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Rachel V Thomas

Reducing Mother-To-Child HIV Transmission To Zero Key To End AIDS In India: Experts

Reducing Mother-To-Child HIV Transmission To Zero Key To End AIDS In India: Experts

Reducing mother-to-child HIV transmission, also called vertical transmission, to zero is crucial to achieve the end AIDS target by 2030 in India, in line with the UN Sustainable Development Goals, said experts.

At the 17th National Conference of the AIDS Society of India (ASICON 2026), health officials and experts together deliberated on the progress made in the country against HIV and also called for a stronger last-mile effort to eliminate AIDS from the country.

While India has made a major reduction in vertical HIV transmission, with just 0.7 percent of infant diagnoses. But the experts stressed the need to further reduce it to zero.

From 25 percent in 2020, the vertical transmission of HIV has come down to 11.75 percent in 2023, according to Dr. Glory Alexander, President of AIDS Society of India (ASI). 

“Before treatments were available to prevent vertical transmission, the risk of a newborn acquiring HIV in India ranged from 15 percent to 45 percent. The risk was nearly 45 percent among infants who were breastfed,” Dr. Alexander said.

She attributed the reduction to the introduction of antiretroviral therapy (ART) and implementation of HIV prevention and treatment guidelines.

"The government has successfully reduced the rate of infant HIV diagnosis (risk of a child getting infected with HIV due to vertical transmission) to 0.71 percent. We need to further reduce it to zero to eliminate vertical transmission of HIV,” Dr. Alexander added.

India reportedly has 27-29 million pregnancies every year. 

As per the latest National AIDS Control Organization (NACO) report, 83 percent of all pregnant women are tested for HIV, and 78 percent of all pregnant women are tested for syphilis in India.

“Out of an estimated 19,000 pregnant women who might be living with HIV in India, over 16,000 were reached by the government-run program and linked to services -- half of them were newly diagnosed with HIV,” Dr. Alexander said. 

NACO runs 794 antiretroviral therapy centers across the country and provides free HIV treatment to 18 lakhs people with HIV.

NACO's over 700 “Suraksha Sewa Kendras” also provide preventive services for people who are at risk of acquiring HIV. 

Dr. Ishwar Gilada, Emeritus President of AIDS Society of India (ASI), called India's progress "commendable."

"But to end AIDS, the last mile approach has to be accelerated and intensified manifold,” the expert said. 

Dr. Gilada stressed the need to "ensure that all key populations know their status, and those with HIV are linked to treatment, care, and support services and remain virally suppressed". 

If a person with HIV is virally suppressed, then there is zero risk of any further HIV transmission, as per the WHO, he added. 

Indian data shows 9-43 times higher HIV rates (as compared to the general population) among key populations, such as men who have sex with men, transgender people, sex workers, people who inject drugs, among others. 

These key populations are hard to reach, which warrants community-led and science-backed approaches, said Dr. Gilada. 

Despite commendable progress in India’s HIV response, there is a huge number of cases of advanced HIV disease (AHD) -- about one third of all people living with HIV in the country, the experts said. 

The World Health Organization (WHO) defines AHD as a CD4 count less than 200 cells per cubic millimeter/ or WHO stage 3/4 in adults/adolescents, and all children less than 5 years old. 

It indicates a severely weakened immune system, high mortality risk, and vulnerability to infections like TB and cryptococcal meningitis.

AHD cases in India are majorly among those who are HIV infected but are not on lifesaving antiretroviral treatment. 

"This could be because HIV infection is undiagnosed in people until they present with opportunistic infections to healthcare centers, or they were not able to adhere to the treatment for a range of reasons,” said Dr Trupti Gilada, Joint Secretary, AIDS Society of India (ASI). 

TB, which is preventable and treatable, is the most common opportunistic infection among people with HIV. 

Another concern is the rising antimicrobial resistance in HIV patients. Studies show that people with HIV are 2-3 times more likely to get drug-resistant forms of TB.

