NATIONAL AIDS CONTROL ORGANISATION | ICMR – NATIONAL INSTITUTE OF MEDICAL STATISTICS MINISTRY OF HEALTH & FAMILY WELFARE, GOVERNMENT OF INDIA HIV ESTIMATES 2019

Suggested citation: National AIDS Control Organization & ICMR-National Institute of Medical Statistics (2020). India HIV Estimates 2019: Report. New Delhi: NACO, Ministry of Health and Family Welfare, .

For additional information about ‘India HIV Estimates 2019: Report’, please contact: Surveillance & Epidemiology-Strategic Information Division National AIDS Control Organisation (NACO) Ministry of Health and Family Welfare, Government of India 6th and 9th Floor Chanderlok, 36, Janpath, New Delhi, 110001

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INDIA HIV ESTIMATES 2019 REPORT

NATIONAL AIDS CONTROL ORGANISATION | ICMR – NATIONAL INSTITUTE OF MEDICAL STATISTICS MINISTRY OF HEALTH & FAMILY WELFARE GOVERNMENT OF INDIA

GoI/NACO/Surveillance/HIV Estimates 2019/200720

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FOREWORD

Disease burden estimations are fundamental to public health policy formulation, resource allocation and implementation design. They further inform impacts of the public health interventions. In view of the importance of disease burden estimates, World Health Organization (WHO) has been publishing global burden disease estimates since 2000. For HIV, The Joint United Nations Programme on HIV/AIDS (UNAIDS) has established a robust system of periodic estimation which is adopted by most member countries.

HIV disease burden estimation is integral to Surveillance and Epidemiology under National AIDS Control Programme (NACP) since 1998. The first round used indigenous spread-sheet based method using findings from the first round of HIV sentinel surveillance. In 2006, HIV burden estimation under NACP took a methodological leap with availability of community-based HIV prevalence estimates from National Family Health Survey (NFHS) in select States and then also adopting WHO/UNAIDS recommended Workbook and Spectrum method. Since then, the process and tools have continued to evolve as the new evidences on assumptions emerge and models are subsequently improved by UNAIDS.

The HIV Estimates 2019 is the latest round providing updated estimates on the key indicators of prevalence, incidence, mortality, and elimination of mother to child transmission (EMTCT) need by States and UTs. The methods improve from previous round in terms of use of most recent fertility estimates, routine testing data of pregnant women and use of NFHS-IV to inform epidemiological curves and other assumptions. The results highlight that while the overall impact on the HIV/AIDS epidemic continue to be significant, there are pockets which require a very intensive and integrated actions by all Stakeholders to bend the epidemic curve. These estimates are further being disaggregated by districts and analyzed in-depth to provide both macro and micro level of evidences for policy making, local level planning and progress monitoring.

The HIV Estimates 2019 report has come out at an opportune moment. It provides evidence on how much progress has been made on at least three of the 2020 fast-track targets and thus provide a baseline for the programme as NACP designs its contour for the next five years. It also indicates locations which need a much more concerted eff ort. I am confident that all Stakeholders will use this report to further enhance evidence driven implementations towards achieving end of AIDS as a public health threat by 2030.

(Arti Ahuja)

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PREFACE

lndia is currently responding to the COVlD-19 pandemic. The SARS-CoV-2 virus has impacted almost all aspects of life and the national HIV/AIDS programme is not an exception. High-risk groups and migrants have been impacted severely being one of the most disadvantaged and marginalized. Movements of people, drugs, testing kits and all other commodities were adversely impacted limiting the availability and access to the services. Also, globally, evidence has emerged that HIV-infected people are more at risk of COVID-19 death compared to HIV-negative patients. The challenges for the National AIDS Control Programme have multiplied with COVID-19 pandemic.

Given the current context, HIV Estimations 2019 report is a timely publication providing the latest evidence on the magnitude and directions of the HIV/AIDS epidemic. The report details the methodology, presents the findings on epidemiological indicators of prevalence-incidence-mortality-EMTCT need and finally discusses the implications for the National AIDS Control Programme. The report further provides evidence on progress towards 2020 fast-track targets. While progress on treatment aspect has been significant, there is still a lot to be done on the prevention of new HIV infections and the elimination of mother to child transmission of HIV. The continued diversity in the epidemic has been reflected systematically with higher prevalence and incidence in the north-eastern region but the high volume of overall size and new infections in the southern, western, central and eastern regions. Knowledge about this diversity will be vital to re-strategize the approaches under the national AIDS response.

HIV Estimations 2019 report concludes the 16th round of surveillance and estimation activities undertaken by NACP. The round directly engaged thousands of front-line workers, programme managers, epidemiologists, demographers, biostatisticians and microbiologists under the leadership of Dr. Shobini Rajan (Deputy Director General, Surveillance and Epidemiology, MoHFW, Gol). I congratulate all of them for successful implementation of another round of one of the world's largest and most diverse surveillance system. I am confident that the rich and timely evidence presented in this report will be used by all stakeholders to fast-track the national AlDS response.

(Alok Saxena )

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ICMR - NATIONAL INSTITUTE OF MEDICAL STATISTICS (INDIAN COUNCIL OF MEDICAL RESEARCH) Department of Health Research, Ministry of Health and Family Welfare, Government of India Ansari Nagar, New Delhi - 110029

Phone : 91-11-26588803 Dr. M. Vishnu Vardhana Rao Telefax : 91-11-26589635 M.Sc(Stat), M.Tech(IT), PhD(Stat) Email : [email protected] Director : [email protected]

PREFACE

India has successfully generated HIV estimates under the 2019 estimations round for national and State/ for the following key parameters: adult HIV prevalence, number of people living with HIV, HIV incidence per 1,000 uninfected population, number of annual new HIV infections, AIDS-related mortality per 100,000 population, number of annual AIDS-related deaths, and finally the need for services to eliminate mother-to-child transmission of HIV in India.

These estimates are developed by the National Working Group on HIV Estimations (NWG) led by the Indian Council of Medical Research – National Institute of Medical Statistics (ICMR-NIMS) – which is the apex technical body for HIV estimations in the country – and the National AIDS Control Organisation (NACO). NWG members include specialists in Demography/Statistics/Epidemiology, Regional Institutes and Medical Colleges, and M&E off icers/ epidemiologists from State AIDS Control Societies, independent national experts, and experts from UNAIDS India, WHO India and PEPFAR/CDC India. Technical advice has also been sought from specialists from the UNAIDS regional and headquarters and Avenir Health. The Technical Resource Group on HIV Surveillance and Estimations (TRG) is the oversight body, who have reviewed and validated the method and results of 2019 HIV estimates round.

2019 round of HIV estimates have been generated using the UNAIDS recommended Spectrum software revision 5.8. Latest demographic, epidemiological and programme data available in the country were updated, with curve-fitting using ‘EPP Classic model’ done with assumptions and parameters informed by available national data as much as possible. These 2019 estimates cannot be compared directly with estimates published previously as the current estimates are based on new assumptions. It is stemmed from evidence and enhancements made in the Spectrum modelling tool, and the updated latest demographic, surveillance and programme data, thus leading to a refined and improved quality.

As the Chairperson of the NWG on HIV estimates, I would like to congratulate all those who have been part of this modelling exercise and worked tirelessly to bring out this critical information for the National AIDS Control Programme in India. Special thanks to Dr. Damodar Sahu, PI & Focal person of Estimation, ICMR-NIMS and his team. I encourage all stakeholders to use this Technical Report on 2019 HIV Estimates as a guide for their decision making, planning and programmatic purposes.

(M. Vishnu Vardhana Rao) Director, ICMR-NIMS Chair National Working Group on HIV Estimations ix INDIA HIV ESTIMATES 2019

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MESSAGE

I must commend the National AIDS Control Organisation (NACO) and the Indian Council of Medical Research-National Institute of Medical Statistics (ICMR-NIMS) for publishing HIV estimates periodically for the past 20+ years: The most recent being under this 2019 estimations round. HIV estimates are a critical source of information on the HIV epidemic and a sound basis to be used as markers to assess the burden of the epidemic and inform programme planning, prioritization, monitoring and impact assessment.

The development of HIV estimations in India is a noteworthy collaborative, pragmatic and scientific one. It engages national experts from ICMR Regional Institutes, Medical Colleges, and State AIDS Control Societies – who are members of the National Working Group on HIV Estimations (NWG) development under the leadership of ICMR-NIMS and NACO, and under oversight of the senior national and international experts body: the Technical Resource Group on HIV Surveillance and Estimations (TRG) which includes UNAIDS, WHO and PEPFAR/CDC.

UNAIDS is very pleased to have provided technical and financial support to this critical work. The 2019 HIV estimates have been generated using the latest version of Spectrum software recommended by UNAIDS for the modelling work; with the latest nationally available demographic, epidemiological and programmatic data inputted to inform State/UT models, end ensuring scientific methodological rigour.

The 2019 HIV estimates provide latest information on the level and trend of adult HIV prevalence, number of people living with HIV, annual new HIV infections, annual AIDS-related deaths, and need for elimination of mother-to-child transmission of HIV services at the national level and across 35 States/UTs. This evidence is made available in a very timely manner as India enters a critical year in its AIDS response. 2020–21 may very likely mark the final year of the National AIDS Control Programme’s current phase IV. 2020 is also a critical year vis-à-vis national targets end-line year as mentioned in the National Strategic Plan 2017–24. This information will hence be very useful to inform stock-taking and HIV programme planning purposes towards the end of AIDS as a public health threat by 2030.

Finally, I would like to reiterate UNAIDS full and continued support to the HIV estimations work led by NACO and ICMR-NIMS and to the NWG and TRG. I remain convinced that with the evidence-based prioritization at local level, the community engagement, and the innovative implementation strategies, we will together advance India towards the end of AIDS.

Dr. Bilali Camara Medical Epidemiologist UNAIDS Country Director for India

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110011

Government of India Ministry of Health & Family Welfare National AIDS Control Organisation 9th Floor, Chandralok Building, 36, Janpath, New Delhi, 110011

ACKNOWLEDGEMENT Biennial HIV Estimations is a key component of spectrum of Surveillance and Epidemiology activities under the National AIDS Control Programme. Being implemented since 1998, HIV Estimations 2019 is the latest in the series updating the epidemiological evidences nationally and by States/UTs. India’s topmost epidemiologist, demographers, bio-statisticians, community representatives with State and national programme managers have actively contributed in the successful completion of HIV Estimations 2019. We acknowledge the contributions made by all stakeholders engaged in the process.

The Technical Resource Group (TRG) for HIV Surveillance and Estimation, first under the chairpersonship of Shri Sanjeeva Kumar (former Special Secretary & DG, NACO, MoHFW, Gol) and now under the chairpersonship of Smt. Arti Ahuja (Additional Secretary & DG, NACO, MoHFW, Gol) and co-chairpersonship of Dr. Sanjay Mehendale (Former Addl. DG, ICMR) approved the process, methods and report for HIV Estimations 2019. Shri Alok Saxena (Joint Secretary, NACO) provided his guidance for timely completion of activities. Dr. D. C. S. Reddy, Prof. Arvind Pandey, Dr. Shashi Kant, Dr. Bilali Camara, Mx. Abhina Aher, Dr. John Stover, Mr Taoufik Bakkali, Dr. Melissa Nyendak, Dr. Laishram Ladu Singh, Dr. Rajesh Kumar, Dr. D. K. Shukla and Dr. Sanjay Dixit strengthened the exercise with their expertise and provided critical technical guidance at all stages as TRG members. Programmatic context for the exercise was provided by Dr. Sunil Gupta (Addl. DG, NACO), Dr. R. S. Gupta (Former DDG, NACO), Dr. Naresh Goel (DDG, NACO), Dr. Anoop Kumar Puri (DDG, NACO), Dr. Chinmoyee Das, Dr. Bhawani Singh Kushwaha, and Dr. Saiprasad Bhavsar (DD, NACO). We place on record our sincere thanks to NACO’s leadership and senior experts for providing vision, insights and support towards HIV Estimations 2019.

National Working Group (NWG), constituted by NACO, was instrumental in planning, organization, and execution of HIV Estimations 2019. Excellent leadership to the working group was provided by Dr. M. Vishnu Vardhana Rao (Director, ICMR-NIMS, New Delhi).

Dr. Pradeep Kumar (NACO) and Dr. Damodar Sahu (ICMR-NIMS), together with Ms. Nalini Chandra (UNAIDS lndia) and Dr. Arvind Kumar (NACO), anchored the implementation of HIV Estimations 2019. Dr. Sheela Godbole (ICMR- NARI, ), Dr. A. Elangovan (ICMR-NIE, Chennai), Dr. M. K. Saha (ICMR-NlCED, Kolkata), Dr. Sanjay Rai (AllMS, New Delhi), Dr. P. V. M. Lakshmi (PGIMER, Chandigarh) and Dr. T. Gambhir (RIMS, Imphal) enriched NWG with their insights into the epidemic for their respective regions. Dr. Srikala Acharya ( DACS), Dr. Pramod Devraj ( SACS), Dr. Richard C. Lalramhluna ( SACS), Dr. Rajesh Gopal, Dr. Anup R. Amin ( SACS) and Dr. M. Janakiram ( SACS) provided State perspective. Ms. Deepika Srivastava Joshi (CDC-DGHT India) and Dr. Rajatashuvra Adhikary (WHO lndia) provided international perspectives to the process. UNAIDS India supported the publication of HIV Estimations 2019 report. We acknowledge the contribution of each of them towards successful completion of HIV Estimations 2019.

Surveillance is information for action. HIV Estimations consolidates the most recent demographic, programmatic and surveillance evidences into key epidemiological parameters. We are confident that all stakeholders will use the latest evidences presented here to fine-tune their responses to further benefit the national AIDS response in the country.

(Shobini Rajan) xiii INDIA HIV ESTIMATES 2019

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Abbreviations ...... xviii

Executive Summary ...... xxi

01 Background ...... 1

02 Process ...... 3

03 Method and Data Inputs ...... 5

3.1 Overview ...... 5

3.2 Spectrum Version 5.8 ...... 6

3.3 Key Methodological/Data Updates in the State/Union Territory Model ...... 6

04 Results ...... 9

4.1 Overview ...... 10

4.2 Adult (15–49 years) HIV Prevalence ...... 10

4.3 Number of People Living with HIV ...... 12

4.4 HIV Incidence ...... 15

4.5 Annual New HIV Infections ...... 17

4.6 AIDS-related Mortality ...... 19

4.7 Annual AIDS-related Deaths ...... 19

4.8 Pregnant Women in Need of Prevention of Mother-to-Child Transmission Services ...... 22

05 Discussion ...... 23

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Annexures ...... 25

Annexure 1: Composition of the National Working Group on HIV Estimations 2019...... 26

Annexure 2: Composition of Technical Resource Group on HIV Surveillance and Estimation ...... 33

Anenxure 3: State and Union Territory-wise summary of HIV Epidemic in 2019, India HIV Estimates 2019 ...... 35

Factsheets ...... 37

Andaman and Nicobar Islands ...... 38

Andhra Pradesh ...... 39

Arunachal Pradesh ...... 40

Assam ...... 41

Bihar ...... 42

Chandigarh ...... 43

Chhattisgarh ...... 44

Daman and Diu ...... 45

Dadra and Nagar Haveli ...... 46

Delhi ...... 47

Goa...... 48

Gujarat ...... 49

Haryana ...... 50

Himachal Pradesh ...... 51

Jammu and and ...... 52

Jharkhand...... 53

Karnataka ...... 54

Kerala ...... 55

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Madhya Pradesh ...... 56

Maharashtra ...... 57

Manipur ...... 58

Meghalaya ...... 59

Mizoram ...... 60

Nagaland ...... 61

Odisha ...... 62

Puducherry ...... 63

Punjab ...... 64

Rajasthan ...... 65

Sikkim ...... 66

Tamil Nadu ...... 67

Telangana ...... 68

Tripura ...... 69

Uttarakhand ...... 70

Uttar Pradesh ...... 71

West Bengal ...... 72

xvii INDIA HIV ESTIMATES 2019 Abbreviations

AIIMS All India Institute of Medical Sciences

AIM AIDS Impact Module

ANC Antenatal Care

CI Confidence Interval

CLHIV Children Living with HIV

CST Care, Support and Treatment

DAPCU District AIDS Prevention Control Unit

EPP Estimation and Projection Package

FSW Female Sex Worker

HSS HIV Sentinel Surveillance

H/TG Hijra/Transgender

IBBS Integrated Biological and Behavioural Surveillance

ICMR Indian Council of Medical Research

ICTC Integrated Counselling and Testing Centre

IDU Injecting Drug User

IIPS International Institute for Population Sciences

MoHFW Ministry of Health and Family Welfare

MSM Men Having Sex with Men

NACO National AIDS Control Organization

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NACP National AIDS Control Programme

NARI National AIDS Research Institute

NFHS National Family Health Survey

NICED National Institute of Cholera and Enteric Diseases

NIE National Institute of Epidemiology

NIMS National Institute of Medical Statistics

NWG National Working Group

PGIMER Postgraduate Institute of Medical Education and Research

PLHIV People Living with HIV

PMTCT Prevention of Mother-to-Child Transmission

RIMS Regional Institute of Medical Sciences

SDG Sustainable Development Goal

TRG Technical Resource Group

UNAIDS Joint United Nations Programme on HIV/AIDS

UT Union Territory

WHO World Health Organization

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xx INDIA HIV ESTIMATES 2019 Executive Summary

