Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

The ART of India’s HIV/AIDS response


From UPSC perspective, the following things are important :

Prelims level: HIV Drugs

Mains level: Objectives of India's National AIDS Control Programme (NACP)

Why in the news? 

On April 1, 2004, the Indian government launched Free Antiretroviral Therapy (ART) for Persons living with HIV (PLHIV). This decision has been one of the most successful .

Emergence of HIV drugs

  • First Antiretroviral Drug Approval: In March 1987, the US FDA approved the first antiretroviral drug, AZT (zidovudine), offering a glimmer of hope for treatment.
  • Additional Drug Approvals: Three more antiretroviral drugs were approved shortly after in 1988, expanding treatment options for HIV/AIDS patients.
  • Introduction of Protease Inhibitors: A significant milestone occurred in 1995 with the introduction of protease inhibitors, a new class of antiretroviral drugs.

The evolution to free ART

  • Millennium Summit Declaration: In 2000, world leaders at the UN General Assembly’s Millennium Summit set a goal to stop and reverse the spread of HIV.
  • Formation of the Global Fund: The Global Fund to Fight AIDS, Tuberculosis, and Malaria was established in 2002, advocating for universal access to HIV prevention, treatment, care, and support services.
  • High HIV Prevalence in India: In 2004, India had an estimated 5.1 million PLHIV, with a population prevalence of 0.4%. However, very few were receiving ART, with only 7,000 PLHIV on treatment by the end of the year.
  • Free ART Initiative: The Indian government’s decision to provide free ART to all adults living with HIV in 2004 was groundbreaking. This initiative aimed to address the barriers of cost and geographical access to treatment.
  • Expansion of ART Facilities: Over two decades, the number of ART centers in India expanded significantly, from less than 10 to around 700. Additionally, 1,264 Link ART centers have provided free ART drugs to approximately 1.8 million PLHIV.
  • ART Eligibility Criteria Evolution: The criteria for initiating ART evolved over the years, starting from CD4 count less than 200 cells/mm3 in 2004, to less than 350 cells/mm3 in 2011, and less than 500 cells/mm3 in 2016. Finally, in 2017, the “Treat All” approach was adopted, initiating ART regardless of CD4 count.
  • Rapid ART Initiation Policy: In 2021, India adopted a policy of rapid ART initiation, starting individuals on treatment within seven days of HIV diagnosis, and sometimes even on the same day. This swift initiation aimed to improve treatment outcomes and prevent transmission.
  • Complementary initiatives  to stop the HIV epidemic: Provision of free diagnostic facilities; attention on prevention of parent to child transmission of HIV (PPTCT) services; prevention, diagnosis and management of opportunistic infections including management of co-infections such as tuberculosis (TB).

Objectives of India’s National AIDS Control Programme (NACP) phase 5 by 2025

Ambitious 95-95-95 Targets: The NACP phase 5 sets ambitious targets known as the 95-95-95 targets, aligned with global targets agreed upon by UNAIDS. These targets aim for:

  • 95% of all people living with HIV to know their HIV status.
  • 95% of all people diagnosed with HIV infection to receive sustained antiretroviral therapy (ART).
  • 95% of all people receiving antiretroviral therapy to achieve viral suppression.
  • These targets are aligned with global targets agreed by the UNAIDS.


  • Delayed Enrolment to ART Facilities:  Late presentation poses challenges to timely initiation of treatment and optimal disease management.
  • Missed doses : Patients often start feeling better after initiating ART, leading to missed doses or discontinuation of treatment that lead to drug resistance


  • Sustained Supply and Availability of ART: Ensuring consistent and uninterrupted access to ART drugs across all regions of the country
  • Private Sector Engagement: Enhancing engagement with the private sector in the care of PLHIV .
  • Training and Capacity Building: Continuous training and capacity building of healthcare staff are essential to  ensure high-quality service delivery.
  • Integration with Other Health Programs: Strengthening integration with other health programs, such as hepatitis, non-communicable diseases (NCDs


India’s ART initiative, launched in 2004, has been pivotal in combating HIV/AIDS. With evolving criteria, rapid initiation policies, and ambitious targets, challenges persist, but measures like sustained supply, private sector engagement, and training are being implemented.

Mains PYQ

Q What are the research and developmental achievements in applied biotechnology? How will these achievements help to uplift the poorer sections of the society? ( UPSC IAS/2021) 

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