On December 1, recognized as World AIDS Day, it is crucial to reflect on the historical context of HIV/AIDS and its impact on India, particularly in the late 20th century. In the mid-1980s, AIDS, caused by the HIV virus, ravaged communities in Southern and Eastern Africa, leading to devastating mortality rates due to opportunistic infections such as tuberculosis (TB). During that period, the lack of treatment meant that nearly all infected individuals would develop AIDS within a few years.
By the early 1990s, India faced a similar crisis, with HIV prevalence in various regions, although the infection rate was below 1% of the adult population. Notably, transmission primarily occurred through unprotected heterosexual intercourse, with exceptions in some northeastern states due to needle sharing among young drug users. In response to this emerging health crisis, India launched the National AIDS Control Project in 1992 with financial backing from the World Bank. This initiative facilitated the establishment of AIDS Cells across various state medical directorates, although the efficiency of fund distribution was often hampered by bureaucratic delays.
A significant development occurred in 1994 when Tamil Nadu transformed its AIDS Cell into a registered society, updating its operational framework to improve fund flows and implement programs more efficiently. This state-level initiative allowed for targeted awareness campaigns that effectively reduced new HIV infections, establishing Tamil Nadu as a model for HIV control. Following Tamil Nadu's success, the Government of India adopted this framework for the Second National AIDS Control Project, resulting in a countrywide decrease in adult HIV prevalence from a peak of 0.54% in 2000 to 0.22% currently.
Despite these achievements, the global situation regarding tuberculosis has remained dire, particularly in India. According to the 2025 Global TB Report from the World Health Organization (WHO), India comprises a quarter of the world's total TB cases. TB is also the leading opportunistic infection among individuals living with HIV, resulting in a significant percentage of AIDS-related deaths in the country. Furthermore, India suffers from a high burden of multidrug-resistant tuberculosis (MDR-TB), contributing to the complexity of managing HIV and TB co-infections.
To address this, India had initially set an ambitious target to eliminate TB by 2025, ahead of the WHO's 2030 goal. Although this goal may not be fully realized, the rate of new TB cases is declining at a faster pace in India compared to global trends. The Indian Ministry of Health and Family Welfare is prioritizing TB testing and reporting to combat both TB and HIV effectively. The Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA) campaign focuses on TB treatment, preventative measures, and community support.
In terms of geographic disparities, five states—Uttar Pradesh, Maharashtra, Madhya Pradesh, Bihar, and Rajasthan—account for over half of India’s TB cases. To combat this issue, Tamil Nadu has begun implementing a predictive model developed by the Indian Council of Medical Research-National Institute of Epidemiology, designed to reduce TB mortality rates through improved diagnostics and treatment pathways. The collaboration between state health missions and central government initiatives emphasizes rapid technology adoption and effective public health delivery.
In conclusion, the progress made in controlling the AIDS epidemic throughout the late 1990s and early 2000s provides valuable insights for addressing the ongoing TB crisis in India. The Tamil Nadu model serves as an exemplary framework for eradication efforts and showcases the potential for effective government intervention in public health crises.