National AIDS Control Organization (NACO), rounds in terms of data inputs, approach Ministry of Health and Family Welfare to handling the survey data as well as (MoHFW), Government of India undertakes assumptions of various epidemiological model-based biennial HIV estimations in parameters. Improvements included collaboration with the Indian Council of updating fertility rates and age distribution Medical Research (ICMR) – National Institute of fertility and updating programmatic of Medical Statistics (NIMS). The objective of and epidemiological data, including use of this biennial exercise is to provide an update State-specific HIV prevalence data (95% on the current status of the HIV epidemic confidence interval [CI]) from the latest in the country/State/Union Territory (UT)/ round of National Family Health Survey district on key epidemiological parameters (NFHS)-IV to calibrate the epidemic curve. of HIV prevalence, new infections and AIDS- For the first time, the HIV Estimations 2019 related mortality. HIV estimations also provide exercise has also used data on routine HIV the need for the elimination of mother-to- testing of pregnant women under NACP to child transmission of HIV. HIV Estimations inform the epidemiological curve. Further, 2019 is the report on the latest round in the the ratio of female to male incidence for series of HIV Estimations process. 15–49 years was also updated using NFHS- IV data. In view of these improvements, HIV estimation employs the Joint United results from HIV Estimations 2019 cannot be Nations Programme on HIV/AIDS (UNAIDS)- compared with any of the previous rounds supported Spectrum tool as an ongoing of estimations and will be considered as activity of the National AIDS Control replacements for all previous estimations Programme (NACP). Spectrum version 5.80 concerning the level and trends of the HIV has been used for the 2019 round of HIV epidemic as well as programmatic needs. Estimations. This tool is developed under the technical guidance of the UNAIDS Reference In 2019 at the national level, there were an Group on Estimates, Modelling, and estimated 23.49 lakh (17.98 lakh – 30.98 lakh) Projections. The use of this tool has not only people living with HIV (PLHIV), with an adult standardized the method but also facilitated (15–49 years) HIV prevalence of 0.22% (0.17– comparison of the State/UT or national 0.29%). Children living with HIV (CLHIV) estimates with the UNAIDS-published global, comprised 3.4% of the total PLHIV estimates. regional and country estimates. HIV-infected women (15+ years) constituted around 44% of the total estimated 15+ years Like all previous rounds, the State/UT models PLHIV. There were 69.22 thousand (37.03 in this round are improved over previous thousand – 121.50 thousand ) new HIV

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infections in 2019 which has declined by HIV incidence per 1,000 uninfected 37% since 2010 and by 86% since reaching population in 2019 was estimated to be the the peak in 1997. There were 58.96 thousand highest in Mizoram (1.18 per 1,000 uninfected (33.61 thousand – 102.16 thousand) AIDS- population), followed by (0.73) related deaths in 2019, which has declined by and (0.34). Other States estimated 66% since 2010 and by 78% since attaining to have HIV incidence per 1,000 uninfected peak mortality in 2005. HIV incidence was population above the national average of estimated at 0.05 per 1,000 uninfected 0.05 were (0.23), Delhi (0.15), population in 2019. Around 20.52 thousand (0.11), (0.10), (14.98 thousand – 28.13 thousand) pregnant (0.09), (0.08), (0.08), women were estimated to be in need of (0.07) and Maharashtra (0.07).The incidence prevention of mother-to-child transmission rate among high-risk groups (HRGs) was (PMTCT). higher than the total incidence estimates.

Mizoram was estimated to have the highest Maharashtra was estimated to have the adult HIV prevalence (2.32% [1.85–2.84%]), highest number of new HIV infections in followed by Nagaland (1.45% [1.15–1.78%]) 2019 (8.54 thousand), followed by Bihar and Manipur (1.18% [0.97–1.46%]). Other (8.04 thousand), (6.72 States/UTs with an estimated adult HIV thousand), (3.97 thousand), prevalence that was higher than the national Gujarat (3.37 thousand) and Delhi (2.99 average included (0.69% thousand). , Chhattisgarh, [0.54–0.89%]), Meghalaya (0.54% [0.46– Andhra Pradesh, Telangana, , Tamil 0.63%]), Telangana (0.49% [0.35–0.66%]), Nadu, Haryana, Punjab and were the (0.47% [0.37–0.59%]), Delhi (0.41% other States with the estimated annual new [0.33–0.50%]), Maharashtra (0.36% [0.25– HIV infections each ranging between 2,000 0.53%]), Puducherry (0.35% [0.20–0.58%]), and 3,000 in 2019. Together, these 15 States (0.27% [0.19–0.46%]), Punjab (0.27% accounted for 83% of the total new HIV [0.22–0.35%]), Dadra and Nagar Haveli infections in the country. (0.23% [0.14–0.37%]), and Tamil Nadu (0.23% [0.16–0.29%]). Nationally, the annual new HIV infections has decreased by 37% since 2010. The decline in Maharashtra had the highest estimated annual new HIV infections has been noted in number of PLHIV (3.96 lakh), followed by all States/UTs except for Tripura, Arunachal Andhra Pradesh (3.14 lakh), Karnataka (2.69 Pradesh, Chhattisgarh and Chandigarh. The lakh), Uttar Pradesh (1.61 lakh), Telangana highest decline has been noted in Karnataka (1.58 lakh), Tamil Nadu (1.55 lakh), Bihar (1.34 (75%), followed by lakh) and Gujarat (1.04 lakh). Together, these (74%) and Andhra Pradesh (65%). Annual eight States constituted 72% of the total new HIV infections are estimated to have PLHIV estimates in the country. West Bengal, increased in Tripura, and Delhi, Punjab, Rajasthan, Madhya Pradesh, Chhattisgarh; while they have stabilized in Odisha and Haryana contributed another Mizoram and West Bengal. 18% of the total PLHIV size.

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AIDS mortality was estimated at 4.43 per accounting for the highest need were 100,000 population in 2019 at the national Maharashtra (14.7% of the total PMTCT level, which peaked at around 25 during needs), Bihar (12.3%) and Uttar Pradesh 2004/05 and then continued to decline. (10.8%), Karnataka (6.8%), Andhra Pradesh State/UT-wise, AIDS mortality per 100,000 (6.8%), Telangana (5%), Gujarat (4.8%), population was estimated to be the highest Rajasthan (4.2%), Tamil Nadu (4.1%) and West in Manipur (36.86), followed by Mizoram Bengal (3.3%). (28.34), Nagaland (26.20), Andhra Pradesh (21.76), Puducherry (15.33), Meghalaya (11.08) The HIV Estimations 2019 report reiterates and Telangana (10.79). In addition, Karnataka that while the country is on track in achieving (9.72), Goa (9.68), Maharashtra (7.81), Haryana the reduction in AIDS-related deaths at the (6.83), Chandigarh (5.74), Chhattisgarh (5.25) national level and also in majority of the and Delhi (5.21) were the other States/UTs States/UTs, fast-tracking the progress to where AIDS mortality was estimated to be at achieve targets for reduction in new HIV 5 per 100,000 population or higher. infections remains a priority. Further, district- level disaggregation of these estimates will Nationally, there were an estimated 20.52 provide a more granular understanding of thousand (14.98 thousand – 28.13 thousand) the epidemic in these States/UTs and may pregnant women who would require further augment the process of prioritization antiretroviral treatment (ART) to prevent at the sub-national level and also strengthen mother-to-child transmission of HIV. States the AIDS response at the local level.

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01 Background

HIV epidemic monitoring has been a to count the number of AIDS-related deaths vital component of strategic information because it will require investigations into activities under the NACP since its inception. the cause of all reported deaths. Model- This is done through a robust institutional based estimates with uncertainty bounds arrangement inclusive of Technical Resource provide scientifically appropriate and Group (TRG) on HIV Surveillance and programmatically acceptable information Estimation, national and regional institutes, on levels and trends of the HIV epidemic, State AIDS Control Societies, and a network which can inform decisions related to of laboratories for testing and re-testing of resource allocation and planning, and an blood specimen (see Figure 1). Under this insight on the impact of the AIDS response. institutional arrangement, ICMR–NIMS is the The first HIV estimation exercise in India was nodal institute for HIV Estimations. conducted in 1998, while the latest round was completed in 2017. Model-based HIV estimation is undertaken biennially under the NACP as one of the HIV Estimation 2019 under the NACP fundamental epidemic monitoring activities. was done using the UNAIDS-supported The objective of this biennial exercise is to Spectrum tool version 5.80. This tool is provide an update on the current status of developed under the technical guidance of the HIV epidemic in the country/State/UT/ the UNAIDS Reference Group on Estimates, district on key epidemiological parameters Modelling and Projections1. Its use has not such as HIV prevalence, new infections and only standardized the method but also AIDS-related mortality. Estimations on the made possible the comparison of the State/ need for measures to eliminate mother-to- UT or national estimates with the UNAIDS- child transmission of HIV are also provided. published global, regional and country estimates. Modelled HIV estimations are critically needed in a country like India as it is not It is important to note that results from HIV possible to enumerate PLHIV by performing Estimations 2019 cannot be compared with a census-based testing of each individual the previous rounds. As a part of the process, for HIV regularly. Similarly, it is not possible State/UT-wise models are prepared for every

1 http://www.epidem.org/

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round of estimations using the latest version can change the trends of HIV prevalence of the Spectrum tool. The State/UT models and incidence over time. Because of these may diff er from one round to the next augmentations to the model and addition for two reasons. First, improvements are of new data to create the estimates for incorporated into the UNAIDS-supported each round, the results from previous Spectrum model itself based on the latest rounds of estimates cannot be compared available evidence and understanding of to the results of the current round, and only the epidemic as well as of the impact of the findings from the current round of estimates programmatic interventions. Second, new shall be used for all references. This is as per demographics, surveillance, survey and the UNAIDS recommendations regarding programme data are incorporated into each the comparison of the latest estimates with of the State/UT models. Such improvements previously published estimates2.

Figure 1: Institutional Framework for HIV Surveillance and Estimation under NACP

NATIONAL AIDS CONTROL ORGANISATION Technical Resource Group on Survellance & Estimation

Nodal Agency: Policy, Strategy & Plan

AIIMS ICMR-NIMS

Nodal Agency: HIV Sentinel Surveillance Coordination and Nodal Agency: HIV Estimation – PLHIV, New Supervision, Analysis and Documentation Infections and AIDS-related Mortality

Quality Control on Testing Labs

CENTRAL TEAM REGIONAL INSTITUTIONS REFERENCE LABORATORIES

Supervision

North Zone Central Zone West Zone South Zone East Zone North East Zone PGIMER AIIMS ICMR–NARI ICMR–NIE ICMR–NICED RIMS Chandigarh New Delhi Pune Chennai Kolkata Imphal (5 States/UTs) (5 States) (7 States/UTs) (7 States/UTs) (6 States/UTs) (5 States)

Technical Validation of New Sites, Training, Monitoring, Supervision & Data Entry; Technical Support & Guidance to SACS in Planning, Implementation, Troubleshooting & Analysis

STATE AIDS CONTROL SOCIETY STATE SURVEILLANCE TEAMS

Primary Implementing Agency in the State Training and Supervision

DAPCU Testing Laboratories

Coordination

Sentinel Sites

2 Joint United Nations Programme on HIV/AIDS (UNAIDS). Methods for deriving UNAIDS estimates. Geneva: UNAIDS; 2016

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02 Process

The process of HIV Estimations 2019 was Sciences (IIPS), the nodal organization for initiated vide NACO’s off ice order no. implementing the NFHS, is also represented T-11020/08/2019-NACO (Surveillance) dated in the NWG. The composition and terms of 21.08.2019. It identified the National Working reference (ToR) of the NWG are placed at Group (NWG) and defined the conceptual annexure 1. framework and activity timeline matrix with the objective of providing the latest As a part of the process, NACO organized epidemiological estimates at the national, a four-day capacity building-cum-expert State and district levels (see Figure 2). It was consultation workshop on HIV Estimations decided that the district-level estimations 2019 for national, regional, and State/UT will be done after publications of State/UT- stakeholders on 27–30 August 2019 with results for HIV Estimations 2019. support from UNAIDS. Jointly, ICMR–NIMS and NACO convened three meetings of The NWG for HIV Estimation 2019 is chaired NWG during which the data inputs, adopted by the Director, ICMR–NIMS, New Delhi approaches and model results were reviewed and co-chaired by the Assistant Director and validated. After the recommendations General – Strategic Information, NACO. It from the NWG, the methods and results for has members with expertise in demography, HIV Estimations 2019 were presented to the epidemiology, statistics, etc. coming from TRG on HIV Surveillance and Estimations national and regional institutes for HIV for their review and recommendations. In Surveillance and Estimation, UNAIDS, World continuation, this technical report presents Health Organization (WHO), Center for the method and results from HIV Estimations Disease Control, independent technical 2019. experts and from NACO. An expert from the International Institute for Population

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Figure 2: Process of HIV Estimations 2019

1. 3. 4. Planning for Capacity Inputs data implementation 2. building on compilation, of HIV Constitution of latest Spectrum review and Estimations NWG tools finalization 2019

8. 5. 6. 7. Preparation, Creation, review Multiple round of internal reviews Presentation release and and finalization & consultation of findings to dissemination of of State/UT-wise with international TRG HIV Estimations projections experts 2019 report

4 INDIA HIV ESTIMATES 2019 03 Method and Data Inputs

3.1 Overview in India in 1986 and accordingly, 1981 has been chosen as the base year under the HIV Estimations 2019 used the UNAIDS- assumption that the epidemic must have supported Spectrum version 5.8, which started earlier. State-specific age and sex was the latest version available during the population projections have been made and implementation period. The final State/UT subsequently used as input in the model model from HIV Estimations 2017 was used after cross-matching them with Census as the starting point to develop the State/UT results for 1991, 2001, and 2011 to ensure models for HIV Estimations 2019. consistency.

Spectrum is a suite of models available AIM accounts for the programme statistics, as analytical tools for policymakers for population sub-groups among 15–49 years informed decision- making. Two of its with their size, HIV prevalence and sex-age modules, namely the DemProj module and pattern of HIV incidence. It factors in all the AIDS Impact Module (AIM), are used for the epidemiological programme-related HIV Estimations.3 inputs such as setting up of the CD4 -based eligibility for treatment, coverage of PMTCT DemProj projects the demographics by age and ART programme. Then the size and and sex for the given locality using inputs on HIV prevalence among various population birth rates (fertility), death rates (mortality), groups including antenatal clinic attendees and migration. Demographics inputs include and population groups at high risk of HIV population size, level, and trends of fertility infection, such as female sex workers (FSW), and mortality, sex ratio at birth and net men having sex with men (MSM), hijra/ migration. Demographics data are entered transgender (H/TG) people and injecting by age and sex to inform the projections. drug users (IDUs) are inputted in the module. The population projection is set from 1981 The next step in AIM is curve fitting. HIV to 2026. The first case of AIDS was detected estimations in India has done the fitting of

3 Stover J, Brown T, Marston M. Updates to the Spectrum/Estimation and Projection Package (EPP) model to estimate HIV trends for adults and children. Sex Transm Infect. 2012 Dec 1;88(Suppl 2): i11-6

5 INDIA HIV ESTIMATES 2019

Figure 3: HIV Estimations Conceptual Framework

Demographic Data Demographic and Results Epidemic Calculations • Number of PLHIV Programme • Mother-to-child • New infections Statistics transmission • AIDS deaths • Child model • Need for ART Epidemic • Adult model • Need for PMTCT Patterns

Surveillance and Survey Data Prevalence / incidence trend (EPP)

the epidemic in the past using ‘Estimation for the assumptions regarding mother- and Projection Package (EPP)-Classic’ to-child transmission rates based on the model, which has also been used during additional evidence available for peripartum HIV Estimations 2019. After generating the and postpartum transmission; however, epidemic curves, the sex-age pattern for diff erences between 5.63 version and 5.80 incidence is inputted and results are then version were in the decimal-point range produced in the AIM. Plausible values of (Table 1). range for each output indicator are then generated through uncertainty analysis tool of AIM by defining the standard deviation 3.3 Key Methodological/ for the given indicator. Figure 3 depicts the Data Updates in the conceptual framework for HIV estimations State/Union Territory using the Spectrum tool. Model 3.2 Spectrum Version 5.8 A. Demographics: a. Total fertility rate and age The Spectrum tool continues to improve distribution of fertility were under the technical guidance of the UNAIDS updated using the latest evidence Reference Group on Estimates, Modelling from the Sample Registration and Projections. The latest updates to the Survey and National Family Health Spectrum/AIM model have been described Surveys. elsewhere.4,5 The update has been made

4 Stover J, Glaubius R, Mofenson L, Dugdale CM, Davies MA, Patten G, Yiannoutsos C. Updates to the Spectrum/AIM model for estimating key HIV indicators at national and subnational levels. 5 Case KK, Johnson LF, Mahy M, Marsh K, Supervie V, Eaton JW. Summarizing the results and methods of the 2019 Joint United Nations Programme on HIV/AIDS HIV estimates.

