HIV is no longer a death sentence but social & behavioural challenges remain – Firstpost

HIV remains a life-changing diagnosis, but advances in treatment and progressive policies have transformed it from a death sentence into a manageable condition that allows a person to have a near-normal lifespan, says Dr Anivita Aggarwal, an infectious disease specialist at Sir Ganga Ram Hospital in Delhi.

Over the years, the HIV incidence rate has consistently fallen in India even as testing and disease surveillance have increased.

Between 2010 and 2023, India’s HIV reduction rate outperformed the global average as infections fell by 44 per cent annually compared to 39 per cent worldwide.

But this is only half the story. According to the United Nations (UN), up to 28 per cent of India’s 26 lakh people living with HIV are not undergoing any treatment.

‘The tip of the iceberg’

In India, policies for the treatment, management, and follow-up of people living with HIV underwent a major update in 2018, and a newer, better treatment regimen was adopted in 2020 that was in line with international best practices, according to Aggarwal.

Despite these advances and the government providing free HIV treatment, Aggarwal says there is still a long way to go in tackling HIV in India because of complex social and behavioural reasons.

Aggarwal tells Firstpost, “We see around 100–150 people with HIV every day and that’s the tip of the iceberg. Few people who opt for private treatment are completely out of the official data. And many of them don’t follow up regularly, which means they never get the full benefits of the ART-led HIV treatment and management regimen that can provide a near-normal lifespan and quality of life.”

Aggarwal says that while people who have consistently taken their medication since diagnosis can now live into their 70s and even 80s, there is a trend where many switch to quacks or occultists who promise a cure.

A person who was part of the Union government’s Aids programme and reproductive health initiatives in the 2000s tells Firstpost that stigma and social pressure have always been the biggest barriers in treating and managing HIV at the grassroots.

“In the government set-up, you get lifetime free treatment and disease management, but you do not have any privacy, and that is perhaps the biggest roadblock. I can recall instances when contact tracing was done such that identities of people with HIV became public and their neighbourhood ostracised them after learning of their diagnosis. Stigma has always been harder to tackle than the virus itself,” says the person, requesting anonymity.

In a paradox-like situation, Aggarwal says that while private healthcare can ensure privacy, it has two major shortcomings.

“Firstly, few people seeking private treatment are completely off the records. Secondly, follow-up in the private sector is not very robust. Altogether, it means that we may not have a very good understanding of infection clusters and how or why the disease is spreading among people seeking treatment in a private set-up,” says Aggarwal.

The promise of ART and HIV’s challenges that remain

As recently as the 1980s and 1990s, HIV was almost always fatal. Planning a family was out of the question. But with the emergence of ART-led HIV treatment and management, not just near-normal lifespans and quality of life but even starting a family is possible.

ART is a therapeutic approach that employs multiple drugs to target HIV at various stages of its action. The aim is to prevent the virus from replicating and spreading inside the body. In simple words, ART suppresses viral load — and that’s why it has been a gamechanger.

With ART, viral replication tackled and viral load is suppressed to undetectable levels and that’s the real gamechanger, according to Aggarwal.

“If HIV is detected early when your CD4 T-cells in the immune system are not low and ART-led treatment is started early, viral load can be brought down to undetectable levels. HIV management works on a ‘U=U’ concept, which means that if the viral load is undetectable, it is untransmissible. A woman with undetectable viral load could very well have a child without HIV,” says Aggarwal.

The numbers show how much of a gamechanger ART has been: Between 2010 and 2024, new HIV infections declined by 48.7 per cent, Aids-related deaths fell by 81.4 per cent, and mother-to-child transmission was down by 74.6 per cent, according to the latest data from the Government of India.

Even though there remains a gap between people living with HIV and those undergoing consistent treatment, the number of people on treatment rose from 14.94 lakh to 18.60 lakh in this period, as per the data.

But even as India has made positive strides, funding to tackle HIV is falling across the world, and the HIV crisis has worsened in many parts of the Global South. Compared to 2023, funding fell by 30–40 per cent this year, and the consequences are damning, according to the UN’s World Aids Day Report 2025.

As a result of such cuts, 3.3 million new HIV infections are expected between 2025 and 2030, according to UN Aids’ modelling. While funding is an issue abroad, challenges in India are social and behavioural.

Aggarwal says that people are well aware that unprotected sex carries the risk of contracting HIV, and yet many simply refuse to use a condom because of personal preference — and that’s not something any state or healthcare policy can enforce.

‘HIV treatment is as simple as managing thyroid’

For a person with HIV, treating and managing it is as simple as managing thyroid, says Aggarwal.

“Just like you take one pill every day for thyroid for life, HIV requires regular pills, some of them daily, under the ART-led regimen. With early detection, timely start of treatment, and consistent adherence, people living with HIV can have a near-normal lifespan and quality of life. We have people in their 70s who are doing fine with regular adherence,” says Aggarwal.

Since India moved to the newer treatment regimen in 2018, cases of HIV drug resistance or people not responding to treatment have largely ebbed.

“In my eight years of practice, I have not seen a single case of HIV drug resistance since India adopted better drugs. And 90 per cent of people with HIV lead almost normal lives with regular adherence to ART,” says Aggarwal.