A crisis point

Nagaland’s HIV crisis demands renewed public attention, not only because the statistics are sobering, but because behind every number lies a life altered, a family shaken and a community strained. According to NACO’s 2022 HIV Estimation, the adult prevalence rate in Nagaland stands at 1.34%, while the general population rate, based on the 2021 HSS report, is 1.61%- the second highest in the country after Mizoram. These figures, far above the national average, reveal an epidemic that has persisted despite decades of interventions. To the credit of health agencies, Nagaland has shown encouraging progress in the UNAIDS 95-95-95 targets: 88% diagnosis, 79% treatment, and 98% viral load suppression as of October. Yet these gains cannot obscure the scale of the crisis. From April to October 2022 alone, 1,315 new cases were detected, pushing the cumulative total since 2006 to 31,152, while 2,619 deaths underline the disease’s unrelenting toll. What is particularly troubling is the spread among the young. About 21% of HIV-positive individuals in the state are below the age of 24. Even more alarming is the infection among children under 14-68 cases in 2022 and a cumulative 1,298 since 2007. These numbers are not mere data points; they are indictments of systemic gaps in prevention, education and protection of minors. Equally pressing is the deep connection between HIV and substance abuse. Nagaland is among India’s top ten states for People Who Inject Drugs (PWID). Opioid use stands at a staggering 25.2%, with injecting drug use accounting for 6.7% of HIV cases. The HIV Sentinel Surveillance 2021 report shows that prevalence among Injecting Drug Users rose from 1.3% in 2017 to 2.24% in 2021-a worrying upward trend. Meanwhile, sexual transmission remains the overwhelming driver, responsible for 87% of infections. These realities expose the social vulnerabilities underlying the epidemic, from drug dependency to unsafe sexual practices and inadequate community engagement. Historical data offer further cause for reflection. In 2002, Tuensang reported an 8% prevalence among antenatal clinic attendees, signalling early warning signs that were never fully contained. Two decades later, the general population prevalence remains dangerously high. Despite years of awareness campaigns, the epidemic has not been “managed”-it has merely evolved. This must be the turning point; HIV/AIDS is preventable, even if it is not curable. Nagaland cannot afford incremental responses or fragmented strategies. What is required is a full-scale, coordinated effort: stronger school-based education, targeted outreach to vulnerable youth, expansion of harm-reduction programmes for drug users, and consistent access to testing and treatment across all districts. Civil society, churches, student bodies and community leaders must assume active roles rather than offer token participation in lieu of beneficiaries of government programmes. Nagaland stands at a crossroads. If urgent, collective action is not taken, the epidemic risks spiralling into a deeper public health catastrophe. The high prevalence is not just a statistic- it is a mirror reflecting societal neglect, silence and stigma. It is therefore, time for society to wake up, for institutions to act decisively, and for the government to respond with the sensitivity and urgency that the crisis demands. Only then can Nagaland hope to reclaim a future where HIV/AIDS no longer casts its long, painful shadow over its people.