Guwahati: Injecting drug use is emerging as one of the biggest drivers of Assam’s growing HIV burden, with the proportion of new cases linked to needle-sharing rising sharply over the past five years, according to data from the Ministry of Health and Family Welfare (MoHFW).

Cases attributed to injecting drug use accounted for 8.5 per cent of new detections in 2020-21. That share rose to around 60-65 per cent in 2023-25.

The rise has come alongside a steep increase in the number of people living with HIV in the state. Assam recorded 33,145 people living with HIV (PLHIV) in 2025-26, up from 11,364 in 2020-21.

That is now the highest PLHIV count among the eight northeastern states. Mizoram has 26,321, followed by Nagaland with 23,731, Manipur with 23,463, Tripura with 10,769, Meghalaya with 9,244, Arunachal Pradesh with 2,630 and Sikkim with 533.

Heterosexual contact continues to be the most commonly reported mode of HIV transmission in Assam overall. But officials have linked the recent rise in IDU-related infections to a combination of factors, including the state’s location as a gateway to the Northeast, the availability of injectable drugs, needle-sharing and population movement.

The largest concentrations of cases are being reported from urban and transit centres, particularly Kamrup (Metropolitan), which includes Guwahati, along with Cachar, Nagaon and Dibrugarh.

Assam has also bucked the broader decline seen in several parts of the country. New HIV infections in the state are estimated to be 8 to 22 per cent higher than the 2010 baseline.

At the same time, more people are getting tested and learning their status. The proportion of people aware of their HIV status — referred to as the “first 95” under the HIV treatment targets — increased from 52 per cent in 2022-23 to 91 per cent in 2025-26.

Arunachal Pradesh sees an even stronger IDU link

The link with injecting drug use is even more pronounced in Arunachal Pradesh, where IDU accounted for as much as 82 per cent of new HIV detections.

The state had only a few hundred people living with HIV in the early part of the decade. By 2025-26, the number had risen to 2,630.

Adult HIV prevalence has also increased significantly, from 0.04 per cent in 2010 to around 0.25-0.26 per cent in 2023-24.

Papum Pare/ICR and Namsai have reported the highest concentrations of cases in the state.

Nagaland and Manipur have seen the pattern change

Injecting drug use was a major factor in the early spread of HIV in Nagaland and Manipur. The pattern has since changed, with unprotected heterosexual contact now accounting for most new infections in both states.

Nagaland continues to have one of the highest adult HIV prevalence rates in India, at 1.37 per cent. The state recorded 23,731 PLHIV in 2025-26.

There has nevertheless been progress on some indicators. New HIV infections and AIDS-related deaths in Nagaland have fallen by nearly 40 per cent since 2010.

Manipur had 23,463 PLHIV in 2025-26, with adult prevalence estimated at 0.81-0.87 per cent. New infections have dropped by around 50 per cent since 2010, while AIDS-related deaths have declined by 65-69 per cent.

Drug use remains a major concern

Dr S.I. Ahmed, Chairman and Medical Director of the AIDS Prevention Society, said Mizoram, Nagaland and Manipur continue to have among the highest adult HIV prevalence rates in the country, along with Andhra Pradesh, Telangana and Karnataka.

He also pointed to a rise in new infections in states such as Tripura and Meghalaya.

“Factors such as socio-economic disparities, drug abuse, high-risk behaviours, and limited healthcare access have contributed to the rapid spread of HIV/AIDS in the region. Despite efforts from governmental and non-governmental organisations, several barriers persist in combating the epidemic,” Dr Ahmed said.

Birendra Kumar Barman, Member of the Pharmacy Council of India (PCI) and president of the Advance Pharmacy Practitioners of Assam (APPA), said drug use has become a central concern in the region’s HIV response.

“The root of the rise of HIV/AIDS cases in the Northeast is drugs. Now, drug use has spread among teenagers and young people across all sections of society, from the elite to the working class. The use of single syringe has also gone up among them. The situation is beyond the control of the parents. At the present situation, drugs have become more popular among the young people than liquor,” Barman said.

He said drug use was also widespread among sections of the labour force, including people from minority communities, and alleged that supply networks targeting young people and workers had expanded into “a big racket.”

“At a time when the younger generations of other countries are busy working with AI technology, our younger generations have to battle with HIV/AIDS. Who can protect them?” Barman said.

HIV burden remains high across the Northeast

The increase is not confined to Assam and Arunachal Pradesh.

Across the Northeast, the number of people living with HIV rose from 1,00,085 in 2024-25 to 1,29,836 in 2025-26.

Mizoram continues to have the highest adult HIV prevalence in India, at 2.73 per cent. Nagaland follows at 1.37 per cent and Manipur at 0.87 per cent.

Assam’s adult prevalence, at 0.13 per cent, remains below the national average of 0.20 per cent. Its concern, however, is the size and speed of growth in its absolute number of cases.

Between 2020 and 2024, HIV-related causes claimed 8,196 lives across the eight northeastern states. Manipur recorded the highest number of deaths at 3,221, followed by Assam with 2,241.

The situation varies considerably from state to state. In Mizoram, the epidemic remains concentrated among people aged 15 to 49, although new detections have declined.

Tripura has seen adult HIV prevalence rise from 0.05 per cent in 2010 to 0.37 per cent in 2023. Between April 2007 and May 2024, 828 HIV-positive students were registered at ART centres in the state; 47 of them died.

Sikkim continues to have the smallest HIV caseload in the region, with 533 PLHIV and an adult prevalence of 0.11 per cent.

The figures show that the HIV epidemic in the Northeast is no longer following a single pattern. In Assam and Arunachal Pradesh, injecting drug use is playing an increasingly prominent role in new infections, while states such as Nagaland, Manipur and Mizoram continue to carry a substantial burden from earlier phases of the epidemic.

The rising HIV burden in Assam and the Northeast also raises questions about the effectiveness of the crackdown by central and state agencies on the drug trade.

Official figures show that drugs worth Rs 2,919 crore had been seized up to January 2026. By July, the value had risen to Rs 3,253 crore.

The scale of the seizures in 2025 alone gives an indication of the volume of drugs being intercepted in the state: 87 kg of heroin, 13,812 kg of ganja, 27.27 lakh psychotropic tablets, 1.26 lakh bottles of cough syrup, 209 kg of opium and 48 kg of morphine.

The number of cases registered under the Narcotic Drugs and Psychotropic Substances (NDPS) Act has also remained high, with annual figures ranging from 12,398 to 16,605 and 16,157 cases.

Since 2021, 25,835 people have been arrested in connection with these cases. In 2025 alone, 3,013 NDPS cases were registered and 4,453 people were arrested.

Yet the number of convictions remains relatively low. Against 16,157 cases and 25,835 arrests since 2021, there have been around 1,000 convictions, while 1,586 cases ended in acquittal for lack of evidence.

Despite the seizures, arrests and cases, the flow of drugs has continued. The problem is no longer confined to a few known pockets or transit routes; drugs are reaching towns and villages across the state, raising questions about how effectively the supply networks are being disrupted.