HIV/AIDS in India: NACO, ART Centres, 95-95-95 Targets & P&C Act 2017

!HIV virion electron micrograph

HIV/AIDS in India remains one of the most consequential public-health success stories of the past quarter century — and one of the most delicate. From an estimated adult HIV prevalence above 0.4 per cent in the early 2000s and a peak annual incidence of new infections of around 270,000 in 2000, India’s adult HIV prevalence has fallen to 0.20 per cent in 2023 (around 2.5 million people living with HIV) with around 65,000 new infections and 33,000 AIDS-related deaths — a decline of 67 per cent in new infections and 80 per cent in AIDS-related deaths from 2010 levels, well outpacing the global average. Yet the absolute number of people living with HIV in India remains the third-highest in the world after South Africa and Mozambique, and the geographic and demographic concentration of new infections in specific key populations means complacency would unravel two decades of gains.

The architecture of India’s response is the National AIDS Control Organisation (NACO), set up as an autonomous body under the Ministry of Health and Family Welfare in 1992 and now in its fifth programmatic phase. NACO’s strategy is anchored in the UNAIDS 95-95-95 targets — that by 2025, 95 per cent of people living with HIV know their status, 95 per cent of those diagnosed are on antiretroviral therapy and 95 per cent of those on therapy achieve viral suppression — and in the rights-based framework of the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017.

The Virus and the Disease

HIV — Human Immunodeficiency Virus — is a retrovirus that targets CD4 T-helper lymphocytes and, by progressive immune depletion, produces Acquired Immunodeficiency Syndrome (AIDS). HIV-1, the globally dominant type, is responsible for almost all infections in India; HIV-2, less transmissible and slower-progressing, is found in pockets of Tamil Nadu, Pondicherry and a few coastal regions. Transmission routes are sexual (unprotected vaginal or anal sex), parenteral (sharing of injection equipment, contaminated blood products and unsafe medical procedures) and vertical (mother to child during pregnancy, childbirth or breastfeeding).

Natural History

In the absence of treatment, the median time from HIV infection to AIDS is around 8 to 10 years. Antiretroviral therapy (ART) — first available in India in the public sector from 2004 — interrupts viral replication, restores CD4 counts and reduces transmission to undetectable levels. A person on effective ART with sustained viral suppression has near-normal life expectancy and does not sexually transmit the virus (the “U=U” principle: undetectable equals untransmittable).

NACO and the Five Phases

The National AIDS Control Organisation was established on 1 August 1992 as the executive arm of the National AIDS Control Programme (NACP). NACP has been delivered through five overlapping phases.

NACP I (1992-1999)

The first phase focused on awareness generation, blood safety and surveillance, with the establishment of State AIDS Control Societies (SACS) in every state. The Blood Banks Regulation under the Drugs and Cosmetics Act was tightened in 1996, mandating HIV testing for every unit of blood.

NACP II (1999-2006)

Phase II decentralised implementation to the SACS, introduced targeted interventions for key populations and rolled out voluntary counselling and testing centres. Antiretroviral therapy was launched in the public sector on 1 April 2004 — initially at eight tertiary centres in six states.

NACP III (2007-2012)

Phase III scaled up the network of integrated counselling and testing centres (ICTCs), expanded targeted interventions through more than 1,500 NGO-led implementers, and rolled out the Prevention of Parent-to-Child Transmission (PPTCT) programme nationally.

NACP IV (2012-2017)

Phase IV operationalised “treat-all” guidelines, integrated TB and HIV services and laid the legal foundation for the HIV/AIDS (Prevention and Control) Act, 2017.

NACP V (2021-2026)

The current phase, NACP-V, was approved by the Cabinet in October 2021 with a financial outlay of INR 15,471 crore for 2021-26. NACP-V commits India to achieving the 95-95-95 targets by 2025 and to ending AIDS as a public-health threat by 2030 in line with SDG 3.3. It emphasises differentiated service delivery, digital case-based surveillance and community-led monitoring.

ART Centres and the Treatment Cascade

Free antiretroviral therapy is delivered at more than 700 ART centres and over 1,300 Link ART Centres across India. First-line treatment for adults and adolescents has been a single-pill, fixed-dose combination of tenofovir, lamivudine and dolutegravir (TLD) since 2020 — the same regimen recommended by WHO for global rollout because dolutegravir has a high barrier to resistance and is well-tolerated. Paediatric formulations of dolutegravir were introduced from 2022. Viral-load testing is now offered at six-monthly intervals to all patients on ART, scaling up from the older CD4-based monitoring.

The 95-95-95 Cascade

India’s progress against the UNAIDS targets, as of the 2024 NACO-ICMR-MoHFW HIV Estimations: around 81 per cent of people living with HIV know their status, around 88 per cent of those diagnosed are on ART, and around 86 per cent of those on ART are virally suppressed. The first 95 — diagnosis — remains the most stubborn gap, particularly among men in the general population and adolescents. The third 95 — viral suppression — is now within reach, an extraordinary achievement given the scale of the programme.

