The relentless battle against HIV/AIDS has been marked by a seemingly Sisyphean trend of global health systems responding to a disease that affects over 40 million people worldwide. While the rate of new HIV infections has drastically fallen by over 60% since the peak in 1996, infection rates among marginalised communities, such as the LGBTQ+ and sex worker populations, still require constant and vigilant attention. In India, through the collaborative efforts of the National AIDS Control Organisation (NACO), the Ministry of Health and Family Welfare, and several civil society organisations, the estimated adult HIV prevalence (15–49 years) has decreased from a national average of 0.55% in 2000 to 0.21% in 2021.
Furthermore, the Annual New Infections (ANI) at the national level have fallen by 46.3% from 2010 to 2021, while AIDS-related deaths have declined by 76.5% during the same period. However, this positive trend appears to have fallen short in Northeast India. At 2.73%, the HIV prevalence in Mizoram stands well above the national average, while Nagaland and Manipur are not far behind at 1.36% and 1.05%, respectively. The seriousness of the situation is further highlighted by a recent Mizoram State AIDS Control Society (MSACS) report, which discloses over 5,600 HIV/AIDS-related deaths in the state since the outbreak in 1990 and the registration of over 11,000 new cases since 2020.
This rising trend is even more concerning when linked to a region where drug consumption and trafficking are serious problems that have worsened over time. In Mizoram alone, over 351 lives have been lost, and more than 4,400 people have been arrested in relation to narcotics trading activities. Moreover, the rampant practice of sex trafficking, coupled with disproportionate socio-economic conditions, has resulted in Northeastern states bearing a disproportionate burden.
The country’s overall response to combating the disease has not been lukewarm, as there is a heightened focus on high-risk states; however, there is no specific budgetary line item for the Northeastern region. Past measures include targeting High-Risk Groups (HRGs) and establishing Antiretroviral Therapy (ART) centres, among others. In states such as Assam, approaches like opioid substitution therapy are being explored as long-term responses to the crisis.
The affected population is also eligible for state-sponsored social protection through various welfare schemes. Meanwhile, the introduction of HIV self-testing in Mizoram has created a new avenue for combating the disease—one that is more convenient and private. This privacy has empowered many in the state to adopt a proactive role in addressing high infection rates and the issue of underdetection caused by social stigma.
However, to sustain the success of this approach, further efforts must be intensified. The HIV/AIDS epidemic in Mizoram is a consequence of both unsafe sexual practices and injecting drug use and must be addressed through a multidimensional strategy. The response should include a targeted harm-reduction approach for People Who Inject Drugs (PWID), nuanced biomedical prevention, and sustained community-led stigma reduction tailored specifically to Mizoram’s contextual needs.
The establishment of Sampoorna Suraksha Kendras (SSKs) is a crucial step towards prevention, but they must be adapted to Mizoram by increasing access to hygienic needles and syringes, opioid substitution therapy (OST) referrals, and the availability of condoms and PrEP. While the state has specific hotspots where transmission rates are higher than average, facilities to accommodate People Living with HIV (PLHIV) remain largely concentrated in and around Aizawl. By combining micro-hotspot outreach with mobile, same-day services, both effectiveness and accessibility can be significantly enhanced.
Establishing partnership models through churches can also be effective, enabling anonymous health drives that initiate testing and linkage to care while avoiding moralising content that may discourage affected individuals from coming forward. These models should be inclusive of Mizoram’s diverse population, which also includes Hindus and Buddhists. They can also serve as training grounds for youth leaders from communities most vulnerable to HIV/AIDS.
The importance of contraceptive use should be promoted through awareness campaigns that reflect the sensibilities and aesthetics of a younger generation. Furthermore, an administrative push towards telemedicine and digital health facilities is essential to accommodate and address potential cases while collecting data for further analysis and evaluation. Joint agreements with institutions such as STPI and NIELIT would be beneficial in meeting these emerging demands.
While India has made significant strides in its battle against HIV/AIDS, the Northeast continues to lag behind. However, state and central policymakers must not regard this pressing issue as a lost cause. Instead, there is a need to move beyond conventional approaches and embrace innovative solutions.
Daryl Elijah is a research assistant, Department of International Relations, Peace and Public Policy (IRP and PP), St Joseph’s University, Bengaluru. He can be reached at: [email protected].
Karamala Areesh Kumar is Head, Department of International Relations, Peace and Public Policy (IRP and PP), St Joseph’s University, Bengaluru. He can be reached at: [email protected]