Map of India showing districts with consistently high HIV prevalence (2007–12)
HIV risk depends on the type of sex. If the HIV-positive person is not on treatment and there is no condom or PrEP, the approximate risk per sexual encounter is:
- Bottom gay (receiving anal sex): ~ 1 in 72, highest risk.
- Top gay (giving anal sex): ~1 in 909.
- Woman during vaginal sex: ~ 1 in 1,250.
- Man during vaginal sex: ~1 in 2,500.
- Oral sex: extremely low risk; confirmed cases are rare
HIV does not spread through kissing, hugging, food, toilets, pools, mosquitoes, or casual contact. Condoms and PrEP greatly reduce risk. With effective ART, an undetectable person does not transmit HIV through sex: U=U (Undetectable = Untransmittable).
In India, HIV is disproportionately concentrated among transgender/hijra communities and gay/bisexual men. This is not because being gay or trans is a problem; it reflects the higher biological risk of unprotected anal sex, plus stigma and unequal access to prevention and healthcare.
Nationally, newly diagnosed cases are most often self-reported as acquired through heterosexual sex. Arunachal Pradesh, Tripura, Assam, and Punjab are exceptions, where shared injecting equipment is reported as the main route. Kerala, Sikkim, and West Bengal report the highest shares attributed to homosexual/bisexual contact.
HIV is serious but preventable and manageable. The answer is protection, routine testing, and treatment. Not shame.