The global challenge of HIV/AIDS remains one of the most pressing public health issues today. According to the latest data from UNAIDS, around 38.4 million people worldwide are living with HIV/AIDS, underlining the need for not only medical intervention but also comprehensive awareness, education, and social change. Despite the significant strides made in treatment and prevention, the confusion surrounding the relationship between HIV and AIDS still persists.

Young people have become influential advocates in the fight against HIV/AIDS. Research from UNICEF shows that youth-led initiatives can lower HIV transmission rates by as much as 45% in targeted communities. These young activists utilize digital platforms and peer-to-peer education to dispel myths, promote safe practices, and foster supportive environments for those affected by HIV/AIDS.

Dr Gowri Kulkarni, an expert in Internal Medicine, explains that while the terms HIV and AIDS are often used interchangeably, they are distinctly different. "HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system, whereas AIDS (Acquired Immunodeficiency Syndrome) is a condition that occurs when HIV severely damages the immune system," she clarifies. To understand the implications of these differences, it's important to explore the fundamental distinctions between the two.

1. HIV is a Virus; AIDS is a Syndrome

HIV is the virus responsible for attacking the body’s immune system, specifically targeting CD4 cells, which are crucial for the body’s defense against infections. As HIV progresses, it destroys these cells, weakening the immune system over time. If left untreated, this continuous damage can lead to AIDS.

AIDS, on the other hand, is a syndrome, not a virus. Dr Kulkarni further elaborates that AIDS is a collection of symptoms and illnesses that emerge when the immune system is severely compromised due to prolonged HIV infection. It represents the most advanced stage of HIV, and is characterized by very low CD4 counts or the onset of opportunistic infections like tuberculosis, pneumonia, or certain cancers.

2. Not Everyone with HIV Develops AIDS

A key distinction to remember is that not everyone with HIV will progress to AIDS. Thanks to advancements in medicine, particularly antiretroviral therapy (ART), individuals living with HIV can manage the virus and maintain a healthy immune system for many years, or even decades, without ever developing AIDS. ART works by suppressing the virus to undetectable levels, effectively preventing the damage HIV would otherwise cause to the immune system.

Without treatment, however, HIV progresses through three stages:

- Acute HIV Infection: This stage occurs shortly after transmission and may include symptoms like fever, fatigue, and swollen lymph nodes.

- Chronic HIV Infection: Often asymptomatic or mildly symptomatic, the virus continues to damage the immune system but at a slower rate.

- AIDS: This is the final stage, marked by severe immune damage and the presence of infections that take advantage of the compromised immune defenses.

3. HIV is Transmissible; AIDS is Not

Another key distinction between HIV and AIDS is the way in which they are transmitted. HIV is highly contagious and can be transmitted through the exchange of bodily fluids such as blood, semen, vaginal fluids, and breast milk. It is primarily spread through unprotected sexual contact, sharing needles, or from mother to child during childbirth or breastfeeding.

AIDS, however, is not transmissible. It is not a disease that can be passed from one person to another. Rather, AIDS is the result of untreated, advanced HIV infection and is a direct consequence of the virus’s damage to the immune system.

4. Diagnosis Methods Differ

HIV and AIDS are diagnosed through different methods. HIV is diagnosed through blood tests or oral swabs that detect the presence of the virus or antibodies produced by the immune system in response to the virus. Early detection of HIV is crucial, as it allows for timely intervention and treatment, which can prevent the virus from progressing to AIDS.

AIDS, on the other hand, is diagnosed using more specific criteria. Dr Kulkarni notes that the diagnosis of AIDS is made when the individual’s CD4 cell count falls below 200 cells/mm³, or when opportunistic infections or certain cancers (such as Kaposi's sarcoma or lymphoma) are detected. Diagnosing AIDS involves a more thorough assessment of the individual’s immune function and overall health, as opposed to just the detection of HIV.

5. Treatment Goals Are Different

The treatment goals for HIV and AIDS differ significantly, although both involve antiretroviral therapy (ART). For HIV, the primary treatment goal is to suppress the virus to undetectable levels, thus maintaining a strong immune system and preventing further transmission of the virus. People living with HIV can often live long, healthy lives if they adhere to ART.

For individuals diagnosed with AIDS, the treatment plan becomes more complex. While ART remains an essential part of managing the virus, treatment for AIDS also focuses on addressing the opportunistic infections and secondary health complications associated with severe immune suppression. The goal of treatment for AIDS is not only to manage the HIV virus but also to improve the quality of life and extend survival by treating these secondary health issues.

Role of Community Engagement in Combatting HIV/AIDS

While the medical community has made great strides in managing HIV, the battle to curb its transmission is also a social and cultural issue. Dr Daman Ahuja, a public health expert, highlights that HIV/AIDS awareness and education are vital to reducing transmission rates and supporting those affected by the virus. "Young people, especially, have become key advocates in the fight against HIV/AIDS," says Dr Ahuja. "Research from UNICEF shows that youth-led initiatives can lower HIV transmission rates by as much as 45% in targeted communities."

Additionally, grassroots activism plays a significant role in raising awareness and addressing stigma. As the World Health Organization reports, community-based interventions have been proven to increase HIV testing rates and improve treatment adherence, which are crucial in the fight against the pandemic.