6 INDIA HIV ESTIMATES 2019

Table 1: Peripartum and Breastfeeding Transmission Rates by Antiretroviral Regimen

Spectrum v5.8 Spectrum v5.63 Breastfeeding Breastfeeding Regimen Perinatal (per month) Perinatal (per month) < 350 ≥ 350 < 350 ≥ 350 No prophylaxis Existing infections CD4 < 200 37 0.89 37 0.81 CD4 200–350 27 0.81 27 0.81 CD4 > 350 15 0.51 15 0.51 Incident infections 18.1 26.9 26.9 18.2 26.9 26.9 Regimen options Single dose nevirapine 7.5 0.99 0.4 8.9 0.78 0.51 WHO 2006 dual ARV regimen 2.2 0.18 0.18 4.1 0.78 0.51 Option A 4.1 0.2 4.1 0.2 Option B 1.9 0.13 1.9 0.13 ART Started before pregnancy 0.26 0.023 0.21 0.013 Started during pregnancy > 4 weeks 1.4 0.11 1.9 0.13 Started during pregnancy < 4 weeks 8.2 0.2 7.6 0.2

B. Programme Statistics: data on the date of birth of

a. The programme data on PMTCT PLHIV on ART using Integrated and ART (adult and paediatric) Management System data. coverage was updated for the C. Epidemic Configuration: years 2017, 2018, and 2019. a. In select States with no HRG b. To project the coverage for the population in the epidemic period 2020–2026, the most configuration in 2017 round of recent trend in coverage scale-up estimation because of limited (the last 1–2 years), as observed in trend prevalence data points, the programme, was used. HRG sub-population was added c. For Chandigarh and Delhi, data on in the epidemic configuration. PLHIV on ART was disaggregated A ratio of antenatal care (ANC) by State of residence and then prevalence point vis-à-vis HRG adjusted accordingly. prevalence in the corresponding d. The size of adult and child PLHIV year for the State was created on ART was reconciled using using local evidence. The ratio

7 INDIA HIV ESTIMATES 2019

was applied to the time series of E. Epidemic Curves Fitting and ANC surveillance data to generate Calibration:

the HRG prevalence time series a. For HRG population, epidemic data points. curve fitting was done using HRG D. Surveillance Data: HSS data.

a. Surveillance data points from the b. For general population, ANC 2019 round of ANC HIV Sentinel surveillance data and routine Surveillance (HSS) were used to stand-alone ICTC data were used update the general population to inform the curve fitting for all data points. States. b. For HRG, the last improvements c. In States with two HIV prevalence for the year 2017 were used in the data points from the community- absence of any new surveillance based survey, the same was used data for the group in curve fitting. c. Routine-testing data from stand- d. HIV prevalence for HRG alone integrated counselling and population was calibrated using testing centre (ICTC) of pregnant HIV prevalence from Integrated women was inputted for the Biological and Behavioural period 2010–2018 as additional Surveillance (IBBS). data points to inform general e. HIV prevalence for the general population curves. population was calibrated using d. For States with two rounds of HIV prevalence (95% CI) from National Family Health Survey NFHS-IV. on HIV prevalence (Andhra F. Sex Ratio: Pradesh, Maharashtra, Karnataka, a. The ratio of female to male Tamil Nadu, Telangana, Uttar incidences for 15–49 years age Pradesh, Manipur and Nagaland group was updated using NFHS-IV [for Nagaland, findings from a data. special study from 2006 was also referred as per previous estimations rounds]), the NFHS data points were inputted for the general population.

8 INDIA HIV ESTIMATES 2019

04 Results

The results from HIV Estimations 2019 on the same as that used in the National Family level and trends of prevalence, incidence, Health Survey for consistency.7 These AIDS-related deaths, and PMTCT needs have groups are: been provided in this report. It is important to reiterate that these results, generated using (i) North: Chandigarh (CH), Delhi (DL), the most updated Spectrum tool and having Haryana (HR), Himachal Pradesh (HP), the most recent data inputs, replace the Jammu & Kashmir (JK),8 Punjab (PJ), results from previous rounds of estimates. Rajasthan (RJ) and (UK) For all comparisons, the time trend data, as (ii) Central: Chhattisgarh (CG), Madhya provided through HIV Estimations 2019, shall Pradesh (MP) and Uttar Pradesh (UP) only be used until the data from the next round of estimation is made available. This (iii) East: Bihar (BH), (JH), Odisha is in accordance with the recommendations (OD), West Bengal (WB) of the UNAIDS, Geneva, stating that results (iv) Northeast: Arunachal Pradesh (AR), from previous years cannot be compared (AS), Manipur (MN), Meghalaya with the results from this year.6 (MG), Mizoram (MZ), Nagaland (NG), (SK) and Tripura (TR) The report provides the national as well as State/UT-wise estimates. For a visual (v) West: Dadra & Nagar Haveli (DNH), comparison, trends on epidemiological Daman & Diu (DD), Goa (GO), Gujarat estimates have been presented for six (GJ), Maharashtra (MH) specific regions depicting each State/UT in the region. The grouping has been kept

6 UNAIDS HIV data and estimates. UNAIDS Geneva. Available at https://www.unaids.org/en/dataanalysis/knowyourresponse/ HIVdata_estimates and accessed on 26.02.2020 7 http://rchiips.org/NFHS/NFHS-4Reports/India.pdf 8 Refer to formar State of Jammu & Kashmir including Ladakh before its reorganization under Jammu and Kashmir Reorganization Act, 2019

9 INDIA HIV ESTIMATES 2019

(vi) South: Andaman & Nicobar Islands 2019, which has declined by 66% since 2010 (AN), Andhra Pradesh (AP), Karnataka and by 78% since attaining its peak in 2005. (KA), (KE), Puducherry (PO), HIV incidence was estimated at 0.05 per Tamil Nadu (TN) and Telangana (TL) 1,000 uninfected population in 2019. Around 20.52 thousand (14.98 thousand – 28.13 4.1 Overview thousand) pregnant women were estimated to be in need of PMTCT (see Table 2). Nationally, there were an estimated 23.49 lakh (17.98 lakh – 30.98 lakh) PLHIV in 2019, with an adult (15–49 years) HIV prevalence 4.2 Adult (15–49 years) of 0.22% (0.17–0.29%). This includes around HIV Prevalence 79 thousand CLHIV accounting for 3.4% Overall, the estimated adult (15–49 years) of the total PLHIV estimates. There were HIV prevalence trend has been declining in 9.94 lakh women living with HIV (15+ India since the epidemic’s peak in the year years) constituting around 44% of the total 2000 and has been stabilizing in recent estimated 15+ years PLHIV. There were years. The estimate for this indicator was 69.22 thousand (37.03 thousand – 121.50 0.22% (0.17–0.29%) in 2019 (see Figure 4). In thousand) new HIV infections in 2019, which the same year, HIV prevalence among adult has declined by 37% since 2010 and by 86% males (15–49 years) was estimated at 0.24% since attaining the peak in 1997. There were (0.18–0.32%) and among adult females at 58.96 thousand (33.61 thousand – 102.16 0.20% (0.15–0.26%). thousand) AIDS-related deaths in the year

Figure 4: Trend of Adult HIV Prevalence in India, 1981–2019 (in %)

2.0

1.5

1.0

0.5

0.0

1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019

10 INDIA HIV ESTIMATES 2019

Table 2: Status of the HIV/AIDS Epidemic in 2019

Adult (15–49 years) HIV prevalence (%) Total 0.22 [0.17–0.29] Male 0.24 [0.18–0.32] Female 0.20 [0.15–0.26] Number of people living with HIV (lakh*) Total 23.49 [17.98–30.98] Adults (15+ years) 22.70 [17.37–29.97] Female(15+ years) 9.94 [7.61–13.00] Children (<15 years) 0.79 [0.58–1.05] HIV incidence per 1,000 uninfected population Total 0.05 [0.03–0.09] Male 0.06 [0.03–0.10] Female 0.05 [0.02–0.08] New HIV infections (thousand) Total 69.22 [37.03–121.50] Adults (15+ years) 65.24 [34.45–115.51] Female (15+ years) 27.58 [14.45–49.53] Children (<15 years) 3.98 [2.49–6.11] Decline in new HIV infections since 2010 (%) Total 37.4 Adults (15+ years) 33.9 Female (15+ years) 32.3 Children (<15 years) 66.1 AIDS-related deaths (thousand) Total 58.96 [33.61–102.16] Adults (15+ years) 55.40 [31.55–96.58] Female (15+ years) 16.76 [8.46–31.73] Children (<15 years) 3.57 [1.94–5.74] Decline in AIDS-related deaths since 2010 (%) Total 66.1 Adults (15+ years) 66.1 Female (15+ years) 73.7 Children (<15 years) 65.3 PMTCT needs (thousand) Total 20.52 [14.98–28.13]

* Lakh = 100,000

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At the sub-national level, three States with being stable to rising. Particularly, adult the highest adult HIV prevalence were from prevalence has been rising in Mizoram and the north-eastern part of the country, namely was stable in Nagaland at a very high level. Mizoram (2.32% [1.85–2.84%]), Nagaland (1.45% The rising HIV prevalence was noted in the [1.15–1.78%]), and Manipur (1.18% [0.97–1.46%]) rest of the north-eastern States. (see Figure 5). Other States/UTs estimated to have adult HIV prevalence higher than the national average were Andhra Pradesh (0.69% 4.3 Number of People [0.54–0.89%]), Meghalaya (0.54% [0.46–0.63%]), Living with HIV Telangana (0.49% [0.35–0.66%]), Karnataka Nationally, there were an estimated (0.47% [0.37–0.59%]), Delhi (0.41% [0.33– 23.49 lakh (17.98 lakh – 30.98 lakh) PLHIV in 0.50%]), Maharashtra (0.36% [0.25–0.53%]), 2019. Maharashtra was estimated to have Puducherry (0.35% [0.20–0.58%]), Goa (0.27% the highest number of PLHIV (3.96 lakh), [0.19–0.46%]), Punjab (0.27% [0.22–0.35%]), followed by Andhra Pradesh (3.14 lakh), Dadra and Nagar Haveli (0.23% [0.14–0.37%]), Karnataka (2.69 lakh), Uttar Pradesh (1.61 and Tamil Nadu (0.23% [0.16–0.29%]). lakh), Telangana (1.58 lakh), Tamil Nadu (1.55

A decline in HIV prevalence, similar to lakh), Bihar (1.34 lakh) and Gujarat (1.04 lakh) the national trend, has been noted in (see Figure 7). Together, these eight States the southern States of Andhra Pradesh, constituted 72% of the total PLHIV estimates Karnataka, Tamil Nadu and Telangana, the in the country. The States of West Bengal, western States of Maharashtra, Goa and Delhi, Punjab, Rajasthan, Madhya Pradesh, Gujarat, the northern States of Punjab and Odisha and Haryana contributed another Haryana, and the north-eastern State of 18% of the total PLHIV size. Overall, 90% of Manipur (Figure 6). In the rest of the States/ PLHIV estimates were from these 15 States UTs, HIV prevalence appeared to range from (see Figure 8).

Figure 5: Estimates of Adult HIV Prevalence by State/UT, 2019 (in %)

3.00 2.32

2.00 1.45 1.18 1.00 0.69 0.54 0.49 0.47 0.41 0.36 0.35 0.27 0.27 0.23 0.22 0.21 0.23 0.20 0.19 0.20 0.18 0.17 0.14 0.14 0.13 0.12 0.11 0.10 0.10 0.10 0.09 0.09 0.09 0.08 0.06 0.06 0.07 0.00 Goa India Bihar Delhi Kerala Sikkim Assam Punjab Tripura Odisha Gujarat Manipur Haryana Mizoram Nagaland Rajasthan Karnataka Telangana Jharkhand Meghalaya Tamil Nadu Tamil Chandigarh Puducherry Uttarakhand Maharashtra West Bengal West Daman & Diu Chhattisgarh Uttar Pradesh Dadra & Nagar Dadra Andhra Pradesh Andhra Madhya Pradesh Madhya Himachal Pradesh Jammu & Kashmir Arunachal Pradesh Andaman & Nicobar

12 INDIA HIV ESTIMATES 2019

Figure 6: Trend of Adult HIV Prevalence in States/UTs, 1981–2019 (in %)

4.00 0.60 3.00 0.50 0.40 2.00 0.30 0.20 1.00 0.10 0.00 0.00 1981 1981 2011 2011 1987 1987 2017 2017 1984 1984 1999 1999 2014 1996 2014 1996 2019 2019 1990 1990 19 93 19 93 2002 2002 2005 2005 2008 2008 MN MZ NG AR AS MG SK TR

0.25 0.40 0.20 0.30 0.15 0.20 0.10 0.10 0.05 0.00 0.00 1981 1981 2011 2011 1987 1987 2017 2017 1984 1984 1999 1999 2014 2014 1996 1996 2019 2019 1990 1990 19 93 19 93 2002 2002 2005 2005 2008 2008 BH JH OD WB CG MP UP

0.50 2.50 0.40 2.00 0.30 1.50 0.20 1.00 0.10 0.50 0.00 0.00 1981 2011 1987 1981 2011 2017 1984 1987 1999 2014 1996 2019 2017 1990 1984 1999 2014 1996 2019 1990 19 93 2002 2005 2008 19 93 2002 2005 2008 HP HR JK PJ RJ UK DL CH GO MH

0.30 3.00 0.25 2.50 0.20 2.00 0.15 1.50 0.10 1.00 0.05 0.50 0.00 0.00 1981 2011 1987 1981 2017 2011 1984 1999 1987 2014 1996 2019 1990 2017 1984 1999 2014 1996 2019 1990 19 93 2002 2005 2008 19 93 2002 2005 2008 GJ DNH DD AP KA KE TN AN PO TL

AN - Andaman and Nicobar Islands, AP - Andhra Pradesh, AR - Arunachal Pradesh, AS - Assam, BH - Bihar, CG - Chhattisgarh, CH - Chandigarh, DD - Daman and Diu, DL - Delhi, DNH - Dadra and Nagar Haveli, GJ - Gujarat, GO - Goa, HP - Himachal Pradesh, HR - Haryana, JH - Jharkhand, JK - Jammu and Kashmir, KA - Karnataka, KE - Kerala, MG - Meghalaya, MH - Maharashtra, MN - Manipur, MP - Madhya Pradesh, MZ - Mizoram, NG - Nagaland, OD - Odisha, PJ - Punjab, PO - Pondicherry, RJ - Rajasthan, SK - Sikkim, TL – Telangana, TN - Tamil Nadu, TR - Tripura, UK - Uttarakhand, UP - Uttar Pradesh, WB - West Bengal

13 INDIA HIV ESTIMATES 2019

Figure 7: Estimates of PLHIV by State/UT, 2019 (in lakh)

5.0

4.0 3.96 3.14

3.0 2.69

2.0 1.61 1.58 1.55 1.34 1.04 0.74

1.0 0.68 0.66 0.63 0.59 0.49 0.45 0.43 0.29 0.23 0.24 0.23 0.20 0.21 0.11 0.11 0.07 0.06 0.05 0.03 0.02 0.01 0.01 0.05 0.00 0.00 0.00 0.0 Goa Delhi Bihar Kerala Sikkim Assam Punjab Tripura Odisha Gujarat Manipur Haryana Mizoram Rajasthan Nagaland Karnataka Telangana Jharkhand Meghalaya Tamil Nadu Tamil Chandigarh Puducherry Uttarakhand West Bengal West Maharashtra Chhattisgarh Daman & Diu Uttar Pradesh Dadra & Nagar Dadra Andhra Pradesh Andhra Madhya Pradesh Madhya Himachal Pradesh Jammu & Kashmir Arunachal Pradesh Andaman & Nicobar

Figure 8: Distribution of PLHIV by State/UT, 2019 (in %)

Rest 10

Haryana, 2 Maharashtra, 17 Odisha, 2

Madhya Pradesh, 3

Rajasthan, 3

Punjab, 3

Delhi, 3 Andhra Pradesh, 13

West Bengal, 3

Gujarat, 4

Bihar, 6 Karnataka, 11

Tamil Nadu, 7 Uttar Pradesh, 7 Telangana, 7

14 INDIA HIV ESTIMATES 2019

4.4 HIV Incidence estimated to have HIV incidence per 1,000 uninfected population above the national Nationally, HIV incidence was estimated at average of 0.05 were Meghalaya (0.23), 0.05 per 1,000 uninfected population in 2019. Delhi (0.15), Tripura (0.11), Chhattisgarh (0.10), It has declined from 0.54 in 1995 to 0.05 in 2019 Haryana (0.09), Punjab (0.08), Telangana (see Figure 9). State/UT-wise, incidence per (0.08), Bihar (0.07) and Maharashtra (0.07). 1,000 uninfected population was estimated to be the highest in the three north-eastern Similar to the national trend, HIV incidence States of Mizoram (1.18 per 1,000 uninfected has declined in most of the States/UTs during population), Nagaland (0.73) and Manipur the period (Figure 11). HIV incidence has been (0.34) in 2019 (see Figure 10). Other States estimated to be increasing in the State of Tripura.

