Treatment must continue for life. There is no cure.
In Ludhiana, a city shaped by industry and migration, HIV continues its quiet spread — not because the tools to fight it are absent, but because the conditions of human life keep outrunning them. Nearly a hundred people are screened each day at the civil hospital's ART centre, and fresh cases emerge weekly, driven by shared needles, interrupted treatment, and the deep silence that stigma enforces. What unfolds here is a story older than any single epidemic: the difficulty of delivering care to people whose lives are defined by movement, poverty, and the fear of being seen.
- Fresh HIV cases are emerging weekly in Ludhiana, with nearly 100 daily screenings at the civil hospital ART centre and an estimated 0.42 percent of the population infected — a figure health officials believe understates the true burden.
- Intravenous drug use and syringe sharing remain the dominant transmission pathways, creating rapid, repeated exposure events in communities where consistent healthcare access is already fragile.
- Migrant workers who begin antiretroviral therapy are forced to abandon treatment when employment moves them elsewhere, breaking the continuity of care that viral suppression requires and raising the risk of onward transmission.
- Stigma acts as a silent accelerant — delaying testing, driving concealment of status, and keeping vulnerable individuals away from the early intervention that could protect both their health and their communities.
- Health authorities are deploying the global 95-95-95 strategy, with viral load testing already completed for over 95 percent of registered patients and targeted outreach directed at high-risk groups including drug users, sex workers, and transgender persons.
Every weekday morning, Ludhiana's civil hospital ART centre receives a steady stream of people seeking HIV testing. Nearly a hundred are screened each day, and positive cases continue to emerge on a weekly basis — a rhythm that has become routine in a city where transmission is outpacing containment.
District health officials estimate that roughly 0.42 percent of Ludhiana's population carries HIV, though they acknowledge the real figure is likely higher, concealed by untested and undiagnosed cases. Intravenous drug use remains the primary driver. Shared needles and syringes pass the virus with alarming efficiency, and despite improved blood screening and years of awareness campaigns, the infections keep coming. Unprotected sex, exposure to infected blood, and mother-to-child transmission during pregnancy account for other cases, but it is the shared syringe that health officials return to again and again.
Ludhiana's migrant workforce adds a structural dimension to the crisis. Workers who begin antiretroviral therapy often relocate when employment demands it, abandoning treatment mid-course. Long-term monitoring becomes impossible. The virus does not wait for economic stability, and people cannot afford to stay in one place for the sake of a medication schedule.
Stigma deepens the problem. Many avoid testing entirely, fearing what a positive result will mean for their place in family and community. Others know their status but remain silent, choosing concealment over the discrimination they expect to face. This delay allows the virus to progress and keeps people isolated from care that could both save their lives and reduce transmission.
Health authorities are now implementing the 95-95-95 framework — targeting 95 percent diagnosis, 95 percent treatment access, and 95 percent viral suppression among registered patients. Viral load testing has already been completed for more than 95 percent of those in care. Outreach focuses on intravenous drug users, migrant labourers, sex workers, transgender persons, and men who have sex with men.
The clinical message is unambiguous: HIV is lifelong, there is no cure, and antiretroviral therapy works only when taken consistently and continuously. Prevention remains the foundation — avoid needle sharing, use protection, get tested, stay in treatment. The difficulty is that none of these instructions resolve the harder problem: a migrant worker choosing between treatment and livelihood, or a person for whom a positive diagnosis means social erasure.
Every weekday morning at Ludhiana's civil hospital, the anti-retroviral therapy centre opens its doors to a steady stream of people seeking testing. Nearly a hundred are screened each day. Some come back positive. It happens weekly now, a rhythm that has become routine in a city where HIV transmission continues to outpace the efforts to contain it.
The numbers tell part of the story. District health officials estimate that roughly 0.42 percent of Ludhiana's population carries HIV, though they acknowledge the real figure is likely higher—hidden cases, people who have never been tested, infections that remain undiagnosed and unreported. What drives these infections is not mysterious. Intravenous drug use remains the primary culprit. People share needles and syringes, contaminated equipment passing from one person to the next, each exchange a potential transmission event. It is, medical experts say, one of the fastest pathways the virus travels. Unprotected sex, exposure to infected blood, transmission from mother to child during pregnancy or birth when medical intervention fails to arrive in time—these remain the other known routes. But it is the needle that keeps appearing in health officials' explanations, the shared syringe that they identify as the persistent problem.
