Meera is a 28-year-old from a small village. Married at 19, she manages the home and looks after the children while her husband works in transport. She learned little about STDs in school, and never discussed protective measures with her husband. When she became unwell a few years ago, clinic visits were delayed because the family worried about gossip. When Meera tested positive during an antenatal visit, she was stunned, since she had been faithful. Her case reflects a common pattern of married, financially dependent women who are infected within relationships where they lack negotiating power.
Every World AIDS Day, the headlines remind us of progress. India’s overall HIV prevalence has fallen since the epidemic’s peak, and millions of people now have access to antiretroviral therapy. Yet for many Indian women, especially those in rural areas and adolescent girls, vulnerability remains stubbornly high. The uphill climb is shaped by gender inequality, limited access to testing and prevention, stigma, and gaps in programmes that don’t always reach the women who need them most.
Unequal Impact
National estimates show a long-term decline in overall adult HIV prevalence, and India’s HIV programme has made measurable gains. But the proportion of infections among women has grown, and many of these infections occur in women who report being monogamous. Multiple studies over the past two decades have found that a large share of HIV-positive married women were likely infected by their husbands’ extramarital risk behaviours. Intimate partner violence (IPV) and unequal power in relationships further increase a woman’s inability to protect herself.
Gender And Social Norms
Biologically, women have a higher per-exposure risk of acquiring HIV than men, but the bigger drivers in India are social. Gender norms that limit women’s mobility, restrict their access to information or income, and tolerate male infidelity create a perfect storm. Women who cannot refuse their partner’s advances, negotiate condom use, or leave violent relationships face much higher exposure. Where stigma or the fear of violence is high, women avoid testing and treatment to prevent disclosure, perpetuating both late diagnoses and onward transmission.
Testing And Access Gaps In Rural Areas
Despite scale-up of Prevention of Parent-To-Child Transmission (PPTCT) services and greater availability of antiretrovirals, large testing and service gaps remain among rural women. Studies and programme reviews have repeatedly found very low levels of HIV testing among both pregnant and non-pregnant women in rural communities. Barriers include lack of awareness, absence of counselling in antenatal care, and fear of stigma. That means many women learn their status late or never.
Mother-to-child Transmission
India’s national programmes for prevention of mother-to-child transmission (PMTCT/PPTCT) have expanded testing and treatment in recent years, and many infants are now protected. Still, recent technical estimates show that mother-to-child transmission has not been eliminated and that gaps persist in coverage and follow-up, particularly among women who deliver outside formal facilities or do not access antenatal care early. Ensuring every pregnant woman is tested and linked to treatment remains crucial.
Adolescent Girls And Young Women
Young women, both married and unmarried, face particular risk. Early marriage, limited sex education, and transactional sex driven by economic need can expose adolescents to HIV. Programmes that target adolescent girls’ empowerment, sexual and reproductive health information, and youth-friendly testing services show promise but are unevenly available, especially in poorer districts.
Stigma And Discrimination
HIV-related stigma continues to reverberate in families, workplaces and health settings. Women who test positive report fear of being ostracised, losing livelihoods, or being blamed for ‘bringing shame’ to the family. This fear discourages disclosure and treatment adherence, and in some instances leads to job loss or reduced marriage prospects, factors that further entrench dependence and vulnerability.
New Prevention Tools
Pre-Exposure Prophylaxis (PrEP) has transformed prevention in many settings. The WHO now recommends long-acting injectable cabotegravir (CAB-LA) as an additional PrEP option for people at substantial risk. This offers an alternative to daily pills and can be particularly useful for women who cannot negotiate condoms or who worry about pill privacy. Global mechanisms (including licensing and agreements with manufacturers) are in progress to expand access, and some Indian manufacturers are working on long-acting formulations. But affordability, rollout plans, and guidance for women’s access must be explicitly prioritised so that rural and economically vulnerable women benefit, not just urban populations connected to a clinic. Oral PrEP (tenofovir/emtricitabine) has been approved in India, but uptake is still limited. Ensuring these options reach adolescent girls and married women at risk will require focused outreach, community trust-building and integration into maternal and reproductive health services.
Treatment Access
India’s ART programme is large and has saved countless lives. Treatment not only protects the health of people living with HIV but also prevents transmission since the growing numbers are suppressed. The challenge for many women is timely diagnosis and sustained access. Travel distance to ART centres, household responsibilities, and fear of disclosure can interrupt care. Decentralised services, link ART centres, community-based distribution, and women-friendly clinic hours can bridge many of these gaps.
Benefits Of Centring Women
Evidence and programme experience point to clear actions that reduce women’s vulnerability:
- Integrate HIV services with maternal and reproductive health so HIV testing and prevention become routine parts of antenatal and family-planning care.
- Expand adolescent-friendly services and comprehensive sex education that empower girls with knowledge and access to prevention (including PrEP).
- Invest in community-level stigma reduction and engage men in prevention and gender-equity work; interventions that address IPV reduce both violence and HIV risk.
- Make PrEP choices (oral and injectable) accessible and affordable to women outside urban hubs by using government procurement, generic manufacturing, and public-private delivery channels.
- Protect women in workplaces and legal spheres by enforcing anti-discrimination policies and linking HIV services to labour and welfare schemes.
India’s success in reducing population-level HIV prevalence is real, but it risks leaving women behind if interventions don’t tackle the root causes of their vulnerability. These include unequal power, stigma, poverty, service gaps and limited prevention choices. Closing that gap means designing programmes that start from women’s realities - offering discreet prevention, linking HIV services to maternal and adolescent care, making treatment accessible in villages, and addressing the social norms that silence women. On World AIDS Day this year, policymakers, health providers and communities should renew a simple promise. Prevention and care must be built around women’s lives, not the other way round.