country-wide planning:
| NACP Phase | Landmark Features | Funding Notes |
|---|---|---|
| NACP-I (1992–1999) | Surveillance, awareness | World Bank support (~USD 84M)³ |
| NACP-II (1999–2006) | Targeted Interventions | External + domestic |
| NACP-III (2007–2012) | ART scale-up | Mixed funding |
| NACP-IV (2012–2017) | Strengthening prevention | ↑ Domestic share |
| NACP-V (2021–2026) | Fully Government-funded | Outlay: ₹15,471.94 crore² |
Global Fund Support
The Global Fund retains a catalytic role.
For 2023–2025:
- Allocation for HIV/TB: ~US$500 million¹¹
- Supports supply chains, diagnostics, and innovations
- The U.S. global HIV response — largely via PEPFAR (the U.S. President’s Emergency Plan for AIDS Relief) — has historically been the largest single-country contribution to worldwide HIV funding. Because India’s HIV programme is mostly domestically funded, the effect is more muted than in many low-income countries.
2024–2025: The New Era of HIV Response in India
What’s Working
- Better ART coverage & viral load monitoring
- Stronger TI programmes
- Reduced infections and improved survival
- Greater decentralisation through State AIDS Control Societies
- Better linkage of HIV and TB services
What Needs More Focus
- Persistent high prevalence in some MSM, transgender and PWID networks
- Uneven ART adherence
- Social stigma and gender barriers
- Wider access to PrEP
- Strengthening services for youth and digital outreach
A Four-Decade Reflection
From fear to awareness, from silence to science, India’s HIV journey is a testament to what public health systems, communities, and governments can achieve when they work together.
But HIV is not over.
On World AIDS Day 2025, the message is simple and urgent:
“End inequalities. End AIDS. Keep the promise.”
References
- National AIDS Control Organisation (NACO). India HIV Estimates 2023: Technical Report. New Delhi: NACO; 2024.
- National AIDS Control Organisation (NACO). NACP Phase-V: Strategy Booklet 2021–2026. New Delhi: NACO; 2021.
- National AIDS Control Organisation. National AIDS Control Programme I: Project Reports and External Evaluations. New Delhi: NACO.
- Tanwar S, Rewari BB, et al. India’s HIV programme: successes and challenges. Indian J Med Res. 2016;143(6):725–728.
- Brahmam GN, et al. HIV risk and programmatic gaps among female sex workers in India. BMC Public Health. 2013;13:234.
- Saggurti N, et al. HIV trends among key populations in India: findings from IBBS. Indian J Public Health. 2018;62(3):201–209.
- Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS Data 2024. Geneva: UNAIDS; 2024.
- UNAIDS. Country Factsheet: India. Geneva: UNAIDS; 2024.
- Pachuau LN, et al. HIV among people who inject drugs in India: a systematic review. Harm Reduct J. 2022;19:21.
- McFall AM, et al. HIV incidence among MSM and PWID in India: cohort findings 2014–2022. J Int AIDS Soc. 2024;27:e26139.
- The Global Fund. India Funding Profile 2023–2025. Geneva: Global Fund; 2023.