Dr. Ashish Chawla, the district health officer, frames it plainly: transmission through contaminated injection equipment continues to be a major concern, and drug-using populations remain highly vulnerable because of repeated unsafe practices. Blood screening protocols have improved significantly over the years. Awareness campaigns have run. Yet the infections keep coming. Prevention gaps persist, particularly in communities where consistent healthcare access is limited or nonexistent.
But there is another obstacle, one that operates not in the body but in the social world. Ludhiana's migrant workforce moves constantly, following employment. A person begins antiretroviral therapy, takes the medication, starts the long process of suppressing their viral load. Then a job opportunity appears elsewhere. They relocate. Treatment stops. Long-term monitoring becomes impossible. The risk of onward transmission rises. Health officials describe this as a significant operational challenge, but the human reality is simpler: people cannot afford to stay in one place, and the disease does not wait for economic stability.
Stigma compounds the problem. Many people avoid testing altogether because they fear what a positive result will mean for their standing in their community, their family, their workplace. Others know their status but conceal it, choosing silence over the discrimination they expect to face. This delay in diagnosis weakens early intervention. It allows the virus to progress unchecked. It keeps people isolated from the treatment that could save their lives and reduce their ability to transmit the infection to others.
The health department has begun implementing what is called the 95-95-95 strategy, a global framework aimed at ensuring that 95 percent of HIV-positive individuals are diagnosed, 95 percent of those diagnosed receive treatment, and 95 percent of those in treatment achieve viral suppression. Viral load testing has already been completed for more than 95 percent of registered patients. The machinery of public health is working. Targeted interventions focus on identified high-risk groups: intravenous drug users, migrant labourers, female sex workers, transgender persons, and men who have sex with men. Screening and outreach in these communities is described as essential to breaking transmission chains.
Dr. Amrit Chawla, the district programme officer, offers the clinical reality: HIV is a lifelong condition. There is no cure. Once a person tests positive, treatment must continue indefinitely. Antiretroviral therapy suppresses the viral load, allowing people to live stable lives and dramatically reducing transmission risk—but only if the medication is taken consistently, only if the person remains in care. Prevention, health authorities emphasize, remains the cornerstone. Avoid needle sharing. Use protection during intercourse. Get tested. Stay on treatment. Seek counselling to reduce stigma and improve compliance. The message is clear. The challenge is that clarity does not solve the problem of a migrant worker who must choose between staying for treatment or leaving for work, or a person in a community where admitting HIV status means social death.
Notable Quotes
Transmission through infected syringe sharing continues to be a major concern. Drug-using populations remain highly vulnerable due to repeated unsafe injection practices.— Dr. Ashish Chawla, district health officer
Once a person is HIV-positive, treatment must continue for life.— Dr. Amrit Chawla, district programme officer
The Hearth Conversation Another angle on the story
Why does Ludhiana see so many new cases each week if the health system is screening 100 people daily?
Because screening finds cases that already exist. The screening is reactive—it catches infections that have already happened. What matters is whether those newly diagnosed people stay in treatment and whether transmission is actually prevented. That's where the system breaks down.
The migrant worker problem seems central. Are people leaving treatment, or are they never starting it in the first place?
Both. Some start and then stop when they relocate. Others never start because they're moving constantly and can't establish continuity of care. From the health system's perspective, it's a nightmare—you can't monitor someone who isn't there.
Stigma seems like the harder problem to solve than drug use or migration. How do you change what people believe about HIV?
You don't change it quickly. Counselling helps. But it requires sustained effort and community trust. Right now, people are choosing silence over treatment because they're more afraid of their neighbours than they are of the virus. That's a social problem, not a medical one.
The 95-95-95 strategy sounds comprehensive. Why isn't it working?
It's working for people who stay in the system. But it assumes people have stable housing, stable employment, stable access to clinics. Ludhiana's migrant population doesn't have that. The strategy is sound. The implementation hits a wall when it meets real life.
Is there a way to reach people before they become high-risk cases?
Prevention messaging exists, but it reaches people who already have access to information and healthcare. The people who need it most—drug users, migrant workers, sex workers—are often outside those networks. You'd need to meet them where they are, not where the health system expects them to be.