The 2015 HIV estimates reaffirm the sustained declining trend in HIV prevalence and in new HIV infections at the national level in India. While HIV prevalence has overall declined from 0.37% in 2000 through 0.34% in 2007 and now to 0.26% in 2015, new infections in the same period have decreased by 66% to 86,000 in 2015. Rapid scale up of Antiretroviral Therapy (ART) has a very significant impact in producing a drop in AIDS-related deaths by 54% from 2007 to 2015.

Stronger models used to produce estimates and more comprehensive data

The estimates were developed under the leadership of the National Institute of Medical Sciences (NIMS)-ICMR with support from experts from AIIMS, NIHFW, UNAIDS, WHO and CDC. Improved, globally recommended modelling instruments were used and new strategic information, including data from India’s latest HIV Sentinel Surveillance among antenatal clinic attendees and the first Integrated Bio Behavioural Surveillance (IBBS) survey conducted at national scale among high risk populations, was analysed to finalise the estimates.

Results of 2015 HIV Estimations

HIV Prevalence

HIV prevalence among adults aged 15-49 years is estimated to have fallen from 0.34% to 0.26% in 2007-2015. Currently adult prevalence is 0.30% among males, and 0.22% among females. Adult prevalence varies significantly across the country with Manipur still having the highest estimated HIV adult prevalence at 1.15%, followed by Mizoram (0.80%), Nagaland (0.78%), Andhra Pradesh &Telangana (0.66%), Karnataka (0.45%), Gujarat (0.42), Goa (0.40%) and Maharashtra (0.37%). Other States/UTs that have an adult prevalence of over 0.20% include in Bihar, Chandigarh, Delhi, Odisha, Rajasthan, Sikkim, Tamil Nadu, Tripura and West Bengal. While declines in adult HIV prevalence persist in all the high prevalence States of South and North-east India, the trend has stabilised in many states like Bihar, Gujarat, Mizoram and Uttar Pradesh. Increasing trends have been detected in a number of States/union territories including Chandigarh, Delhi, Tripura, Punjab, Jharkhand, Haryana and Sikkim.

People Living with HIV (PLHIV)

Nationally, 21.17 lakhs (range of 17.11 lakhs–26.49 lakhs) people were living with HIV at the end of 2015. Among these, around 40% are females, while children (<15 years) account for 6.5%. Eighteen percent of these PLHIV are in Andhra Pradesh & Telangana, followed by 14% in Maharashtra, 9% in Karnataka, 8% in Gujarat and 7% in Bihar.

The number of PLHIV has remained relatively stable over the past eight years – 2007 to 2015 –; which were the focus of the present estimates. The number has stabilised because, while a growing number of PLHIV survive longer due to expansion of ART, fewer people are now getting infected with HIV.

Annual New HIV Infections

India HIV Estimates 2015 project 0.86 lakh annual new HIV infections in 2015, a decrease from 2.51 lakh in 2000 and 1.28 lakh in 2007. However, the rate of decrease is slowing down in recent years. New HIV infections during 2007-15 fell faster in children (51%) than in adults (29%). Andhra Pradesh & Telangana, Bihar, Gujarat and Uttar Pradesh presently account for 47% of the total new infections among adults. Other states with high numbers of new infections include Maharashtra, Odisha, Rajasthan, Tamil Nadu and West Bengal.

Annual new HIV infections steadily decreased at the National level since the HIV epidemic’s peak in 2000-2001.While HIV infections continue to decline in most States including high HIV burden States, such as Andhra Pradesh& Telangana, Karnataka and Maharashtra, there is a rise in new infections in some states like Assam, Chhattisgarh, Gujarat, Tripura and Uttar Pradesh.

AIDS-related Deaths

Deaths related to AIDS, according to new improved modelling taking higher survival into account, have declined in the 2007-2015 period from 1.51 lakh to 0.67 lakh. The decrease can largely be attributed to the exponential expansion of ART with its coverage growing at national scale from 1.35 lakh in 2007 to 8.52 in 2014. Overall AIDS-related deaths in India have declined by 54% since 2007. The largest numbers of AIDS-related deaths are taking place in Andhra Pradesh, Bihar, Maharashtra and West Bengal. These four States account for 47% of the total AIDS-related deaths. The other states in India where high numbers of AIDS-related deaths are occurring are Gujarat, Karnataka, Odisha, Rajasthan, Tamil Nadu and Uttar Pradesh.  According to the new HIV estimations, a total of 4.5 lakhs deaths have been averted from 2007 to 2015.

ART and PPTCT needs

The number of PLHIV in need of ART and the number of pregnant women in need of antiretroviral prophylaxis to prevent parents to child transmission (PPTCT) of HIV in 2015 is estimated at 13.45 lakh and 35 thousands respectively.

Acknowledge achievement of MDG 6, Gear up to End AIDS

The HIV Estimation 2015 show that India has been successful in achieving the MDG 6 goal of halting and reversing the HIV epidemic by 2015. The fact that new infections have declined by 66% from 2000 and 2015, and AIDS-related deaths fallen by 54% from 2007 to 2015, is a concrete proof that India has delivered on its global commitment in achieving MDG 6.

While India’s success story continues, the current estimates highlight key challenges that will need to be addressed with urgency as the programme moves ahead to achieve NACP IV goals in the short term, the 90-90-90 targets in the intermediate term, and to end the AIDS epidemic in the longer term. The slow-down identified in the rate of decrease of new HIV infections in last few years is a key issue, while scope of improvements in ART and PPTCT coverage exists. It is therefore imperative to go beyond consolidating past gains and reinvigorate the inclusive national response in collaboration with all stakeholders, including development partners and civil society, to fast track progress towards commonly agreed targets and goals in order to eliminate the epidemic.

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MV