HIV/AIDS (Prevention and Control) Act, 2017

The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017, came into force in September 2018 and represents one of the world’s first rights-based legal frameworks for HIV.

Key Provisions

The Act prohibits discrimination against persons living with HIV in employment, education, healthcare, insurance, housing and access to public office. It mandates informed consent before HIV testing (with limited public-health exceptions for court orders, organ donation and epidemiological surveys). It requires confidentiality and informed disclosure. It establishes the post of an Ombudsperson in every state to address complaints. It mandates that anti-retroviral therapy and management of opportunistic infections be provided as a measure to be taken by the Central and State Governments — a statutory anchor for free ART. Section 14(1) of the Act guarantees ART as a measure that “as far as possible” will be provided by the government, and the Supreme Court has repeatedly reinforced this commitment.

Implementation

By 2024 most major states had appointed an Ombudsperson. Enforcement remains uneven, but landmark adjudications — including disability-related dismissals from defence forces and discrimination in private employment — have established a body of jurisprudence under the Act.

Key Populations

NACP’s targeted interventions focus on the populations at substantially higher risk of HIV acquisition and transmission.

Female Sex Workers

Female sex workers (FSW) have a national HIV prevalence of around 1.6 per cent — eight times the general adult prevalence. Targeted interventions through NGO-led peer outreach have expanded condom use to above 90 per cent in most sites.

Men Who Have Sex with Men and Transgender Persons

Men who have sex with men (MSM) and transgender (Hijra) populations have national HIV prevalence of around 2.7 per cent and 3.1 per cent respectively. Stigma and the historical criminalisation of same-sex relations (until the 2018 Section 377 verdict in Navtej Singh Johar) have constrained outreach. Post-2018, NACO has expanded community-led services through TRANS clinics in metropolitan cities and the Mitr Clinic network.

People Who Inject Drugs

People who inject drugs (PWID), particularly in Manipur, Nagaland, Mizoram and Punjab, have a national HIV prevalence of around 8.8 per cent — the highest of any key population. Opioid substitution therapy (buprenorphine), needle-and-syringe exchange and detoxification services run through NGO partners.

Migrants and Truckers

Migrant workers and long-distance truckers act as bridge populations linking high-prevalence corridors to lower-prevalence home districts. NACP runs dedicated migrant interventions at source-and-destination sites and trucker interventions at the major transport corridors.

ICTC and Testing

Integrated Counselling and Testing Centres (ICTCs) are the gateway to the HIV cascade. India has more than 38,000 ICTCs across primary, secondary and tertiary facilities — the largest network of HIV-testing sites in any single country. Testing is free, confidential and based on the three-test rapid testing algorithm. Community-based testing through trained outreach workers, self-testing pilots and HIV testing services for spouses of newly diagnosed patients (Index Testing) are being scaled up under NACP-V.

Mother-to-Child Elimination

The Prevention of Parent-to-Child Transmission (PPTCT) programme tests all pregnant women attending antenatal care for HIV. HIV-positive mothers receive lifelong ART (Option B+ since 2013) and exposed infants receive prophylaxis with nevirapine and early infant diagnosis using dried-blood-spot PCR at six weeks. India’s vertical transmission rate has fallen from over 25 per cent in 2010 to below 4 per cent by 2024 — the country has formally declared elimination of mother-to-child transmission of HIV as a public-health goal under NACP-V. The WHO triple-elimination validation framework (HIV, syphilis and Hepatitis B) is now being applied. The wider public health system and the one-health approach inform the cross-cutting strengthening required to sustain these gains, just as nutritional support — outlined in the malnutrition literature — shapes adherence and outcomes.

Current Prevalence and Geography

Adult HIV prevalence in India is 0.20 per cent in 2023 — well below the global average of 0.6 per cent. The high-prevalence pockets are now concentrated in Nagaland (1.30 per cent), Mizoram (2.37 per cent — the highest in India), Manipur (1.05 per cent), Andhra Pradesh (0.63 per cent), Karnataka (0.43 per cent) and Telangana (0.41 per cent). The Northeast cluster is driven by injecting drug use and onward sexual transmission; the southern cluster reflects the legacy of long-standing migration and sex-work corridors. New infections are increasingly concentrated in young adults aged 15-24, particularly among MSM and PWID populations — the demographic that NACP-V has prioritised.

HIV/AIDS in India for UPSC

HIV/AIDS in India is a recurring topic in UPSC General Studies Paper II (health and governance) and Paper III (science and technology). Candidates should know that the National AIDS Control Organisation was set up in 1992 with five overlapping programmatic phases (NACP-V running 2021-26 with an outlay of INR 15,471 crore), that the UNAIDS 95-95-95 targets are the global benchmarks for 2025, that the HIV/AIDS (Prevention and Control) Act, 2017, came into force in September 2018 and is one of the world’s first rights-based HIV laws, that first-line ART is the tenofovir-lamivudine-dolutegravir fixed-dose combination since 2020, and that Mizoram has the highest state-level adult prevalence at 2.37 per cent.

Frequently Asked Questions

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