Ending the HIV/AIDS epidemic by 2030 : India’s next big public health opportunity

Ms V Hekali Zhimomi
India stands at a turning point in its battle against HIV/AIDS. Four decades after the first case was reported, the country has built one of the world’s most expansive and resilient National HIV prevention and treatment programme. The National AIDS and STD Control Programme (NACP) has shown undeniable gains.
New infections have fallen by nearly half since 2010, AIDS-related deaths have dropped by more than 80%, viral suppression now exceeds 97% among those on treatment, and India has transitioned entirely on to Dolutegravir-based regimens—placing it among the global leaders in treatment efficacy.
However, there can be no room for complacency. As the country transitions into the NACP Phase-VI (NACPVI) for 2026–31, it must confront the reality that India’s epidemic is still evolving, and in some places, it is accelerating. The overall low National prevalence of 0.20% masks emerging hotspots and newer vulnerabilities. States like Assam, Arunachal Pra-desh, Tripura and Punjab have reported rising incidence, driven largely by injecting drug use. Among people who inject drugs, HIV prevalence is forty times the National average, with some hotspots reporting exponential increases. With an estimated one-in-160 chance of transmission from a single needle-sharing event, HIV epidemics linked to injecting drug use can spiral rapidly if not responded effectively.
In addition, a growing proportion of new infections now occur among individuals acquiring HIV from casual or regular partners—signalling a shift beyond traditional “key populations”. India’s young demographic-2.25 crore adolescents entering the 15–25 age cohort annually- remains vulnerable with easy access to digital platforms enabling risky sexual behaviour and substance use.
India has made substantial gains in reducing vertical transmission. Universal screening and treat- ment of antenatal mothers for HIV and syphilis, early infant diagnosis, and  paediatric prophylaxis have driven mother to child transmission down from over 25% in 2020 to 10% in 2024. Yet, this remains above the five percent threshold for elimination.
Simply put, the virus has adapted. It affects the younger, is more dispersed, and exploiting newer vulnerabilities. Addressing these challenges requires a fresh blueprint. The NACP-VI is envisioned as India’s boldest and most forward-looking HIV strategy. It aligns with SDG 3.3 of ending AIDS as a public health threat by 2030—and is rooted in four big shifts.
First, India’s diverse vulnerability profile calls for transforming prevention to follow people—not categories. Beyond traditional “high-risk groups,” the programme must address overlapping vulnerabilities created by social and structural factors. Under the Sampoorna Suraksha framework, universalised prevention will ensure interventions reach vulnerable individuals rather than labels. AI-driven self-risk assessments, virtual outreach, newer pharmaceutical tools, and disease surveillance platforms for tracking hotspots or super-spreaders will power the next generation of prevention and service linkage. Strategies targeted at epidemics driven by IV drug use will be central to the NACP-VI in reversing the epidemic.
Second, NACP VI needs to build on detect early, treat effectively, retain for life approach. India’s success in expanding high quality, free of cost anti-retroviral treatment and viral suppression is unprecedented. Nevertheless, retention for treatment adherence and early diagnosis remain work in progress. Linkage pathways using ABHA, telemedicine and digital follow-ups for ART dispensation will help overcome service delivery barriers. NACP-VI’s integration with ABHA and Ayushman Arogya Mandirs is an opportunity to mainstream HIV care within the wider public health ecosystem.
Third, eliminating vertical transmission of HIV and Syphilis is a National Health imperative. By augmenting synergies with RMNCH+A, data inflow from private sector and decentralised supply chains for screening kits, India can achieve elimination by 2030. However, this requires every pregnant woman—regardless of geography, caste, income or marital status—to be reached.

(To be contd)