Figure 9: Trend of HIV Incidence in India, 1990–2019 (per 1,000 uninfected population)

1.5

1.0

0.5

0.0 2011 1991 1997 1992 1995 2012 2017 1993 1994 1998 1999 1996 2013 2018 2015 2014 2016 2019 2001 2010 1990 2007 2002 2008 2009 2003 2004 2005 2006 2000

Figure 10: HIV Incidence by State/UT, 2019 (per 1,000 uninfected population)

1.5 1.18

1.0 0.73

0.5 0.34 0.23 0.17 0.16 0.15 0.11 0.10 0.09 0.08 0.08 0.08 0.07 0.07 0.07 0.05 0.05 0.05 0.05 0.05 0.05 0.04 0.04 0.04 0.04 0.04 0.04 0.04 0.03 0.03 0.02 0.02 0.03 0.03 0.02 0.0 Goa India Delhi Bihar Kerala Sikkim Assam Punjab Tripura Odisha Gujarat Haryana Manipur Mizoram Nagaland Rajasthan Karnataka Telangana Jharkhand Meghalaya Tamil Nadu Tamil Puducherry Chandigarh West Bengal West Maharashtra Uttarakhand Chhattisgarh Daman & Diu Uttar Pradesh Dadra & Nagar Dadra Andhra Pradesh Andhra Madhya Pradesh Madhya Jammu & Kashmir Himachal Pradesh Arunachal Pradesh Andaman & Nicobar

15 INDIA HIV ESTIMATES 2019

Figure 11: Trend of HIV Incidence in States/UTs, 1981–2019 (per 1,000 uninfected population)

6.00 0.60 5.00 0.50 4.00 0.40 3.00 0.30 2.00 0.20 1.00 0.10 0.00 0.00 2017 2017 1981 1981 2011 2011 2014 2014 2019 2019 1987 1987 1993 1993 1984 1984 1999 1999 1996 1996 2002 2002 2005 2005 2008 2008 1990 1990

MN MZ NG AR AS MG SK TR

0.50 0.60

0.40 0.50 0.40 0.30 0.30 0.20 0.20 0.10 0.10 0.00 0.00 2017 2017 1981 1981 2011 2011 2014 2014 2019 2019 1987 1987 1993 1993 1984 1984 1999 1999 1996 1996 2002 2002 2005 2005 2008 2008 1990 1990

BH JH OD WB CG MP UP

5.00 0.60 4.00 0.50 0.40 3.00 0.30 2.00 0.20 0.10 1.00

0.00 0.00 2017 2017 1981 1981 2011 2011 2014 2014 2019 2019 1987 1987 1993 1993 1984 1984 1999 1999 1996 1996 2002 2002 2005 2005 2008 2008 1990 1990 HP HR J&K PJ RJ UK DL CH GO MH

5.00 0.40 0.35 4.00 0.30 3.00 0.25 0.20 2.00 0.15 0.10 1.00 0.05 0.00 0.00 2017 2017 1981 1981 2011 2011 2014 2014 2019 2019 1987 1987 1993 1993 1984 1984 1999 1999 1996 1996 2002 2002 2005 2005 2008 2008 1990 1990

GJ DNH DD AP KA KE TN AN PO TL

AN - Andaman and Nicobar Islands, AP - Andhra Pradesh, AR - Arunachal Pradesh, AS - Assam, BH - Bihar, CG - Chhattisgarh, CH - Chandigarh, DD - Daman and Diu, DL - Delhi, DNH - Dadra and Nagar Haveli, GJ - Gujarat, GO - Goa, HP - Himachal Pradesh, HR - Haryana, JH - Jharkhand, JK - Jammu and Kashmir, KA - Karnataka, KE - Kerala, MG - Meghalaya, MH - Maharashtra, MN - Manipur, MP - Madhya Pradesh, MZ - Mizoram, NG - Nagaland, OD - Odisha, PJ - Punjab, PO - Pondicherry, RJ - Rajasthan, SK - Sikkim, TL – Telangana, TN - Tamil Nadu, TR - Tripura, UK - Uttarakhand, UP - Uttar Pradesh, WB - West Bengal

16 INDIA HIV ESTIMATES 2019

The incidence rate among HRGs was higher Figure 12: HIV Incidence among HRG than the total incidence estimates. In Tamil in Select States (per 1,000 uninfected population) Nadu, HIV incidence among H/TG people was 0.18%, almost 18 times higher than the FSW non-high risk population group. Among

FSW, incidence (percentage) was as high 2.12 as 2.12% in Meghalaya followed by 1.14% in Mizoram and Nagaland, 0.81% in Haryana, 1.14 1.14

0.67% in Maharasthra, 0.66% in Telangana 0.81 0.67 0.66 and 0.63% in Karnataka. Among MSM, 0.63 0.30 0.30 0.28 0.24 0.22 0.16 incidence (percentage) was estimated at 0.14 0.89% in Manipur, 0.88% in Bihar, 0.65% Delhi

in Rajasthan, 0.55% in West Bengal and Sikkim Punjab Odisha Haryana Mizoram Nagaland Karnataka Telangana

0.51% in Himachal Pradesh. Among IDUs, Meghalaya Uttarakhand Maharashtra incidence (percentage) was estimated at Andhra Pradesh Andhra

16.4% in Uttar Pradesh, followed by 9.74% in Arunachal Pradesh Bihar, 3.71% in Maharasthra, 3.61% in Delhi, MSM 3.51% in Haryana, 3.04% in Jharkhand, 2.80% 0.89 in Mizoram, 2.47% in Chhattisgarh and 2.40% 0.88 in Madhya Pradesh. 0.65 0.55 0.51 0.46 0.28 0.27 4.5 Annual New HIV 0.27 0.18 0.16 Infections 0.14

Nationally, there were 69.22 thousand (37.03 Bihar Kerala Punjab Odisha thousand – 121.50 thousand) estimated new Gujarat Manipur Rajasthan HIV infections in 2019. This translates into Karnataka West Bengal West Uttar Pradesh

190 new infections every day and eight new Pradesh Madhya Himachal Pradesh infections every hour. IDU State/UT-wise, Maharashtra was estimated 16.40 to have the highest number of new HIV infections in 2019 (8.54 thousand), followed by Bihar (8.04 thousand), Uttar Pradesh (6.72 9.74 thousand), West Bengal (3.97 thousand),

Gujarat (3.37 thousand) and Delhi (2.99 3.71 3.61 3.51 3.04 2.80 2.47 2.40 1.64 1.69 1.30 0.86 thousand). In addition, Madhya Pradesh, 0.92 Chhattisgarh, Andhra Pradesh, Telangana, Rajasthan, Tamil Nadu, Haryana, Punjab and Delhi Bihar Punjab Tripura Odisha Haryana Odisha were the other States with estimated Mizoram Jharkhand Tamil Nadu Tamil West Bengal West Maharashtra Chhattisgarh annual new HIV infections ranging between Uttar Pradesh

2,000 and 3,000 in 2019 (see Figure 13). Pradesh Madhya

17 INDIA HIV ESTIMATES 2019

Together, these 15 States accounted for 83% all States/UTs except for Tripura, Arunachal of the total new HIV infections in the country. Pradesh, Chhattisgarh and Chandigarh (see Figure 14). Among States/UTs, the highest Nationally, annual new HIV infections have decline has been noted in Karnataka (75%), decreased by 37% since 2010. The decline in followed by Himachal Pradesh (74%) and annual new HIV infections has been noted in Andhra Pradesh (65%).

Figure 13: Annual New HIV Infections by State/UT, 2019 (in thousand)

10.0 8.54 8.04 8.0 6.72

6.0 3.97

4.0 3.37 2.99 2.89 2.83 2.82 2.82 2.77 2.62 2.62 2.37 2.17 1.57 1.55 1.33 1.30 2.0 1.37 0.96 0.73 0.80 0.49 0.45 0.32 0.26 0.16 0.12 0.07 0.07 0.06 0.02 0.02 0.02 0.0 Goa Delhi Bihar Kerala Sikkim Assam Punjab Tripura Odisha Gujarat Manipur Haryana Mizoram Nagaland Rajasthan Karnataka Telangana Jharkhand Meghalaya Tamil Nadu Tamil Puducherry Chandigarh Uttarakhand West Bengal West Maharashtra Chhattisgarh Daman & Diu Uttar Pradesh Dadra & Nagar Dadra Andhra Pradesh Andhra Madhya Pradesh Madhya Himachal Pradesh Jammu & Kashmir Arunachal Pradesh Andaman & Nicobar

Figure 14: Percentage Change in Annual New HIV Infections by State/UT, 2010–2019

300.0 264.5 62.2 6.3 6.5 0.5 0.0 -0.5 -6.5 -12.3 -16.2 -22.7 -29.1 -26.9 -35.2 -34.4 -24.8 -24.2 -46.1 -37.4 -36.0 -35.9 -36.6 -41.6 -38.4 -38.3 -48.7 -44.4 -44.0 -46.4 -73.8 -52.1 -75.1 -64.9

-300.0 Goa India Delhi Bihar Kerala Sikkim Assam Punjab Tripura Odisha Gujarat Manipur Haryana Mizoram Rajasthan Nagaland Karnataka Telangana Jharkhand Meghalaya Tamil Nadu Tamil Chandigarh Uttarakhand Maharashtra West Bengal West Chhattisgarh Uttar Pradesh Andhra Pradesh Andhra Madhya Pradesh Madhya Himachal Pradesh Jammu & Kashmir Arunachal Pradesh

18 INDIA HIV ESTIMATES 2019

4.6 AIDS-related UT-wise, Andhra Pradesh was estimated to have the highest number of AIDS deaths Mortality in 2019 (11.43 thousand), followed by Nationally, AIDS-related mortality was Maharasthra (9.69 thousand), Karnataka estimated at 4.43 per 100,000 population (6.39 thousand), Telangana (4.08 thousand), in 2019, which peaked at around 25 during Uttar Pradesh (3.87 thousand) and Tamil 2004/05 and then continued to decline Nadu (3.01 thousand). In addition, Bihar, (see Figure 15). State/UT-wise, AIDS-related Haryana, Madhya Pradesh, Odisha, Gujarat, mortality per 100,000 population was Chhattisgarh, Punjab, West Bengal, Delhi estimated to be the highest in Manipur and Manipur were the other States with an (36.86), followed by Mizoram (28.34), estimated AIDS deaths ranging between Nagaland (26.20), Andhra Pradesh (21.76), 1,000 and 2,400 in 2019 (see Figure 18). Puducherry (15.33), Meghalaya (11.08) State/UT-wise, annual AIDS-related deaths and Telangana (10.79). The other States/ were estimated to have declined from 2010 UTs where AIDS-related mortality was to 2019 in nearly all States/UTs excluding estimated to be at 5 per 100,000 population Meghalaya, Arunachal Pradesh, Tripura, or higher were Karnataka (9.72), Goa Jammu and Kashmir, Jharkhand and Assam (9.68), Maharashtra (7.81), Haryana (6.83), (see Figure 19). In Sikkim and Bihar, the trend Chandigarh (5.74), Chhattisgarh (5.25) and for this indicator was almost stable, while Delhi (5.21) (see Figures 16 and 17). in Delhi the decline was marginal (5%). On the other hand, AIDS-related deaths have 4.7 Annual AIDS-related declined by 70–80% in Karnataka, Telangana, Deaths Tamil Nadu, Maharashtra, Himachal Pradesh, West Bengal and Andhra Pradesh. The other Nationally, 58.96 thousand (33.61 thousand States where AIDS-related deaths have – 102.16 thousand) AIDS-related deaths declined by more than 50% since 2010 were were estimated in the year 2019. State/ Punjab, Goa, Chhattisgarh, Kerala, Madhya Pradesh, Manipur, Gujarat and Mizoram.

Figure 15: Trend of AIDS Mortality in India, 1990–2019 (per 100,000 population)

50

40

30

20

10

0 1991 2011 1997 1992 2017 1993 1994 1995 1996 1998 1999 2012 2013 2014 2015 2016 2018 2019 1990 2001 2010 2007 2002 2003 2004 2005 2008 2009 2000 2006

19 INDIA HIV ESTIMATES 2019

Figure 16: Trend of AIDS Mortality in India, 1990–2019 (per 100,000 population)

180 14 160 12 120 10 8 80 6 4 40 2

0 0

2017

2019 2014

2017 2011 1981 2011 2014

2019 1981

1987 1987 1993

1984

1993 1999 1999

2002 2008

2005 1996

2002 1996 2005

2008 1984

1990 1990 MN MZ NG AR AS MG SK TR

10 20

8 16

6 12

4 8

2 4

0 0 2017 2017 1981 1981 2011 2011 2014 2014 2019 2019 1987 1987 1993 1993 1984 1984 1999 1999 1996 1996 2002 2002 2005 2005 2008 2008 1990 1990

BH JH OD WB CG MP UP

20 120

16 100 80 12 60 8 40 4 20 0 0 2017 1981 1981 2011 2011 2014 2019 1987 1987 2017 1993 1993 1984 1984 1999 1999 2014 1996 1996 2002 2002 2019 2005 2005 2008 2008 1990 1990

HP HR J&K PJ RJ UK DL CH GO MH

14 140 12 120 10 100 8 80 6 60 4 40 2 20 0 0 1981 1981 2011 2011 1987 1987 2017 2017 1993 1993 1984 1984 1999 1999 2014 2014 1996 1996 2002 2002 2019 2019 2005 2005 2008 2008 1990 1990

GJ DNH DD AP KA KE TN AN PO TL

AN - Andaman and Nicobar Islands, AP - Andhra Pradesh, AR - Arunachal Pradesh, AS - Assam, BH - Bihar, CG - Chhattisgarh, CH - Chandigarh, DD - Daman and Diu, DL - Delhi, DNH - Dadra and Nagar Haveli, GJ - Gujarat, GO - Goa, HP - Himachal Pradesh, HR - Haryana, JH - Jharkhand, JK - Jammu and Kashmir, KA - Karnataka, KE - Kerala, MG - Meghalaya, MH - Maharashtra, MN - Manipur, MP - Madhya Pradesh, MZ - Mizoram, NG - Nagaland, OD - Odisha, PJ - Punjab, PO - Pondicherry, RJ - Rajasthan, SK - Sikkim, TL – Telangana, TN - Tamil Nadu, TR - Tripura, UK - Uttarakhand, UP - Uttar Pradesh, WB - West Bengal

20 INDIA HIV ESTIMATES 2019

Figure 17: AIDS Mortality by State/UT, 2019 (per 100,000 population)

50.0

40.0 36.86

30.0 28.34 26.20 21.76

20.0 15.33 10.79 11.08 9.72 9.68 7.81 6.83

10.0 5.74 5.25 5.21 4.75 4.43 4.05 4.01 3.88 3.08 2.23 1.89 1.71 2.37 2.04 1.67 1.67 1.50 1.40 1.17 1.14 0.93 0.97 0.96 0.64 0.46 0.0 Goa India Delhi Bihar Kerala Sikkim Assam Punjab Tripura Odisha Gujarat Manipur Haryana Mizoram Nagaland Rajasthan Karnataka Telangana Jharkhand Meghalaya Tamil Nadu Tamil Puducherry Chandigarh Uttarakhand Maharashtra West Bengal West Daman & Diu Chhattisgarh Uttar Pradesh Dadra & Nagar Dadra Andhra Pradesh Andhra Madhya Pradesh Madhya Himachal Pradesh Jammu & Kashmir Arunachal Pradesh Andaman & Nicobar

Figure 18: AIDS Deaths by State/UT, 2019 (in thousand)

20.00

15.00 11.43 9.69 10.00 6.39

5.00 4.08 3.87 3.01 2.33 1.95 1.82 1.74 1.57 1.48 1.42 1.37 1.10 1.08 0.71 0.57 0.57 0.53 0.43 0.36 0.36 0.34 0.26 0.09 0.17 0.13 0.07 0.02 0.02 0.01 0.01 0.02 0.00 0.00 Goa Bihar Delhi Kerala Sikkim Assam Punjab Tripura Odisha Gujarat Manipur Haryana Mizoram Nagaland Rajasthan Karnataka Telangana Jharkhand Meghalaya Tamil Nadu Tamil Puducherry Chandigarh Uttarakhand Maharashtra West Bengal West Chhattisgarh Daman & Diu Uttar Pradesh Dadra & Nagar Dadra Andhra Pradesh Andhra Madhya Pradesh Madhya Himachal Pradesh Jammu & Kashmir Arunachal Pradesh Andaman & Nicobar

21 INDIA HIV ESTIMATES 2019

Figure 19: Percentage Change in Annual AIDS-related Deaths by State/UT, 2010–2019

150 135.5 88.9 80.0 20.0 1.8 2.9 0.3 0.0 0 -4.7 -14.3 -14.2 -18.2 -20.5 -26.4 -32.7 -34.7 -37.7 -38.7 -50.0 -53.4 -53.2 -52.4 -50.6 -55.9 -65.2 -67.4 -70.3 -70.0 -70.0 -72.6 -72.6 -70.6 -71.8 -80.4 -150 Goa Delhi Bihar Kerala Sikkim Assam Punjab Tripura Gujarat Odisha Manipur Haryana Mizoram Nagaland Rajasthan

Karnataka Jharkhand Telangana Telangana Meghalaya Tamil Nadu Tamil Chandigarh Uttarakhand Maharashtra West Bengal West Chhattisgarh Daman & Diu Uttar Pradesh Dadra & Nagar Dadra Andhra Pradesh Andhra Madhya Pradesh Pradesh Madhya Jammu & Kashmir Himachal Pradesh Himachal Pradesh Arunachal Pradesh Arunachal Pradesh Andaman & Nicobar

4.8 Pregnant Women (10.78%), Karnataka (6.79%), Andhra Pradesh (6.76%), Telangana (5.02%), Gujarat (4.80%), in Need of Prevention Rajasthan (4.21%), Tamil Nadu (4.12%) and of Mother-to-Child West Bengal (3.31%). States accounting for Transmission Services 2–3% of the total PMTCT needs each are Madhya Pradesh, Chhattisgarh, Delhi, Odisha, Nationally, there were an estimated 20.52 Punjab and Haryana. The States of Nagaland, thousand (14.98 thousand – 28.13 thousand) Manipur, Jharkhand, Assam, Meghalaya and pregnant women who would require ART Mizoram account for 1–2% of the total PMTCT to prevent mother-to-child transmission of needs each while the remaining States/UTs HIV. States accounting for the highest need have an estimated need of less than 1% each were Maharashtra (14.66% of the total PMTCT (see Figure 20). needs), Bihar (12.31%) and Uttar Pradesh

Figure 20: Need for PMTCT of HIV by State/UT, 2019

5,000

4,000 3,007

3,000 2,525 2,212

2,000 1,392 1,386 1,029 985 864 845 679 1,000 606 580 574 485 464 423 397 346 327 359 278 265 155 96 53 33 12 50 34 21 12 8 5 4 4 0 Goa Bihar Delhi Kerala Sikkim Assam Tripura Punjab Odisha Gujarat Manipur Haryana Mizoram Rajasthan Nagaland Karnataka Telangana Jharkhand Meghalaya Tamil Nadu Tamil Puducherry Chandigarh Uttarakhand Maharashtra West Bengal West Chhattisgarh Daman & Diu Uttar Pradesh Dadra & Nagar Dadra Andhra Pradesh Andhra Madhya Pradesh Madhya Himachal Pradesh Jammu & Kashmir Arunachal Pradesh Andaman & Nicobar

22 INDIA HIV ESTIMATES 2019

05 Discussion

As a signatory to the United Nations in many of the erstwhile high prevalence declaration on Sustainable Development southern and western States, it has been Goals (SDGs), India is committed to rising in many States, probably reflecting achieving the “End of AIDS” as a public the increasing survival of HIV-infected health threat by 2030. Specific 2020 Fast- population due to successful care, support Track Targets, including 75% decline in new and treatment programme. Gradual HIV infections from the 2010 baseline value, increase in the number of PLHIV in various attainment of 90-90-90 treatment goals, States/UTs in the coming years will have to elimination of mother-to-child transmission be accounted for by the programme during of HIV and elimination of HIV/AIDS- the strategic planning of the activities such related stigma and discrimination, have as HIV testing, ART treatment, etc. been identified to anchor the global AIDS response towards attaining the “ENDGAME” In the erstwhile high prevalence and by 2030. HIV Estimations 2019 provides early epidemic States of Andhra Pradesh, critical epidemiological updates using the Maharasthra, Karnataka, Tamil Nadu latest tool and data not only by informing and Telangana, both the prevention and the policymakers, programme managers treatment programmes have been highly and all other related stakeholders on the successful. As the annual new infections latest status of the epidemic but also as the have declined more than annual deaths, present benchmark to inform the progress the prevalence has declined in these States, on 2020 Fast-Track Targets and 2030 “End which can be attributed to the significant of AIDS” goal. impact of the national programme.