Health Conditions A-Z

health

HIV- Human Immunodeficiency Disease

aids

HIV transmission

HIV treatment

Vertical HIV transmission

antimicrobial resistance

antiretroviral therapy

ASICON 2026

NACO

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Reducing mother-to-child HIV transmission, also called vertical transmission, to zero is crucial to achieve the end AIDS target by 2030 in India, in line with the UN Sustainable Development Goals, said experts. At the 17th National Conference of the AIDS Society of India (ASICON 2026), health officials and experts together deliberated on the progress made in the country against HIV and also called for a stronger last-mile effort to eliminate AIDS from the country. While India has made a major reduction in vertical HIV transmission, with just 0.7 percent of infant diagnoses. But the experts stressed the need to further reduce it to zero. From 25 percent in 2020, the vertical transmission of HIV has come down to 11.75 percent in 2023, according to Dr. Glory Alexander, President of AIDS Society of India (ASI).  “Before treatments were available to prevent vertical transmission, the risk of a newborn acquiring HIV in India ranged from 15 percent to 45 percent. The risk was nearly 45 percent among infants who were breastfed,” Dr. Alexander said.She attributed the reduction to the introduction of antiretroviral therapy (ART) and implementation of HIV prevention and treatment guidelines. "The government has successfully reduced the rate of infant HIV diagnosis (risk of a child getting infected with HIV due to vertical transmission) to 0.71 percent. We need to further reduce it to zero to eliminate vertical transmission of HIV,” Dr. Alexander added.Intensifying Last-Mile Approach India reportedly has 27-29 million pregnancies every year. As per the latest National AIDS Control Organization (NACO) report, 83 percent of all pregnant women are tested for HIV, and 78 percent of all pregnant women are tested for syphilis in India. “Out of an estimated 19,000 pregnant women who might be living with HIV in India, over 16,000 were reached by the government-run program and linked to services -- half of them were newly diagnosed with HIV,” Dr. Alexander said. NACO runs 794 antiretroviral therapy centers across the country and provides free HIV treatment to 18 lakhs people with HIV. NACO's over 700 “Suraksha Sewa Kendras” also provide preventive services for people who are at risk of acquiring HIV. Dr. Ishwar Gilada, Emeritus President of AIDS Society of India (ASI), called India's progress "commendable.""But to end AIDS, the last mile approach has to be accelerated and intensified manifold,” the expert said. Increase HIV Testing ManifoldDr. Gilada stressed the need to "ensure that all key populations know their status, and those with HIV are linked to treatment, care, and support services and remain virally suppressed". If a person with HIV is virally suppressed, then there is zero risk of any further HIV transmission, as per the WHO, he added. Indian data shows 9-43 times higher HIV rates (as compared to the general population) among key populations, such as men who have sex with men, transgender people, sex workers, people who inject drugs, among others. These key populations are hard to reach, which warrants community-led and science-backed approaches, said Dr. Gilada.  Reducing Advanced HIV Disease Despite commendable progress in India’s HIV response, there is a huge number of cases of advanced HIV disease (AHD) -- about one third of all people living with HIV in the country, the experts said. The World Health Organization (WHO) defines AHD as a CD4 count less than 200 cells per cubic millimeter/ or WHO stage 3/4 in adults/adolescents, and all children less than 5 years old. It indicates a severely weakened immune system, high mortality risk, and vulnerability to infections like TB and cryptococcal meningitis.AHD cases in India are majorly among those who are HIV infected but are not on lifesaving antiretroviral treatment. "This could be because HIV infection is undiagnosed in people until they present with opportunistic infections to healthcare centers, or they were not able to adhere to the treatment for a range of reasons,” said Dr Trupti Gilada, Joint Secretary, AIDS Society of India (ASI). TB, which is preventable and treatable, is the most common opportunistic infection among people with HIV. Another concern is the rising antimicrobial resistance in HIV patients. Studies show that people with HIV are 2-3 times more likely to get drug-resistant forms of TB.  