Unraveling the Intricacies: Integrated and Enhanced Surveillance and Epidemiology for HIV, Syphilis, and Related Co-Infections Under the National AIDS and STD Control Programme in India

Background: Integrated and Enhanced Surveillance and Epidemiology (IESE) framework is a key surveillance tool for monitoring the level and trends of the human immunodeficiency virus (HIV) and related co-infections in the country. Objectives: This paper describes the level and trends of the human immunodeficiency virus (HIV) epidemic in the country, along with the sero-prevalence of the related infections based on the various surveillance surveys and disease burden activities undertaken under the IESE framework. Materials and Methods: HIV sentinel surveillance (HSS) monitors the prevalence of HIV, Syphilis, hepatitis B, and hepatitis C in eight population groups through periodic facility-based surveys. The collected data is then used in estimating the HIV burden using a globally used modeling tool. Here, we present the results from the latest round of HSS and HIV disease burden estimation to highlight epidemic status by location and population. Results: In 2023, adult HIV prevalence was 0.20% nationally, with a 44% drop in annual new infections and a 79% drop in acquired immune deficiency syndrome (AIDS)-related deaths since 2010. The incidence-prevalence ratio was 2.69, and the incidence-mortality ratio was 1.15 in 2023. The proportion of people living with HIV (PLHIV) aged 50+ among total PLHIV increased from 17% in 2000 to 37% in 2023. Two states and 29 districts had over 1% prevalence, with rising new infections in six states/union territories: Tripura, Arunachal Pradesh, Meghalaya, Punjab, Dadra and Nagar Haveli and Daman and Diu, and Assam. HIV prevalence ranged from 0.89% among migrants to 9.03% among people who inject drugs (PWID). Among HIV-positive individuals, syphilis sero-positivity was between 1% and 1.84%. Conclusion: The HIV/acquired immune deficiency syndrome (AIDS) epidemic in India remains low nationally, with new infections and AIDS-related deaths declining faster than global averages. However, certain states and key populations are experiencing a rising epidemic, potentially due to injecting drug use and casual heterosexual risk behavior. The high prevalence of co-infections necessitates integrated care to reduce morbidity and mortality among those infected.