HIV Estimations 2019 has reiterated that The results on new HIV infections suggest while India’s successful response to AIDS that while success on prevention aspects epidemic continues, there is no scope for continue, the current achievement is still complacency. While adult HIV prevalence far from the target set. Nationally, new HIV has continued to decline nationally and infections have declined by 37% between

23 INDIA HIV ESTIMATES 2019

2010 and 2019 in comparison to the global seen at the national level. Meghalaya, average of 23% (between 2010 and 2019) Arunachal Pradesh, Tripura, Jammu and but yet far from the envisaged target of 75%. Kashmir, Jharkhand, Assam, Sikkim, Bihar and Delhi have exhibited a stable to rising State/UT-wise, till 2019, Karnataka has already trend in AIDS-related deaths. This is an achieved the 2020 prevention targets, with area of concern and needs exploration and Himachal Pradesh and Andhra Pradesh appropriate programmatic response. also nearing the targets. It is a concern that no other States/UTs have achieved The status of HIV/AIDS epidemic in the a decline of 60% or more till 2019. Tripura, States of north-eastern India is indeed Arunachal Pradesh, Chhattisgarh, West alarming. Except for Manipur, the HIV Bengal, Mizoram and Nagaland face a major prevalence in these States has shown a challenge of preventing new HIV infections, stable to rising trend due to a relatively where it has continued to rise/remain stable higher number of annual new HIV infections. between 2010 and 2019. Annual new HIV infections have, in fact, increased in Arunachal Pradesh and Tripura Care, support and treatment (CST) while being almost stable in Mizoram and programme has been at the core of India’s Nagaland during 2010–2019. There is a clear successful AIDS response. Although its need for community-driven integrated AIDS implementation followed that of prevention response in these States on an urgent basis activities by almost two decades and they to respond to the growing HIV problem in were initiated as late as in 2004, rapid scale- the region. up of CST programme under NACP has set up a global benchmark. Between 2010 and Under the NACP in India, HIV Estimations 2019 in India, the number of PLHIV on ART has 2019 has established that the country is increased almost fourfold while globally, the on track to achieve the reductions in AIDS- same has increased threefold (between 2010 related deaths nationally as well as in many and 2018). During the period between 2010 States/UTs. However, the initiatives for and 2019, AIDS-related deaths have declined arresting the number of new HIV infections nationally by almost 66% in comparison to require more focused attention to achieve the global average of 39% decline against the SDG Target 3.3.1. Further insights on the target to achieve 75% decline by 2020. district-level estimates will provide a more In the erstwhile high prevalence States of granular understanding of the epidemic in Andhra Pradesh, Karnataka, Maharasthra, the States/UTs of special concern because Tamil Nadu and Telangana, the decline in that data will be more meaningful in micro- AIDS-related deaths has ranged from 70% planning, local-level prioritization and local to 80% (between 2010 and 2019), which programmatic response. has been a major reason for the decline

24 INDIA HIV ESTIMATES 2019

Annexures

25 INDIA HIV ESTIMATES 2019

Annexure 1: Composition of the National Working Group on HIV Estimations 2019

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Annexure 2: Composition of Technical Resource Group on HIV Surveillance and Estimation

Chair: Shri Sanjeeva Kumar, Former Special Secretary and Director General, NACO / Smt Arti Ahuja, Additional Secretary and Director General, NACO

Co-chair: Dr. Sanjay Mehendale, Additional Director General, ICMR

Member Secretary: Dr. Shobini Rajan, DDG (Surveillance & Epidemiology), NACO

Members:

1. Shri Alok Saxena, Joint Secretary, NACO

2. Dr. Henk Bekedam, Country Representative, WHO India

3. Dr. Bilali Camara, Country Director, UNAIDS India

4. Dr. N. S. Dharmshaktu, Principal Advisor to Ministry on Public Health, MoHFW, GOI

5. Dr. Peter Ghys, Director, Strategic Information and Evaluation, UNAIDS, Geneva

6. Dr. D. C. S. Reddy, Former Head of Department, Department of Community Medicine, Banaras Hindu University, Lucknow and Ex-NPO, WHO India

7. Prof. Arvind Pandey, Advisor, National Institute of Medical Statistics, New Delhi

8. Dr. Rajesh Kumar, Head, School of Public Health, PGIMER, Chandigarh

9. Dr. Samiran Panda, Director, National AIDS Research Institute, Pune

10. Dr. Manoj Vasant Murhekar, Director, National Institute of Epidemiology, Chennai

11. Dr. Shanta Dutta, Director, National Institute of Cholera and Enteric Diseases, Kolkata

12. Dr. Shashi Kant, Professor and Head, Centre for Community Medicine, All India Institute for Medical Sciences, New Delhi

13. Dr. S. Baby Vasumathi, Director, Institute of Obstetrics & Gynaecology, Madras Medical College, Chennai

14. Dr. Sanjay Dixit, Department of Community Medicine, MGM Medical College, Indore

33 INDIA HIV ESTIMATES 2019

15. Dr. D. K. Shukla, Former I/C Director, ICMR-NIMS, New Delhi

16. Dr. Laxmisha Chandrashekar, Head of Department, Department of Dermatology and STD, JIPMER, Puducherry

17. Mr. Taoufik Bakkali, UNAIDS Regional Support Team for Asia and the Pacific, Bangkok

18. Dr. Laishram Ladu Singh, Off iciating Director, International Institute for Population Sciences, Mumbai

19. Dr. Jagdish Chandra, Former Director, Kalawati Saran Children’s Hospital, New Delhi

20. Dr. Timothy Holtz, Director, DGHT, CDC India

21. Dr. John Stover, Vice President, Avenir Health and member UNAIDS HIV Estimation Reference Group

22. Mr. Ashok R. Kavi, Chairman, The Humsafar Trust

23. Mx. Abhina Aher, Associate Director, India HIV/AIDS Alliance

24. Dr. Naresh Goel, Deputy Director General, NACO

25. Dr. R. S. Gupta, Former Deputy Director General, NACO

26. Dr. Anoop Kumar Puri, Deputy Director General, NACO

Overall Coordination

1. Dr. Damodar Sahu, Scientist F & HIV Estimation Focal Person, ICMR-NIMS

2. Dr. Pradeep Kumar, Programme Off icer, Surveillance, NACO

34 INDIA HIV ESTIMATES 2019 Upper bound Estimate Lower bound PMTCT needs (in thousand) PMTCT 2019 AIDS AIDS 2010– related related deaths, in annual % change Upper bound Estimate (in thousand) related deaths, 2019 related Lower bound Total number of annual AIDS- Total Upper bound Estimate 100,000 population, 2019 100,000 AIDS-related mortality per AIDS-related Lower bound 2019 2010– new HIV new in annual % change infections, infections, Upper bound Estimate (in thousand) HIV infections, 2019 HIV infections, Lower bound Total number of annual new number of annual new Total Upper bound Estimate HIV incidence per 1,000 HIV incidence per 1,000 Lower bound uninfected population, 2019 uninfected Upper bound Estimate thousand) Lower bound Total number of PLHIV, 2019 (in number of PLHIV, Total Upper bound 2019 Estimate 0.17 0.22 0.29 1,798.99 2,348.86 3,098.83 0.03 0.05 0.09 37.03 69.22 121.50 -37.38 2.51 4.43 7.59 33.61 58.96 102.16 -66.07 14.98 20.52 28.13 0.05 0.14 0.37 0.20 0.49 1.29 0.01 0.05 0.29 0.01 0.02 0.13 -52.38 0.50 4.05 12.41 0.00 0.02 0.06 -14.29 0.00 0.01 0.01 0.03 0.06 0.11 3.16 6.04 10.47 0.01 0.02 0.07 0.10 0.32 0.92 -35.98 0.23 0.97 2.28 0.03 0.13 0.31 20.00 0.03 0.05 0.09 0.04 0.06 0.1 0.39 0.66 1.03 0.02 0.05 0.09 0.03 0.07 0.14 62.22 0.48 1.14 2.11 0.01 0.02 0.03 88.89 0.01 0.01 0.01 prevalence (15–49 yrs), (15–49 prevalence Percentage of adult HIV Percentage Lower bound Andaman & Nicobar Jammu & Kashmir and Ladakh INDIA Arunachal Pradesh No. State/UT No. 1 45 Assam 0.086 Bihar 0.11 0.097 Chandigarh 0.18 0.18 Chhattisgarh 0.15 0.249 & Nagar Dadra 18.97 83.02 0.210 Daman & Diu 0.12 21.22 Delhi 0.3311 0.27 134.49 0.14 0.1912 Goa 24.42 0.19 31.99 185.61 0.41 0.26 0.1213 0.17 Gujarat 0.23 0.03 0.03 42.52 0.5 0.2714 Haryana 0.37 0.17 1.52 0.17 0.04 0.2 0.07 0.46 Himachal Pradesh 55.64 55.4615 0.23 0.47 0.22 0.21 0.05 0.06 2.36 0.09 67.94 3.20 0.1216 0.26 0.34 93.27 0.75 1.01 3.23 0.10 Jharkhand 0.0617 83.49 0.12 3.19 4.53 103.51 37.25 0.4718 Karnataka 0.37 0.10 0.15 1.33 0.03 0.09 8.04 1.19 0.15 119.4919 Kerala 44.76 0.07 7.53 0.13 0.06 0.47 13.47 0.67 5.60 1.70 0.15 0.08 1.78 0.04 Pradesh Madhya 20 0.59 0.01 0.08 0.03 55.16 14.92 0.25 Maharashtra 21 -26.91 0.17 0.22 0.05 2.83 0.14 -22.75 7.05 218.71 0.08 0.06 0.1122 Manipur 0.97 0.03 0.07 22.75 0.36 0.04 1.95 0.70 0.32 269.47 0.07 0.46 Meghalaya 4.11 1.2323 8.80 0.53 20.18 0.09 0.1 33.65 0.03 0.13 1.18 0.14 2.62 Mizoram 338.7124 2.04 2.99 0.12 0.02 288.60 0.54 0.14 1.67 0.02 0.01 1.46 6.55 Nagaland 1.15 24.2125 0.01 0.13 0.01 396.35 0.07 0.20 0.63 4.55 0.02 3.37 3.82 46.34 Odisha 0.1226 23.55 0.04 2.18 3.30 0.02 1.72 577.01 31.83 1.45 0.02 0.06 0.14 -35.94 4.52 Puducherry 0.2 9.51 0.0327 0.79 59.30 6.31 28.56 0.03 0.14 0.07 0.04 1.78 0.42 0.01 5.25 1.85 Punjab 0.22 0.05 0.2428 2.62 72.09 0.11 0.35 3.19 80.10 11.28 0.60 -35.17 2.33 0.17 Rajasthan 0.08 2.77 35.19 18.05 0.0729 0.70 0.57 8.03 0.02 0.58 2.32 -44.00 0.27 4.55 0.02 3.66 0.91 42.81 0.16 Sikkim 0.03 13.0830 5.21 4.35 1.83 1.30 0.17 22.55 2.84 0.35 0.16 5.74 0.11 0.75 0.93 1.57 Nadu 0.05 Tamil 2.83 0.0431 4.95 1.06 0.24 0.18 -12.35 1.89 49.15 0.07 8.47 0.34 2.41 3.77 2.37 0.14 -0.30 54.18 16.12 27.41 8.88 0.50 0.35 Telangana 32 3.53 1.48 0.06 0.15 4.77 0.23 9.68 1.67 1.79 59.22 -73.75 4.49 47.59 Tripura 5.24 0.4933 0.59 0.67 65.83 20.05 8.54 -24.81 1.60 3.19 0.04 0.49 1.60 0.80 -75.15 0.04 2.26 Uttarakhand 0.1634 0.19 26.14 0.48 3.02 0.62 0.00 0.31 62.98 0.28 7.84 20.10 0.66 0.73 6.83 24.62 84.51 0.37 1.10 0.09 2.53 Uttar 1.2135 Pradesh 2.89 1.59 0.05 5.88 -55.89 0.57 0.06 0.23 114.95 0.09 0.00 76.40 0.96 0.35 0.96 0.05 0.73 0.33 0.01 -38.38 3.54 Bengal West 0.97 8.97 0.13 1.79 0.29 1.17 4.77 -24.20 0.02 1.57 0.40 0.07 9.72 157.51 0.41 0.16 0.73 0.08 0.01 1.69 0.07 1.04 0.02 3.96 0.1 0.17 1.77 0.76 1.18 114.37 0.07 -38.73 1.49 1.62 2.49 213.21 0.04 16.28 -16.24 -4.67 0.98 1.00 0.58 2.12 0.38 0.01 -29.09 0.01 0.14 0.05 0.46 0.07 -18.18 1.55 0.13 154.61 7.81 0.1 1.70 0.03 0.80 0.01 0.05 1.95 0.10 0.13 0.46 3.86 1.40 2.17 -48.67 0.1 24.59 -50.55 1.40 0.03 1.50 0.17 -70.00 0.13 197.84 0.85 16.96 0.07 2.05 0.09 -65.24 0.01 0.08 1.58 0.13 36.86 0.01 0.43 0.26 6.39 2.97 0.57 2.56 2.23 0.85 0.01 0.13 0.00 8.17 8.49 2.37 0.12 2.04 2.82 0.13 4.91 1.37 0.01 0.02 0.02 120.78 -6.47 56.70 0.16 0.72 10.69 2.77 0.61 52.65 -38.33 0.91 0.01 0.04 0.99 3.63 11.08 -26.37 0.00 10.96 4.10 0.02 -70.59 0.35 160.60 2.86 9.69 15.34 1.96 1.06 0.02 0.72 -80.36 3.98 1.20 0.01 -39.06 74.20 13.89 2.85 0.07 0.02 -36.60 0.33 2.90 1.14 14.19 26.20 213.63 21.05 0.04 0.04 0.53 2.82 3.77 103.61 -0.51 1.08 1.00 1.08 -41.59 0.08 0.26 6.18 0.03 3.88 38.70 0.02 3.25 0.23 0.42 0.05 1.82 0.07 0.02 -71.81 0.99 5.95 17.49 1.66 15.33 0.46 1.39 -34.38 2.62 0.04 0.36 0.07 0.54 5.42 0.33 0.03 4.75 0.35 2.96 0.04 28.34 -52.06 2.27 0.11 -53.37 2.00 29.63 4.90 -52.42 0.93 0.07 0.45 0.53 0.17 0.57 1.28 0.05 43.93 7.79 -53.16 0.07 6.03 3.01 0.17 0.31 -44.38 0.12 0.11 0.26 135.53 1.57 0.64 3.93 0.84 1.94 0.97 1.74 0.21 0.29 10.79 0.43 4.12 0.49 0.26 2.22 0.36 0.23 0.16 0.36 2.35 -34.72 6.72 18.06 2.43 3.97 0.34 1.42 0.45 0.61 0.50 0.24 0.77 0.50 4.01 0.28 0.00 10.60 0.71 0.86 0.31 6.98 2.28 0.65 -32.73 0.52 2.33 364.29 0.34 -46.09 0.00 7.09 -46.37 1.20 0.40 264.52 -50.00 4.08 0.40 -67.44 0.51 0.02 1.84 0.50 0.02 1.67 -20.49 0.84 0.20 6.84 0.49 0.21 0.36 0.03 0.70 3.08 0.61 0.64 0.00 3.01 0.46 0.06 -72.64 0.27 0.46 1.71 1.40 4.81 0.00 0.86 0.33 0.63 5.33 0.91 0.68 3.03 2.98 1.06 0.21 0.00 -72.62 0.01 1.03 0.68 0.01 1.91 0.34 1.52 0.56 0.02 1.37 3.87 0.54 0.85 0.04 2.92 6.89 1.20 -14.21 80.00 -70.34 0.07 -37.70 0.02 0.45 0.10 0.03 1.72 0.68 0.13 0.04 2.21 1.05 2.94 2 Pradesh Andhra 3 0.54 0.69 0.89 247.13 313.73 404.46 0.02 0.05 0.13 1.06 2.82 6.69 -64.87 12.32 21.76 34.43 6.48 11.43 18.10 -70.03 0.98 1.39 2.01 Annexure 3: State and Union Territory-wise Summary of HIV Epidemic in 2019, India HIV Estimates 2019 Summary of HIV Epidemic in 2019, 3: State and Union Territory-wise Annexure 35 INDIA HIV ESTIMATES 2019

36 INDIA HIV ESTIMATES 2019

Factsheets

37 38 Andaman and Nicobar Islands

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 1.0

Female Male 0.47 0.19 0.01 Female Male 0.12 0.16 Adults Female Children 0.04 0.05 [0.05-0.31] [0.06-0.43] (15+ years) (15+ years) (<15 years) [0.01-0.24] [0.02-0.33] 0.14 [0.19-1.25] [0.07-0.51] [0.007-0.04] 0.05 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 2001 2007 2002 2005 2003 2008 2004 2009 2006 Total 0.49 Total Total 2000 [0.05-0.37] [0.20 -1.29] [0.01-0.29]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.3 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 52.5 Adults (15+ years) 0.019 0.007 0.002 53.3 0.01 0.006 0.001 Adults Female Children Female Adults Female Children 0.0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (<15 years)

(15+ years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [0.006-0.121] [0.002-0.05] [0.001-0.006] [0.002-0.05] [0.00-0.01] [0.00-0.004] 2010 0.02 33.3 0.02 Total Children 52.38 (<15 years) Total [0.01 -0.13] AIDS mortality per 100,000 population T o t a l [0.002 -0.06] 25.0

