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 onto 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 (NACP VI) 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 Pradesh, 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 treatment 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 reverse 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.
Fourth, the programme must renew its emphasis on ending stigma. Stigma is the single biggest driver of invisibility, delayed diagnosis, and untreated infection. The HIV & AIDS (Prevention and Control) Act, 2017 is a rights-based legislation for infected and affected people living with HIV AIDS. The act promotes service uptake in a stigma and discrimination free environment. Yet stigma persists in homes, hospitals, workplaces, and even policies and strong concerted efforts must be taken to address persisting stigma and discrimination.
India’s journey in HIV prevention has been marked with several courageous milestones. Investing early in HIV containment and prevention led to reversal of the epidemic trajectory, saving an entire generation from suffering and morbidity; and resulting in a healthy demographic dividend contributing to the economic growth story. NACP’s demonstrable track record of service delivery on scale strengthens the foundation for the last push. Now more than ever, science is on the side of India’s HIV/AIDS elimination vision. Our vibrant biotechnology and pharmaceutical industry can fast track development and scale-up of drugs, vaccines, and diagnostics, providing the tail winds for the elimination efforts.
Yet, in a journey of thousand miles, the last mile is always the hardest. The last mile for ending HIV AIDS as a public health threat is not just biomedical—it is social, digital, behavioural, and structural. NACP-VI provides a forward-looking roadmap that is technologically modern, epidemiologically precise, and socially grounded. Underpinned by an unwavering government commitment and a resilient public health system, India will ride stridently on the opportunity—to show the world that ending an epidemic is possible when science, community, and policy move together.
The author is Additional Secretary and Director General, National AIDS Control Organization (NACO), MoHFW.
