The India HIV Estimates 2021 fact sheet released by the National AIDS Control Organisation (NACO) presents an in-depth picture of HIV prevalence in India, providing invaluable insights into prevalence, new infections, and deaths in the country and among its states. This analysis examines the major points in the report, citing successes and ongoing challenges in India’s HIV response.
How does HIV/AIDS affect people?
Human Immunodeficiency Virus (HIV) is a virus that infects the body’s immune system, specifically CD4 cells (T cells). If left untreated, HIV increasingly damages the immune system, allowing the body to become susceptible to opportunistic infections and some cancers. The most developed form of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), with severe immune deficiency that results in a life-threatening disease.
HIV is transmitted mainly by certain body fluids, such as blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk, usually through unprotected sex, needle sharing, or mother-to-child transmission during pregnancy, birth, or breastfeeding. Although HIV has no cure, treatment with effective Antiretroviral Therapy (ART) can suppress the virus, enabling individuals with HIV to live a long and healthy life and avoid transmission.
How prevalent is HIV in Indian states?
Prevalence is the proportion of people living with HIV at a specified time. As per the 2021 estimates, India’s national adult (15-49 years) HIV prevalence was 0.20%. But this national estimate hides wide regional disparities. South Indian states with higher prevalence rates in 2021 were Mizoram (2.70%), Nagaland (1.24%), Manipur (1.06%), Telangana (0.54%), and Andhra Pradesh (0.52%).
Considering the trend between 2010 and 2021, the statistics indicate a positive trend at the national level, with adult HIV prevalence reducing from 0.26% to 0.20%. This is seen in the majority of states. Some states that reported significant reductions in adult prevalence from 2010 to 2021 are Andhra Pradesh (from 0.66% to 0.52%), Karnataka (from 0.45% to 0.32%), Maharashtra (from 0.43% to 0.31%), and Tamil Nadu (from 0.32% to 0.23%). While the bigger picture is one of decline, the continued high prevalence rates in some North-Eastern states and southern states reinforce the necessity for geographically specific, ongoing prevention and treatment initiatives.
How many new cases do we see annually (2010-2021)?
Annual new infections, or incidence, is an important measure of the success of prevention programs. At the national level, India achieved a remarkable 46% drop in estimated annual new HIV infections from 2010 to 2021. This impressive decrease is a result of the scaled-up prevention efforts targeting key populations, targeted interventions, and greater awareness.
Looking at the state-level data, there is diverse progress. Most states realised dramatic decreases in new infections. For example, Meghalaya registered an 80% decline, Odisha a 79% decline, Tripura a 78% decline, and Bihar a 74% decline in the same period. These numbers reflect effective containment in varied environments. But the picture is not entirely rosy. A few countries had an increase in estimated new infections between 2010 and 2021, notably Mizoram (+52%) and Arunachal Pradesh (+9%), which points to localised dynamics, possibly injecting drug use or other risk factors, that call for immediate and localised public health intervention to counteract these worrying trends.
AIDS-related deaths (2021) and percentage change (2010-2021)
Reducing AIDS-related deaths is a key goal, largely achieved through access to Antiretroviral Therapy (ART). The NACO 2021 estimates reported approximately 42,000 estimated AIDS-related deaths in India during the year.
From a trend perspective, India registered an impressive 76% drop in estimated annual deaths due to AIDS between 2010 and 2021. This precipitous drop directly stems from the large-scale availability and utilisation of free ART coverage under the National AIDS Control Programme. This indicates that a majority of individuals living with HIV are being diagnosed and enrolled in life-saving treatment. State-wise statistics reflect this success as well. Most states documented significant reductions in deaths, with a few observing declines of more than 80%, including West Bengal, Punjab, Rajasthan, and Maharashtra. Although almost all states documented a reduction, the rate differed, implying that diagnostic challenges, linkage to care, or treatment follow-through might still be an issue in some areas.
Summary of the HIV prevalence
According to Table 1 of the India HIV Estimates 2021 Fact Sheet, adult HIV prevalence in India in 2021 was estimated at 0.21%, with an approximate 24.01 lakh persons living with HIV across the country. The figures vary across sexes and age groups. Adult prevalence among males (0.22%) is narrowly higher than that of females (0.19%). Likewise, the HIV incidence rate per 1000 uninfected population is higher in the case of males (0.05) than in females (0.04).
Among the estimated 62.97 thousand new infections each year, adults aged 15+ years represent the largest proportion (57.97 thousand), including 15.08 thousand in young people aged 15-24. The estimated deaths due to AIDS in 2021 were 41.97 thousand. Per 100,000 population, the mortality rate is far greater in males (4.21) than in females (1.88). Though in total deaths have fallen by 76.54% since 2010, the percentage change was greatest among females (82.74%). Children (<15 years) account for 0.70 lakh of PLHIV and 2.51 thousand deaths annually.
Conclusion
The data stands as a sobering reminder that the battle is still far from won. The ongoing high prevalence in some states, combined with worrying spikes in new cases in a handful of areas, serves to underscore the necessity for down-at-the-grass-roots analysis and hyper-local interventions. Sustained political commitment, continued funding, focused outreach to key populations, timely diagnosis, and ensuring uninterrupted access to ART remain paramount to achieving the goal of ending the AIDS epidemic as a public health threat in India.
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