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 15.0 child transmission of HIV (in thousand) Adults (15+ years) 14.29 14.3 T o t a l Female (15+ years) 0.0 2011 2017 2012 2015 2013 2018 2014 2019 2016 50.0 0 . 0 1 2010 Children (<15 years) [0.00 -0.01]

2019 2019 2019

2018

2017

2016 2018 2018

2015

2014

2013

2017 2017

2012

2011

2010

2016

2016 2009

2008

2007

2015 2006 2015

2005

2004

2003

2014 2014

2002 2001

population

2000

2013

2013

1999

1998

1997

2012

2012 1996

1995

1994

2011

1993

Adult (15–49 years) HIV prevalence years) (15–49 Adult 2011 HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990 2010 2010 0 0.0 7.0 0.3 0.0 100.0 0.24

Male 0.06 Children (<15 years)

[0.02-0.15] Total 0.05 3.15 3.15 [0.02- 0.13] Total 11.43 Female (15+ years) 0.05 [6.48-18.10] Female [0.02-0.11] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 11.19 11.19 Adults (15+ years) (15+ years) AIDS-related mortality AIDS-related (in thousand) [6.29- 17.82][6.29- 5.57] [1.57- 0.40] [0.12- 1.39 [0.98-2.01]

7.19

Children (<15 years) 87.8 60.7 60.6

Adults Female Children Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission (<15 years) (15+ years) (15+ years) (15+ years) Total Total Female 143.66 143.66 (15+ years) 313.73 [247.13- 404.46] [247.13- [ 114.86-182.88] [5.26-9.39] T o t a l 64.87 64.87 78.3 85.5 69.3 infections since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children Adults 306.53 (15+ years) (15+ years) Number of people living with HIV (in thousand) [241.05- 395.46] [241.05- 0.15 0.15 Children (<15 years)

0.74 Male 1.15 1.15 Female 2.82 Total [0.55-0.98] (15+ years) [1.06- 6.69] [1.06- Total 0.69 [0.54-0.89] 0.64 Female T o t a l 2.66 2.66 70.03 Adults [0.51-0.82] (15+ years) (15+ years) [0.96- 6.43][0.96- 2.73] [0.42- [0.08-0.26] Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in thousand) HIV infections New Decline in HIV new Andhra Pradesh Pradesh Andhra

39 40 Arunachal Pradesh

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 0.3

Female Male 0.63 0.25 0.02 Female Male 0.05 0.07 Adults Female Children 0.04 0.06 [0.03-0.09] [0.04-0.12] (15+ years) (15+ years) (<15 years) [0.02-0.08] [0.02-0.11] [0.36-0.99] [0.14-0.39] [0.01-0.03] 0.06 0.05 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 2001

0.66 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.04-0.10] [0.39-1.03] [0.02-0.09]

New HIV infections (in Increase/Decline in new AIDS-related mortality 0.3 HIV incidence per 1,000 uninfected thousand) HIV infections since 2010 (in thousand) population (%) 69.0+ Adults (15+ years) 0.07 0.02 0.002 75.0+ 0.015 0.005 0.002 Adults Female Children Female Adults Female Children 0.0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (<15 years) 2011 2017

(15+ years) 2012 2015 2013 2018 2014 2019 2016 [0.02-0.13] [0.01-0.05] [0.001-0.003] [0.006-0.028] [0.002-0.010] [0.001-0.004] 2010 0.07 33.3- 0.02 Total Children 62.22+ (<15 years) Total [0.03-0.14] T o t a l [0.01-0.03] 5.0 AIDS mortality per 100,000 population

Increase/Stability in AIDS-related mortality Need for services to prevent mother-to- since 2010 (%) 114.3+ child transmission of HIV (in thousand) Adults (15+ years) 88.89+ 66.7+ T o t a l Female (15+ years) 0.0

0.01 2011 2017 2012 2015 2013 2018 2014 2019 2016 0.0 2010 Children (<15 years) [0.01-0.01]

2019 2019 2019

2018

2017

2016

2018 2018

2015

2014

2013

2017 2017

2012

2011

2010

2016 2016 2009

2008

2007

2006 2015 2015

2005

2004

2003

2014 2014

2002 2001

population 2000

2013 2013

1999

1998

1997

2012 2012 1996

1995

1994

1993 2011

Adult (15–49 years) HIV prevalence years) (15–49 Adult 2011

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990

2010 2010 0 0 5.0 0.3 0.3 0.0 0.06 0.06 Children

(<15 years) Male 0.04

[0.03-0.06] Total 0.04 0.20 0.20 0.57 Total [0.03-0.05] Female (15+ years) 0.04 [0.42-0.75] Female [0.03-0.05] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 0.33 0.50 0.50 Adults (15+ years) (15+ years) [0.36-0.66] [0.14-0.28] [0.05-0.08] AIDS-related mortality AIDS-related (in thousand) [0.28-0.40] 0.93

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission

19.7 13.2 55.6 Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years) Total Total 8.93 Female (15+ years) 21.22 21.22 [7.88-10.33] [0.81-1.08] [18.97-24.42] T o t a l 22.75 22.75 6.1+ 5.5+ 19.0- Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children 20.28 Adults (15+ years) (15+ years) [18.09-23.36] Number of people living with HIV (in thousand) 0.06 0.06 Children (<15 years)

Male 0.09

[0.08-0.11] 0.59 1.33 Female Total (15+ years) [1.01-1.78] Total 0.09 [0.08-0.10] 0.08 Female T o t a l 1.79+ 1.79+ 1.26 1.26 Adults [0.07-0.09] (15+ years) (15+ years) Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) [0.96-1.70] [0.45-0.82] [0.05-0.08] Increase/Decline in AIDS-related mortality in AIDS-related Increase/Decline since 2010 (%) Assam

41 42 Bihar

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 0.7

Female Male 127.16 52.38 7.31 Female Male 0.15 0.20 Adults Female Children 0.06 0.08 [0.09-0.21] [0.12-0.28] (15+ years) (15+ years) (<15 years) [0.02-0.10] [0.03-0.14] [78.17-175.36] [31.69-72.44] [4.56-10.19] 0.18 0.07 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 134.49 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.11-0.24] [83.02-185.61] [0.03-0.12]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.3 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 27.5 Adults (15+ years) 7.33 2.97 0.70 26.9 1.78 0.51 0.54 Adults Female Children Female Adults Female Children 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (<15 years) 2011 2017

(15+ years) 2012 2015 2013 2018 2014 2019 2016 [2.86-12.42] [1.11-5.10] [0.36-1.06] [0.58-3.43] [0.13-1.10] [0.23-0.86] 2010 8.04 20.1 2.33 Total Children 26.91 (<15 years) Total [3.23-13.47] T o t a l [0.79-4.35] 5.0 AIDS mortality per 100,000 population

Increase/Decline in AIDS-related mortality Need for services to prevent mother-to- since 2010 (%) 0.28+ child transmission of HIV (in thousand) Adults (15+ years) 0.30- 36.4- T o t a l Female (15+ years) 0.0

2.53 2011 2017 2012 2015 2013 2018 2014 2019 2016 2.4- 2010 Children (<15 years) [1.60-3.54]

2019 2019 2019

2018

2017

2016

2018

2018

2015

2014

2013

2017 2017

2012

2011

2010

2016 2016 2009

2008

2007

2006 2015 2015

2005

2004

2003

2014 2014

2002 2001

population

2000

2013 2013

1999

1998

1997

2012

2012 1996

1995

1994

2011 1993 Adult (15–49 years) HIV prevalence years) (15–49 Adult 2011

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992 population mortality per 100,000 AIDS

1991

1990 2010 2010 0 0.0 0.3 2.0 0.0 25.0 0.003

Children (<15 years) 0.10 0.10 Male

Total 0.08 [0.03-0.14] 0.01 0.01 Total 0.09 Female 0.05 0.05 (15+ years) Female [0.04-0.13] [0.02-0.09] [0.03-0.17] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 0.08 Adults 0 . 0 1 (15+ years) (15+ years) [0.04-0.13] [0.007-0.02] [0.001-0.004] AIDS-related mortality AIDS-related (in thousand) [0.01-0.02 ] [0.01-0.02 0.06 0.06

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission 3.1- 3.1- 9.5+ 71.4- 71.4- Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years)

Total Total 0.67 Female (15+ years) [1.52-3.19] [0.45-0.88] [0.04-0.07] 2.36 2.36 T o t a l 6.31+ 61.0 25.0 38.7 Increase/Decline in new HIV in new Increase/Decline since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children 2.29 Adults (15+ years) (15+ years) [1.47-3.10] Number of people living with HIV (in thousand) 0.002 0.002 Children 001-0.003] (<15 years)

Male 0.22 0.22

[0.14-0.31] 0.03 Female 0.12 0.12 Total 0.19 Total (15+ years) [0.04-0.20] [0.12-0.26] 0.14 Female T o t a l [0.09-0.19] 38.73 38.73 0.11 Adults (15+ years) (15+ years) Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) [0.03-0.19] [0.01-0.05] [0. Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related Chandigarh

43 44 Chhattisgarh

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 2.0

Female Male 40.41 18.77 2 .1 1 Female Male 0.19 0.22 Adults Female Children 0.10 0.10 [0.14-0.25] [0.16-0.28] (15+ years) (15+ years) (<15 years) [0.06-0.15] [0.06-0.15] [30.36-52.70] [14.09-25.06] [1.62-2.80] 0.20 0.10 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 42.52 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.15-0.27] [31.99-55.46] [0.06-0.15]

New HIV infections (in Increase/Decline in new HIV AIDS-related mortality 0.3 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 10.5+ Adults (15+ years) 2.61 1.30 0.21 17.5+ 1.33 0.55 0.14 Adults Female Children Adults Female Children Female 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [1.54-3.81] [0.76-1.93] [0.14-0.30] [0.82-2.05] [0.33-0.86] [0.09-0.21] 2010 2.83 25.3- 1.48 Total Children 6.55+ (<15 years) Total [1.70-4.11] T o t a l [0.93-2.26] 25.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 57.0 child transmission of HIV (in thousand) Adults (15+ years) 55.89 58.0 T o t a l Female (15+ years) 0.0

0.58 2011 2017 2012 2015 2013 2018 2014 2019 2016 42.0 2010 Children (<15 years) [0.41-0.80]

2019 2019 2019

2018

2017

2016

2018 2018

2015

2014

2013

2017 2017

2012

2011

2010

2016 2016 2009

2008

2007

2006 2015 2015

2005

2004

2003

2014 2014

2002 2001

population 2000

2013 2013

1999

1998

1997

2012 2012 1996

1995

1994

1993 2011

Adult (15–49 years) HIV prevalence years) (15–49 Adult 2011

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990 2010 2010 0 1.0 0.5 0.0 0.0 15.0 0.001 0.001

Children 001-0.001] (<15 years) Male 0.08

0.01 0.01 Total 0.001 0.001 0.07 Total [0.03-0.13] Female 001-0.003] [0. (15+ years) 0.05 0.05 [0.00-0.01 ] [0.00-0.01 Female [0.03-0.10] [0.04-0.14] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected Adults 0.005 0.005 0.004 (15+ years) (15+ years) AIDS-related mortality AIDS-related (in thousand) [0.003-0.009] [0. [0.003-0.006] 0.01 0.01 Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission 16.7- 16.7- 50.0- 50.0- 10.0+ 10.0+ Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years)

Total Total 0.11 Female (15+ years) [0.08-0.16] [0.007-0.01] [0.34-0.67] 0.47 0.0 83.3 72.2 T o t a l 4.55+ 4.55+ Increase/Decline in new HIV in new Increase/Decline since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children 0.45 Adults (15+ years) (15+ years) [0.32-1.15] Number of people living with HIV (in thousand) 0.001 0.001 Children (<15 years)

0.17 Male [0.12-0.25] Total 0.02 0.005 0.005 Female 0.17 0.17 Total (15+ years) [0.01-0.04] [0.12-0.23] 0.14 Female T o t a l 70.0 [0.10-0.20] 0.02 0.02 Adults [0.01-0.03] [0.003-0.009] [0.001-0.002] (15+ years) (15+ years) Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related Daman and Diu

45 46 Dadra and Nagar Haveli

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 1.0

Female Male 0.72 0.26 0.02 Female Male 0.19 0.26 Adults Female Children 0.14 0.19 [0.12-0.30] [0.16-0.41] (15+ years) (15+ years) (<15 years) [0.05-0.26] [0.07-0.37] [0.45-1.15] [0.16-0.41] [0.01-0.03] 0.23 0.17 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 0.75 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.14-0.37] [0.47-1.19] [0.06-0.32]

New HIV infections (in Increase in new HIV AIDS-related mortality 0.5 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 70.7+ Adults (15+ years) 0.07 0.02 0.004 78.6+ 0.006 0.002 0.003 Adults Female Children Adults Female Children Female 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [0.02-0.13] [0.009-0.04] [0.002-0.007] [0.002-0.01] [0.001-0.005] [0.002-0.005] 2010 0.07 100+ 0.01 Total Children 72.09+ (<15 years) Total [0.03-0.14] T o t a l [0.004-0.02] 15.0 AIDS mortality per 100,000 population

Increase/Decline in AIDS-related mortality Need for services to prevent mother-to- since 2010 (%) 40.0- child transmission of HIV (in thousand) Adults (15+ years) 18.8- 33.3- T o t a l Female (15+ years) 0.0

0 . 0 1 2011 2017 2012 2015 2013 2018 2014 2019 2016 200+ 2010 Children (<15 years) [0.007-0.018]

2019

2019 2019

2018

2017

2016

2018 2018

2015

2014

2013

2017 2017 2012

2011

2010

2016 2016 2009

2008

2007

2006 2015 2015

2005

2004

2003

2014 2014

2002 2001

population

2000

2013 2013

1999

1998

1997

2012

2012 1996

1995

1994

2011

2011

Adult (15–49 years) HIV prevalence years) (15–49 Adult 1993 HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990 2010 2010 0 1.5 0.5 0.0 15.0 0.0 0.09 Children (<15 years) 0.16

Male

0.15 Total 0.29 0.29 1.10 [0.10-0.22] Total Female (15+ years) 0.12 [0.67-1.79] Female [0.08-0.19] [0.11-0.25] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 0 . 5 7 1.00 1.00 Adults [0.46-0.72] [0.61-1.65] [0.15-0.52] [0.06-0.13] (15+ years) (15+ years) AIDS-related mortality AIDS-related (in thousand) 2 .0 2

Children

(<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission

34.7 32.0 62.0 Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years) Total Total 23.84 Female (15+ years) 67.94 67.94 [55.64-83.49] [19.35-29.00] [1.68-2.46] T o t a l 35.94 35.94 3.7 12.6 14.8 Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children 65.91 Adults (15+ years) (15+ years) [53.94-81.15] Number of people living with HIV (in thousand) 0.08 Children (<15 years)

Male 0.47

[0.38-0.58] 1.10 1.10 Female Total 2.99 2.99 (15+ years) 0.41 Total [1.95-4.55] [0.33-0.50] 0 . 3 3 Female 4.67 4.67 T o t a l [0.27-0.41] 2.90 2.90 Adults (15+ years) (15+ years) Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) [1.89-4.45] [0.706-1.69] [0.05-0.11] Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related Delhi

47 48 Goa

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 6.0

Female Male 4.42 1.83 0.1 0 Female Male 0.25 0.29 Adults Female Children 0.03 0.03 [0.18-0.43] [0.20-0.48] (15+ years) (15+ years) (<15 years) [0.01-0.13] [0.01-0.14] [3.13-7.31] [1.27-3.03] [0.06-0.20] 0.27 0.03 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 4.53 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.19-0.46] [3.20-7.53] [0.01-0.14]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.2 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 40.2 Adults (15+ years) 0.05 0.02 0.004 41.0 0.16 0.03 0.002 Adults Female Children Adults Female Children Female 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [0.01-0.22] [0.005-0.09] [0.002-0.01] [0.08-0.44] [0.01-0.10] [0.001-0.009] 2010 0.06 69.2 0.17 Total Children 44.00 (<15 years) Total [0.01-0.24] T o t a l [0.09-0.46] 50.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 64.6 child transmission of HIV (in thousand) Adults (15+ years) 65.24 81.8 T o t a l Female (15+ years) 0.0

0.02 2011 2017 2012 2015 2013 2018 2014 2019 2016 86.7 2010 Children (<15 years) [0.02-0.04]

2019

2019 2019

2018

2017

2016

2018 2018

2015

2014

2013

2017 2017 2012

2011

2010

2009 2016 2016

2008

2007

2006

2015 2015

2005

2004

2003

2014 2014

2002 2001

population 2000

2013 2013

1999

1998

1997

2012 2012 1996

1995

1994

1993

2011 Adult (15–49 years) HIV prevalence years) (15–49 Adult 2011

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000 1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990

2010 2010 0 1.0 0.3 0.0 0.0 10.0 0.15 0.15 Children (<15 years)

Male 0.05

Total 0.05 0.55 1.57 Total Female [0.04-0.07] (15+ years) [1.21-2.12] 0.05 Female [0.04-0.07] [0.04-0.07] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 1.41 Adults 0.99 [1.08-1.93] [0.38-0.78] [0.12-0.19] (15+ years) (15+ years) [0.85-1.20] AIDS-related mortality AIDS-related (in thousand) 3 .7 9

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission 77.1 27.2 29.5

Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years) Total Total 42.26 Female (15+ years) [37.86-48.04] [3.35-4.36] 103.51 103.51 [93.27-119.49] T o t a l 35.17 35.17 59.8 56.3 49.3 Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children 99.71 Adults (15+ years) (15+ years) Number of people living with HIV (in thousand) [89.73-115.34] 0.14 Children (<15 years)

0.21 Male

[0.19-0.25] 1.48 1.48 Female 3.37 Total (15+ years) Total 0.20 [2.62-4.52] [0.17-0.22] 0.1 6 Female T o t a l [0.27-0.41] 50.55 50.55 3.22 Adults (15+ years) (15+ years) Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related [2.49-4.34] [1.13-2.00] [0.11-0.17] Gujarat

49 50 Haryana

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 1.0

Female Male 43.26 14.97 1.49 Female Male 0.15 0.26 Adults Female Children 0.07 0.12 [0.13-0.19] [0.21-0.32] (15+ years) (15+ years) (<15 years) [0.04-0.09] [0.08-0.16] [35.91-53.44] [12.56-18.05] [1.27-1.80] 0.21 0.09 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 44.76 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.17-0.26] [37.25-55.16] [0.06-0.13]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.3 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 6.5 Adults (15+ years) 2.54 0.82 0.07 8.2 1.84 0.49 0.10 Adults Female Children Adults Female Children Female 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [1.66-3.56] [0.55-1.14] [0.05-0.10] [1.40-2.42] [0.36-0.67] [0.08-0.13] 2010 2.62 71.7 1.95 Total Children 12.35 (<15 years) Total [1.72-3.66] T o t a l [1.49-2.56] 15.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 25.1 child transmission of HIV (in thousand) Adults (15+ years) 26.37 36.0 T o t a l Female (15+ years) 0.0

0.42 2011 2017 2012 2015 2013 2018 2014 2019 2016 43.4 2010 Children (<15 years) [0.33-0.54]

2019

2019 2019

2018

2017

2016

2018 2018

2015

2014

2013

2017 2017 2012

2011

2010

2016 2009 2016

2008

2007

2006

2015 2015

2005

2004

2003

2014

2014

2002 2001

population 2000

2013

2013 1999

1998

1997

2012 1996 2012

1995

1994

1993

Adult (15–49 years) HIV prevalence years) (15–49 Adult 2011

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000 2011

1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990 2010 2010 1.0 0.0 0.3 0.0 0.0 10.0

0.003 Children Male 0.02 (<15 years)

Total 0.02 0.02 [0.02-0.03] 0.01 0.01 Total 0.07 Female 0.02 (15+ years) Female [0.05-0.13] [0.01-0.03] [0.02-0.04] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected

0.05 0.05 0.06 0.06 Adults (15+ years) (15+ years) [0.04-0.07] [0.04-0.12] [0.007-0.02] [0.001-0.006] AIDS-related mortality AIDS-related (in thousand) 0. 2 0

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission 81.5 73.4 69.5 Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years)

Total Total 2.61 2.61 Female (15+ years) [2.08-3.33] [0.15-0.26] 7.05 7.05 [5.60-8.80] T o t a l 73.75 73.75 81.3 69.6 69.2 Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children 6.84 Adults (15+ years) (15+ years) [5.44-8.53] Number of people living with HIV (in thousand) 0.005 0.005 Children (<15 years)

0.14 Male

[0.11-0.18] 0.06 0.06 0.16 Total Female (15+ years) 0.12 0.12 Total [0.11-0.24] [0.09-0.15] 0.09 Female T o t a l [0.07-0.12] 70.59 0.15 0.15 Adults (15+ years) (15+ years) [0.11-0.23] [0.04-0.10] [0.004-0.008] Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related Himachal Pradesh Himachal Pradesh

51 52 Jammu and Kashmir and Ladakh

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 0.5

Female Male 5.83 2.19 0. 2 0 Female Male 0.05 0.07 Adults Female Children 0.02 0.03 [0.02-0.09] [0.04-0.13] (15+ years) (15+ years) (<15 years) [0.01-0.06] [0.01-0.08] [3.04-10.22] [1.11-3.87] [0.11-0.32] 0.06 0.02 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 6.04 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.03-0.11] [3.16-10.47] [ 0.0 1 - 0.07 ]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.1 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 34.9 Adults (15+ years) 0.30 0.12 0.008 20.6 0.11 0.02 0.01 Adults Female Children Adults Female Children Female 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [0.09-0.90] [0.04-0.36] [0.003-0.01] [0.02-0.28] [0.003-0.06] [0.004-0.02] 2010 0.32 63.6 0.13 Total Children 35.98 (<15 years) Total [0.10-0.92] T o t a l [0.03-0.31] 5.0 AIDS mortality per 100,000 population

Increase in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 21.6+ child transmission of HIV (in thousand) Adults (15+ years) 20.0+ 21.1+ T o t a l Female (15+ years) 0.0

0 . 0 5 2011 2017 2012 2015 2013 2018 2014 2019 2016 7.7+ 2010 Children (<15 years) [0.03-0.09]

2019 2019 2019

2018

2017

2016

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2012 2012 1996

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1993 2011

Adult (15–49 years) HIV prevalence years) (15–49 Adult 2011

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990

2010 2010 0 0.1 5.0 0.5 0.0 0.0 0.06 0.06 Children

(<15 years) Male 0.04

Total 0.04 0.11 Total [0.02-0.07] 0.43 0.43 Female (15+ years) [0.13-0.91] 0.03 Female [0.02-0.06] [0.02-0.07] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 0.36 0.36 0 . 3 5 Adults [0.11-0.79] [0.03-0.30] [0.02-0.12] (15+ years) (15+ years) [0.23-0.53] AIDS-related mortality AIDS-related (in thousand) 1.18 1.18

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission

18.8 29.7 24.3 Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years) Total Total 9.57 Female (15+ years) [6.17-14.28] [0.76-1.75] 22.75 22.75 [14.92-33.65] T o t a l 24.81 17.7- 12.1+ 30.8- Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children 21.56 Adults (15+ years) (15+ years) [14.13-31.82] Number of people living with HIV (in thousand) 0.11 Children (<15 years)

Male

0.09

[0.06-0.14] 0.55 Female 1.30 1.30 Total (15+ years) Total 0.09 [0.60-2.41] [0.06-0.13] 0.08 Female T o t a l [0.05-0.12] 1.18 2.90+ 2.90+ Adults (15+ years) (15+ years) Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) Increase/Decline in AIDS-related mortality in AIDS-related Increase/Decline since 2010 (%) [0.54-2.23] [0.25-1.06] [0.06-0.18] Jharkhand

53 54 Karnataka

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 7.0

Female Male 261.15 133.21 8.31 Female Male 0.48 0.45 Adults Female Children 0.02 0.02 [0.38-0.61] [0.35-0.58] (15+ years) (15+ years) (<15 years) [0.01-0.05] [0.01-0.05] [213.09-329.05] [108.98-167.44] [6.17-10.99] 0.47 0.02 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 269.47 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.37-0.59] [218.71-338.71] [0.01-0.05]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.3 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 71.7 Adults (15+ years) 1.42 0.70 0.14 71.7 6.13 2.05 0.24 Adults Female Children Adults Female Children Female 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [0.60-3.28] [0.29-1.62] [0.08-0.23] [3.68-10.18] [1.10-3.84] [0.13-0.40] 2010 1.57 88.7 6.39 Total Children 75.15 (<15 years) Total [0.70-3.53] T o t a l [3.86-10.69] 100.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 80.1 child transmission of HIV (in thousand) Adults (15+ years) 80.36 86.0 T o t a l Female (15+ years) 0.0

1.39 2011 2017 2012 2015 2013 2018 2014 2019 2016 84.8 2010 Children (<15 years) [1.00-2.00]

2019 2019 2019

2018

2017

2016

2018 2018

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2014

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2016 2009

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population 2000

2013 2013

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2012 2012 1996

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1993 2011

Adult (15–49 years) HIV prevalence years) (15–49 Adult 2011

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000 1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990

2010 2010 0 1.0 1.0 0.0 0.0 10.0 0.03 Children

(<15 years) Male 0.03

Total 0.02 0.02 0.19 [0.01-0.05] Total 0.53 Female (15+ years) 0.02 [0.35-0.99] Female [0.01-0.04] [0.01-0.05] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 0.49 0.49 0 .1 6 Adults (15+ years) (15+ years) [0.32-0.93] [0.11-0.42] [0.02-0.06] [0.12-0.24] AIDS-related mortality AIDS-related (in thousand) 0.75

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission

19.2 67.3 67.3 20.2 Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years) Total Total 10.84 10.84 Female (15+ years) 24.21 24.21 [9.04-14.51] [0.61-1.00] [20.18-31.83] T o t a l 24.20 24.20 48.6 64.6 53.6 Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children 23.46 Adults (15+ years) (15+ years) [19.62-30.90] Number of people living with HIV (in thousand) 0.03 Children (<15 years)

Male 0.09

[0.07-0.12] 0.35 0.35 Female Total 0.80 (15+ years) Total 0.08 [0.50-1.59] [0.07-0.11] 0.07 Female T o t a l 53.37 53.37 [0.06-0.10] 0.76 Adults (15+ years) (15+ years) [0.47-1.53] [0.22-0.70] [0.02-0.06] Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related Kerala

55 56 Madhya Pradesh

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 1.0

Female Male 56.93 20.30 2.35 Female Male 0.07 0.12 Adults Female Children 0.03 0.05 [0.06-0.10] [0.09-0.17] (15+ years) (15+ years) (<15 years) [0.01-0.04] [0.03-0.08] [44.48-76.90] [16.14-26.60] [1.84-3.12] 0.10 0.04 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 59.30 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.08-0.14] [46.34-80.10] [0.02-0.06]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.1 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 8.4 Adults (15+ years) 2.74 0.90 0.14 9.1 1.69 0.38 0.11 Adults Female Children Female Adults Female Children 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (<15 years) 2011 2017

(15+ years) 2012 2015 2013 2018 2014 2019 2016 [1.50-4.55] [0.47-1.48] [0.09-0.22] [1.05-2.76] [0.20-0.71] [0.07-0.18] 2010 2.89 67.8 1.82 Total Children 16.24 (<15 years) Total [1.60-4.77] T o t a l [1.14-2.96] 10.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 52.2 child transmission of HIV (in thousand) Adults (15+ years) 53.16 66.1 T o t a l Female (15+ years) 0.0

0.61 2011 2017 2012 2015 2013 2018 2014 2019 2016 63.5 2010 Children (<15 years) [0.43-0.86]

2019 2019 2019

2018

2017

2016

2018 2018

2015

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2017 2017

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population

2000

2013 2013

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2012 2012 1996

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2011

2011 Adult (15–49 years) HIV prevalence years) (15–49 Adult 1993

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990 2010 2010 0 7.0 0.0 0.3 0.0 50.0 0.49 0.49

Children Male 0.07 (<15 years)

Total 0.07 [0.03-0.16] [0.03-0.16] 2.46 2.46 Total 9.69 Female 0.07 (15+ years) Female [4.91-21.05] [0.03-0.17] [0.03-0.17] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 3.01 9.19 Adults [2.27-4.12] (15+ years) (15+ years) [4.69-20.24] [0.97-6.10] [0.20-0.91] AIDS-related mortality AIDS-related (in thousand) 12.55 12.55

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission

61.8 61.8 31.0 31.0 35.3 Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years) Total Total 167.78 167.78 Female (15+ years) 396.35 396.35 [119.64-242.42] [8.94-17.44] [288.60-577.01] T o t a l 38.38 38.38 67.7 76.7 72.0 Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children Adults 383.79 (15+ years) (15+ years) Number of people living with HIV (in thousand) [278.09-560.00] 0.61 Children (<15 years)

Male 0.38 0.38 3.75 3.75 [0.26-0.56] Total 8.54 Female (15+ years) [3.77-20.10] Total 0.36 [0.25-0.53] 0.33 Female T o t a l 71.81 71.81 7.92 7.92 [0.23-0.49] Adults (15+ years) (15+ years) Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) [3.35-19.05] [1.59-9.22] [0.37-1.08] Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related Maharashtra

57 58 Manipur

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 10.0

Female Male 27.04 12.85 1.52 Female Male 1.13 1.22 Adults Female Children 0.33 0.34 [0.93-1.40] [0.99-1.52] (15+ years) (15+ years) (<15 years) [0.16-0.59] [0.17-0.62] [22.20-33.43] [10.63-15.95] [1.25-1.87] 1.18 0.34 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 28.56 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.97-1.46] [23.55-35.19] [0.17-0.59]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.7 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 19.5 Adults (15+ years) 0.89 0.43 0.06 16.2 0.99 0.39 0.08 Adults Female Children Adults Female Children Female 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [0.43-1.59] [0.21-0.78] [0.04-0.09] [0.65-1.54] [0.23-0.67] [0.06-0.12] 2010 0.96 73.0 1.08 Total Children 29.09 (<15 years) Total [0.48-1.69] T o t a l [0.72-1.66] 150.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 52.3 child transmission of HIV (in thousand) Adults (15+ years) 55.3 52.42 Female (15+ years) 0.0 T o t a l

0 . 3 6 2011 2017 2012 2015 2013 2018 2014 2019 2016 54.1 2010 Children (<15 years) [0.26-0.50]

2019

2019 2019

2018

2017

2016

2018 2018

2015

2014

2013

2017 2017 2012

2011

2010

2016 2016 2009

2008

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2006 2015 2015

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2002 2001

population 2000

2013 2013

1999

1998

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2012 2012 1996

1995

1994

2011 1993

Adult (15–49 years) HIV prevalence years) (15–49 Adult 2011

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000 1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990 2010 2010 0 0.7 2.0 0.0 0.0 25.0 0.05 0.05

Children Male 0.24 (<15 years)

Total 0.23 [0.18-0.31] [0.18-0.31] 0.11 Total 0.36 Female 0.22 (15+ years) Female [0.26-0.45] [0.17-0.30] [0.18-0.31] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 0 . 2 8 0.21 0.21 Adults [0.23-0.34] (15+ years) (15+ years) [0.30-0.38] [0.07-0.15] [0.04-0.06] AIDS-related mortality AIDS-related (in thousand) 0.58

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission 46.7 46.7 44.7 44.7 48.9 Adults Female

Children (<15 years) (15+ years) (15+ years) (15+ years) Total Total 5.04 Female (15+ years) [4.26-5.91] [0.49-0.65] [9.51-13.08] 11.28 11.28 T o t a l 48.67 48.67 22.2+ 162.8+ 183.2+ Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children 10.69 Adults (15+ years) (15+ years) [9.01-12.51] Number of people living with HIV (in thousand) 0.04 Children (<15 years)

0.57 Male [0.48-0.67] 0.33 0.73 Total .25-0.43] [0.04-0.06] Female (15+ years) Total 0.54 [0.57-0.98] [0.46-0.63] 0.51 Female T o t a l [0.43-0.60] 0.68 Adults 135.53+ 135.53+ (15+ years) (15+ years) Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) Increase in AIDS-related mortality since 2010 (%) in AIDS-related Increase [0.53-0.91] [0 Meghalaya Meghalaya

59 60 Mizoram

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 10.0

Female Male 19.33 8.38 0.71 Female Male 2.06 2.58 Adults Female Children 1.02 1.34 [1.65-2.52] [2.03-3.18] (15+ years) (15+ years) (<15 years) [0.63-1.46] [0.83-1.94] [15.48-23.76] [6.80-10.21] [0.58-0.87] 2.32 1.18 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 20.05 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [1.85-2.84] [16.12-24.62] [0.73-1.70]

New HIV infections (in Increase/Decline in new HIV AIDS-related mortality 2.0 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 3.0+ Adults (15+ years) 1.32 0.55 0.05 2.6+ 0.28 0.11 0.054 Adults Female Children Female Adults Female Children 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (<15 years) 2011 2017

(15+ years) 2012 2015 2013 2018 2014 2019 2016 [0.81-1.89] [0.33-0.79] [0.03-0.06] [0.17-0.45] [0.06-0.19] [0.03-0.07] 2010 1.37 47.9- 0.34 Total Children 0.51- (<15 years) Total [0.85-1.96] T o t a l [0.21-0.52] 100.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 53.5 child transmission of HIV (in thousand) Adults (15+ years) 49.6 50.0 Female (15+ years) 0.0 T o t a l

0.27 2011 2017 2012 2015 2013 2018 2014 2019 2016 16.9 2010 Children (<15 years) [0.21-0.33]

2019 2019 2019

2018

2017

2016

2018 2018

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Adult (15–49 years) HIV prevalence years) (15–49 Adult 1993 HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992 population mortality per 100,000 AIDS

1991

2010 1990 2010 0 1.5 1.0 0.0 0.0 100.0 0.06 0.06

Children (<15 years) 0.75 Male

0.73 Total [0.49-0.97] 0.16 0.16 0.57 Total Female (15+ years) 0.71 [0.33-0.84] Female [0.49-0.95] [0.52-1.01] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 0.50 Adults 0.40 (15+ years) (15+ years) [0.28-0.75] [0.08-0.26] [0.04-0.08] AIDS-related mortality AIDS-related (in thousand) [0.31-0.50] 0.89

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission 0.3- 3.8+ 62.4- 62.4- Adults

Female Children (<15 years) (15+ years) (15+ years) (15+ years) Total Total 9.99 Female (15+ years) [7.93-11.98] [0.69-1.11] [18.05-27.41] 22.55 22.55 T o t a l 6.47- 6.47- 38.7 33.9 40.4 Adults (15+ years) (15+ years) Adults Increase/Decline in new HIV in new Increase/Decline since 2010 (%) infections Female (15+ years) Female Children (<15 years) Children 21.65 Adults (15+ years) (15+ years) [17.34-26.32] Number of people living with HIV (in thousand) 0.06 0.06 Children (<15 years)

1.50 Male

[1.16-1.83] 0.68 Female 1.55 Total (15+ years) 1.45 Total [1.04-2.05] [1.15-1.78] 1.41 Female [1.12-1.70] T o t a l 34.72 34.72 1.48 1.48 Adults (15+ years) (15+ years) Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related [0.99-1.96] [0.47-0.91] [0.04-0.08] Nagaland

61 62 Odisha

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 1.0

Female Male 46.81 21.50 2.33 Female Male 0.13 0.15 Adults Female Children 0.05 0.05 [0.11-0.16] [0.13-0.18] (15+ years) (15+ years) (<15 years) [0.04-0.07] [0.04-0.07] [40.61-56.45] [18.57-25.79] [1.96-2.93] 0.14 0.05 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 49.15 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.12-0.17] [42.81-59.22] [0.04-0.07]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.2 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 34.2 Adults (15+ years) 2.03 1.01 0.13 29.8 1.60 0.67 0.12 Adults Female Children Female Adults Female Children 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (<15 years) 2011

(15+ years) 2017 2012 2015 2013 2018 2014 2019 2016 [1.51-2.79] [0.74-1.40] [0.10-0.17] [1.17-2.25] [0.46-0.98] [0.09-0.17] 2010 2.17 68.5 1.74 Total Children 38.33 (<15 years) Total [1.62-2.97] T o t a l [1.28-2.43] 15.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 30.6 child transmission of HIV (in thousand) Adults (15+ years) 32.73 34.9 T o t a l Female (15+ years) 0.0

0.49 2011 2017 2012 2015 2013 2018 2014 2019 2016 51.7 2010 Children (<15 years) [0.40-0.61]

2019 2019 2019

2018

2017

2016

2018 2018

2015

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2011

2010

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2011 2011

Adult (15–49 years) HIV prevalence years) (15–49 Adult 1993

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992 population mortality per 100,000 AIDS

1991

1990 2010 2010 0 0.5 3.0 0.0 0.0 25.0 0.008

Children (<15 years) 0.17 Male

0.16 0.16 Total 0.08 [0.06-0.38] [0.06-0.38] Total 0.26 0.26 Female (15+ years) 0.14 [0.11-0.50] Female [0.05-0.35] [0.07-0.40] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 0.25 0.25 Adults 0.03 (15+ years) (15+ years) [0.10-0.48] [0.02-0.17] [0.003-0.01] AIDS-related mortality AIDS-related (in thousand) [0.02-0.06] 0.14

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission 48.1 48.1 38.2 63.2 63.2 Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years)

Total Total 1.87 Female (15+ years) [1.13-2.98] [0.07-0.22] [2.83-7.84] 4.77 4.77 11.1- T o t a l 285.7+ 39.06 39.06 425.0+ Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children 4.63 Adults (15+ years) (15+ years) [2.74-7.62] Number of people living with HIV (in thousand) 0.007 Children (<15 years)

Male 0.36 [0.20-0.62] 0.09 Total 0.26 Female (15+ years) Total 0.35 [0.10-0.61] [0.20-0.58] 0.33 Female T o t a l [0.19-0.54] 0.25 0.25 Adults 364.29+ 364.29+ (15+ years) (15+ years) [0.09-0.59] [0.03-0.23] [0.003-0.01] Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) Increase/Decline in AIDS-related mortality in AIDS-related Increase/Decline since 2010 (%) Puducherry

63 64 Punjab

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 2.0

Female Male 64.03 24.70 1.80 Female Male 0.23 0.31 Adults Female Children 0.07 0.09 [0.19-0.29] [0.25-0.41] (15+ years) (15+ years) (<15 years) [0.04-0.12] [0.05-0.15] [52.54-82.36] [20.22-31.47] [1.47-2.29] 0.27 0.08 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 2001 2007 2002 2005 2003 2008 2004 2009 2006 Total 65.83 Total Total 2000 [0.22-0.35] [54.18-84.51] [0.05-0.14]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.3 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 33.6 Adults (15+ years) 2.30 0.91 0.06 30.9 1.33 0.45 0.08 Adults Female Children Adults Female Children Female 0 (15+ years) (15+ years) (<15 years) (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [1.34-3.99] [0.54-1.55] [0.04-0.10] [0.90-2.20] [0.28-0.77] [0.06-0.12] 2010 2.37 75.6 1.42 Total Children 36.60 (<15 years) Total [1.40 -4.10] T o t a l [0.97-2.33] 25.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- child transmission of HIV (in thousand) 67.9 Adults (15+ years) 67.44 65.3 0.0 T o t a l Female (15+ years) 2011 2017 2012 2015 2013 2018 2014

0.46 2019 2016 58.5 2010 Children (<15 years) [0.36-0.63]

2019

2019 2019

2018

2017

2016

2018 2018

2015

2014

2013

2017

2017 2012

2011

2010

2016 2016 2009

2008

2007

2006 2015 2015

2005

2004

2003

2014 2014

2002 2001

population

2000

2013 2013

1999

1998

1997

2012 2012 1996

1995

1994

2011 1993

Adult (15–49 years) HIV prevalence years) (15–49 Adult 2011

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000 1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990 2010 2010 0 0.2 0.5 5.0 0.0 0.0 0.05 0.05

Children (<15 years) Male 0.04

Total 0.04 0.11 [0.02-0.05] 0.71 Total Female (15+ years) 0.03 [0.36-1.20] Female [0.02-0.04] [0.02-0.06] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 0.66 Adults 0 . 8 6 (15+ years) (15+ years) [0.33-1.10] [0.04-0.22] [0.02-0.09] AIDS-related mortality AIDS-related (in thousand) [0.64-1.06] 2.67 2.67

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission 35.3 39.6 65.9 65.9

Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years) Total Total 22.60 22.60 Female (15+ years) [16.54-27.81] [2.04-3.21] 62.98 62.98 [47.59-76.40] T o t a l 41.59 7.9 71.8 45.5 Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children Adults 60.29 60.29 (15+ years) (15+ years) [45.55-73.23] Number of people living with HIV (in thousand) 0.12 0.12 Children (<15 years)

0.14 Male

[0.10-0.16] 1.01 1.01 Female 2.77 Total 0.11 (15+ years) Total [1.58-3.98] [0.08-0.14] 0.09 Female T o t a l [0.06-0.11] 20.49 20.49 2.64 2.64 Adults (15+ years) (15+ years) Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) [1.49-3.83] [0.54-1.45] [0.07-0.16] Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related Rajasthan

65 66 Sikkim

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 0.5

Female Male 0.33 0.12 0.01 Female Male 0.05 0.08 Adults Female Children 0.03 0.04 [0.03-0.12] [0.04-0.17] (15+ years) (15+ years) (<15 years) [0.01-0.10] [0.01-0.14] [0.17-0.73] [0.06-0.27] [0.008-0.02] 0.07 0.03 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 0.35 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.03-0.15] [0.19-0.76] [0.01-0.12]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.2 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 33.3 Adults (15+ years) 0.007 0.008 0.001 27.3 0.004 0.001 0.001 Adults Female Children Female Adults Female Children (15+ years) (15+ years) (<15 years) 0 (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [0.02-0.07] [0.003-0.03] [0.00-0.003] [0.001-0.014] [0.00-0.004] [0.00-0.002] 2010 0.02 50.0 0.004 Total Children 34.38 (<15 years) Total [0.01-0.08] T o t a l [0.001-0.016] 5.0 AIDS mortality per 100,000 population

Stability in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 0.0 child transmission of HIV (in thousand) Adults (15+ years) 0.0 0.0 T o t a l Female (15+ years) 0.0

0 . 0 0 4 2011 2017 2012 2015 2013 2018 2014 2019 2016 0.0 2010 Children (<15 years) [0.002-0.009]

2019 2019 2019

2018

2017

2016

2018 2018

2015

2014

2013

2017 2017

2012

2011

2010

2016 2016 2009

2008

2007

2015 2006 2015

2005

2004

2003 2014 2014

2002 2001

population

2000

2013 2013

1999

1998

1997

2012 2012 1996

1995

1994

2011

2011

Adult (15–49 years) HIV prevalence years) (15–49 Adult 1993 HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990 2010 2010 0 0.2 0.0 5.0 0.0 25.0 0.06 0.06

Children Male 0.04 (<15 years)

Total 0.04 [ 0.0 1 - 0.07 ] 0.92 0.92 3.01 Total Female (15+ years) 0.03 [1.67-5.33] Female [0.01-0.06] [0.02-0.07] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 2.94 2.94 Adults 0.85 0.85 [1.64-5.16] [0.44-1.79] [0.01-0.13] (15+ years) (15+ years) AIDS-related mortality AIDS-related (in thousand) [0.56-1.20] 3.05 3.05

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission

81.6 81.6 40.2 40.2 Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years) Total Total 69.84 69.84 Female (15+ years) [52.22-89.12] [1.99-4.14] 154.61 154.61 [114.37-197.84] T o t a l 44.38 44.38 78.1 72.1 85.8 Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children Adults 151.55 (15+ years) (15+ years) Number of people living with HIV (in thousand) [112.37-193.13] 0.08 Children (<15 years)

Male 0.24 [0.17-0.32] 1.14 1.14 2.62 Total Female (15+ years) Total 0.23 [1.08-4.90] [0.16-0.29] 0.21 0.21 Female T o t a l [0.15-0.27] 72.62 72.62 2.53 2.53 Adults (15+ years) (15+ years) [1.02-4.75] [0.46-2.14] [0.04-0.14] Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related Tamil Nadu Tamil

67 68 Telangana

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 5.0

Female Male 153.57 69.99 3.94 Female Male 0.44 0.53 Adults Female Children 0.07 0.08 [0.32-0.59] [0.37-0.74] (15+ years) (15+ years) (<15 years) [0.02-0.14] [0.03-0.18] [112.01-208.27] [51.97-92.55] [2.70-5.50] 0.49 0.08 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 157.51 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.35-0.66] [114.95-213.21] [0.03-0.16]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.3 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 49.3 Adults (15+ years) 2.64 1.13 0.17 49.2 3.90 1.35 0.17 Adults Female Children Female Adults Female Children (15+ years) (15+ years) (<15 years) 0 (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [0.97-5.65] [0.41-2.46] [0.08-0.29] [2.24-6.59] [0.66-2.29] [0.07-0.30] 2010 2.82 73.7 4.08 Total Children 52.06 (<15 years) Total [1.06-5.95] T o t a l [2.28-6.84] 100.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 72.4 child transmission of HIV (in thousand) Adults (15+ years) 75.2 72.64 Female (15+ years) 0.0 T o t a l

1.03 2011 2017 2012 2015 2013 2018 2014 2019 2016 76.8 2010 Children (<15 years) [0.68-1.52]

2019 2019 2019

2018

2017

2016

2018 2018

2015

2014

2013

2017 2017

2012

2011

2010

2016

2016 2009

2008

2007

2015 2006 2015

2005

2004

2003

2014 2014

2002 2001

population

2000

2013 2013

1999

1998

1997

2012 2012 1996

1995

1994

2011 1993

Adult (15–49 years) HIV prevalence years) (15–49 Adult 2011

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990

2010 2010 0 5.0 0.5 0.2 0.0 0.0

0.004 Children 0.13 Male (<15 years)

0.11 Total [0.07-0.17] Total 0.02 0.02 0.005 0.005 Female 0.10 0.10 (15+ years) Female [0.01-0.04] [0.06-0.14] [0.09-0.19] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 0.01 0.01 Adults 0.03 (15+ years) (15+ years) [0.006-0.03] [0.002-0.01] [0.002-0.006] AIDS-related mortality AIDS-related (in thousand) [0.02-0.04] 0.06 0.06 Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission Adults 274.6+ 274.6+ Female 275.0+ 275.0+ 100.0+ 100.0+ Children

(<15 years) (15+ years) (15+ years) (15+ years) Total Total 1.13 1.13 Female (15+ years) [0.80-1.51] [0.05-0.08] [2.04-3.77] 2.86 2.86 T o t a l 264.52+ 264.52+ 66.7+ 33.3+ 100.0+ Increase in new HIV in new Increase since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children 2.79 Adults (15+ years) (15+ years) [1.98-3.68] Number of people living with HIV (in thousand) 0.01 0.01 Children (<15 years)

0.11 Male [0.08-0.15] 0.18 0.18 Total 0.45 Female (15+ years) 0.10 Total [0.29-0.65] [0.07-0.13] 0.08 Female T o t a l [0.06-0.11] 80.0+ 80.0+ 0.44 0.44 Adults (15+ years) (15+ years) Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) [0.27-0.64] [0.11-0.26] [0.006-0.01] Increase in AIDS-related mortality since 2010 (%) in AIDS-related Increase Tripura

69 70 Uttarakhand

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 0.5

Female Male 10.54 4.21 0.40 Female Male 0.10 0.16 Adults Female Children 0.04 0.05 [0.08-0.13] [0.12-0.20] (15+ years) (15+ years) (<15 years) [0.02-0.06] [0.03-0.08] [8.13-13.69] [3.33-5.44] [0.32-0.52] 0.13 0.04 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 10.96 2001 Total 2007

Total Total 2002 2005 2003 2008 2004 2009 2006 2000 [0.10-0.17] [8.49-14.19] [0.03-0.07]

New HIV infections (in Decline in new HIV AIDS-related mortality 0.2 HIV incidence per 1,000 uninfected thousand) infections since 2010 (%) (in thousand) population 44.8 Adults (15+ years) 0.46 0.18 0.02 41.2 0.32 0.09 0.02 Adults Female Children Female Adults Female Children (15+ years) (15+ years) (<15 years) 0 (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [0.29-0.73] [0.11-0.29] [0.01-0.029] [0.19-0.50] [0.04-0.15] [0.01-0.03] 2010 0.49 65.5 0.34 Total Children 46.09 (<15 years) Total [0.31-0.77] T o t a l [0.21-0.54] 10.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 11.2 child transmission of HIV (in thousand) Adults (15+ years) 15.6 14.21 Female (15+ years) 0.0 T o t a l

0 . 1 0 2011 2017 2012 2015 2013 2018 2014 2019 2016 44.4 2010 Children (<15 years) [0.07-0.13]

2019

2019 2019

2018

2017

2016

2018 2018

2015

2014

2013

2017 2017

2012

2011

2010

2016 2016 2009

2008

2007

2015 2015 2006

2005

2004

2003 2014 2014

2002 2001

population

2000

2013 2013

1999

1998

1997

2012 2012 1996

1995

1994

2011 2011

Adult (15–49 years) HIV prevalence years) (15–49 Adult 1993

HIV incidence per 1,000 uninfected uninfected HIV incidence per 1,000

1992

AIDS mortality per 100,000 population population mortality per 100,000 AIDS

1991

1990 2010 2010 0 0.2 0.5 0.0 10.0 0.0 0.37

Children Male 0.04 (<15 years)

Total 0.03 [0.02-0.05] [0.02-0.05] 0.66 3.87 Total Female 0.02 0.02 (15+ years) [1.91-6.89] Female [0.01-0.03] [0.02-0.06] HIV incidence per 1,000 HIV incidence per 1,000 population uninfected 3.50 Adults 2.21 [1.71-6.29] [0.26-1.46] [0.20-0.58] (15+ years) (15+ years) [1.72-2.94] AIDS-related mortality AIDS-related (in thousand) 7.34

Children (<15 years) Need for services to prevent mother-to- services to prevent Need for of HIV (in thousand) child transmission 45.3 45.3 45.0 60.4 60.4

Adults Female Children (<15 years) (15+ years) (15+ years) (15+ years) Total Total 55.08 55.08 Female (15+ years) [40.88-71.50] [5.39-9.97] 160.60 160.60 [120.78-213.63] 58.0 48.9 T o t a l 36.2 46.37 Decline in new HIV Decline in new since 2010 (%) infections Adults (15+ years) (15+ years) Adults Female (15+ years) Female Children (<15 years) Children Adults 153.25 (15+ years) (15+ years) Number of people living with HIV (in thousand) [114.97-203.68] 0.44 0.44 Children (<15 years)

0.12 0.12 Male [0.09-0.16] 2.06 2.06 6.72 Total Female (15+ years) 0.10 Total [3.93-10.60] [0.07-0.13] 0.07 Female 37.7 37.7 T o t a l [0.06-0.10] 6.28 6.28 Adults (15+ years) (15+ years) [3.61-9.97] [1.19-3.25] [0.29-0.62] Adult (15–49 yrs) HIV (15–49 Adult (%) prevalence (in HIV infections New thousand) Decline in AIDS-related mortality since 2010 (%) Decline in AIDS-related Uttar Pradesh

71 72 West Bengal

Adult (15–49 yrs) HIV Number of people living with HIV HIV incidence per 1,000 Adult (15–49 years) HIV prevalence prevalence (%) (in thousand) uninfected population 1.0

Female Male 71.59 31.54 2.61 Female Male 0.09 0.10 Adults Female Children 0.04 0.04 [0.06-0.12] [0.07-0.14] (15+ years) (15+ years) (<15 years) [0.02-0.07] [0.02-0.08]

0.09 [50.81-99.99] [22.53-44.40] [1.83-3.80] 0.04 0.0 1991 2011 1997 2017 1992 2012 1993 1995 1998 2015 2013 1994 1999 2018 2014 1996 2019 2016 1990 2010 2001 2007 2002 2005 2003 2008 2004 2009 2006 Total 74.20 Total Total 2000 [0.07-0.13] [52.65-103.61] [0.02-0.07]

New HIV infections (in Increase/Decline in new HIV AIDS-related mortality 0.2 infections since 2010 (%) HIV incidence per 1,000 uninfected thousand) (in thousand) population 7.0+ Adults (15+ years) 3.79 1.77 0.175 7.4+ 1.30 0.50 0.06 Adults Female Children Female Adults Female Children (15+ years) (15+ years) (<15 years) 0 (15+ years) (15+ years) (15+ years) (<15 years) 2011 2017 2012 2015 2013 2018 2014 2019 2016 [1.84-6.69] [0.86-3.18] [0.09-0.28] [0.65-2.77] [0.21-1.10] [0.02-0.15] 2010 3.97 56.4- 1.37 Total Children 0.51+ (<15 years) Total [1.94-6.98] T o t a l [0.68-2.92] 10.0 AIDS mortality per 100,000 population

Decline in AIDS-related mortality since 2010 (%) Need for services to prevent mother-to- 69.6 child transmission of HIV (in thousand) Adults (15+ years) 71.2 70.34 Female (15+ years) 0.0 T o t a l

0.68 2011 2017 2012 2015 2013 2018 2014 2019 2016 80.1 2010 Children (<15 years) [0.45-1.05]

Model-based biennial HIV estimations is undertaken under National AIDS Control Programme to provide update on the current status of the HIV epidemic on key epidemiological parameters of prevalence, incidence, AIDS-related mortality and EMTCT need. HIV Estimations 2019 is the latest round in the series of HIV Estimations process. This report presents the method and State/UT-wise findings on key epidemiological parameters from HIV Estimations 2019.