The ultimate goal of organizations like UNAIDS is to eliminate the HIV/AIDS pandemic by 2030. Achieving this requires global collaboration, from medical treatment advancements to public health strategies, education, and advocacy. Dr Kulkarni’s insight underscores the importance of early detection, treatment adherence, and community support in the fight against HIV/AIDS.

Dr Gowri Kulkarni is Head of Medical Operations at MediBuddy and Dr Daman Ahuja, a public health expert and has been associated with Red Ribbon Express Project of NACO between 2007-12.

Recent reports of more than 7,000 people aged 18 to 25 testing HIV positive in Karnataka have put the spotlight on HIV among India's younger population.

The development has prompted the Karnataka government to expand HIV awareness, counselling, and voluntary testing initiatives across colleges. But the numbers raise a bigger question: are young people actually seeing higher HIV transmission, or are more infections simply being detected?

In an exclusive conversation with HealthandMe, Dr. Ishwar Gilada, President Emeritus, AIDS Society of India and a globally acclaimed HIV/STI/ infectious diseases expert, shed light on the recent trends and patterns of HIV cases in India in the last few years. He also explained the shifting nature of HIV awareness, sexual behaviour, testing and prevention in India.

Factors Driving HIV Risk Among Young Population

1. The Cohort Effect

According to the doctor, India's HIV epidemic initially showed a steady increase after the first cases were identified in 1986 until at least 2005. He said cases were static from 2005 to 2010 and even started going down till 2020. He said that we started seeing an increase again in the last five to six years.

The doctor attributed the sudden increase in cases to what he described as a “cohort effect” which is affecting people born around or after 2000.

He explains, "Cohort affects those who are born, whom we call millennium babies, who are born either in 2000 or after that. Millennium babies, who are now 20-25 are more vulnerable."

2. Lack of HIV Awareness Campaigns

The doctor believes another reason could be that young people today were not exposed to the intensive HIV awareness campaigns that existed during the early 2000s.

He says, “They are vulnerable because high-profile campaigns for HIV awareness were there from around 2000 to 2005. After that, they stopped as improved HIV treatment started.”

Also read: Thailand’s HIV Cases Cross 550,000 In 2026; Over 25,000 Among 15–24s

3. Changing Sexual Behaviour

The doctor said another important factor is the changing nature of sexual relationships and how people perceive risk.

“Earlier it was believed that if you frequent red light areas, you may pick up HIV from sex workers. But young people say that we don't go to red light areas.”

According to the doctor, this perception can be misleading because sexual contact can occur in many different settings like massage parlours where one may also have access to services related to sex work.

He also pointed towards sexual relationships involving multiple partners. He says that there is a lot of interpersonal sexual contact happening and without any commitment with unknown partners. He says, "They do not consider them either self or that person at risk.”

He also highlighted HIV risk among homosexual men. He says, "After Section 377 has been repealed, same sex among has become more frequent. They do not consider themselves to be at high risk because they think that they are not having sex with the female or a sex worker.”

4. PrEP And PEP Awareness Are Misunderstood

The doctor also raised an interesting concern about growing awareness of HIV prevention medicines like PrEP and PEP.

“There is awareness about PEP, post-exposure prophylaxis, and pre-exposure prophylaxis. So what they started thinking even if we take a risk, there is a PEP available. If we have to take a risk, we can take a PrEP and we can have a medicine and then we can have sex.”

He also said people may selectively use prevention based on how risky they believe another person appears. The result, he said, is a potentially dangerous mismatch between perceived risk and actual risk.

5. Stigma May Stop People From Testing And Taking Treatment

The fear of being identified as someone living with HIV can become a barrier to diagnosis and treatment. For younger people, the problem can be even more difficult because they may live with their families and have little privacy. The doctor said society needs to recognise that HIV is now a manageable infection.

“Society has to accept that this is now infection, manageable, better than diabetes, better than many other diseases.”

He also argued that stigma is not confined to the public. “We have to blame medical community.”

He alleged that in healthcare, patients continue to get treated differently. He recalled a case involving one of his patients who was hospitalised.

He says, “One of my patients told me they wrote they had written HIV positive on my bed when I was hospitalised. So, if this is the way you are discriminating, that person won't be maintaining his anonymity of HIV that he did for 25 years.”

Also read: Tivicay: US FDA Approves Drug to Treat HIV In Newborns

How To Prevent HIV Transmission?

1. HIV Self-Testing Should Be Improved

The doctor identified HIV self-testing as one area where he believes India's programme could be strengthened. He says, “One of the flaws of the national program is home HIV testing kit is not allowed in the program. Though you can buy the home testing kit on Amazon,it is not available in the program. So marginalised people will not get tested.”

He also raised concerns about the price of commercially available kits. He says kits that cost Rs 700 to 800 must not priced more than Rs 100 to 200.

2. Limited Access To PrEP

PrEP, or pre-exposure prophylaxis, was another area the doctor believes requires greater attention. “PrEP is not part of the national program,” he said, adding that PrEP has been approved in India but is not sufficiently integrated into the public programme. He said if this is fixed, people who are not aware of their HIV status will also try to find out.

3. HIV Stigma Remains A Major Problem

One of the strongest messages the doctor gives is how HIV treatment has changed dramatically, but it is still stigmastised. He explained that treatment can also suppress the virus to the point where sexual transmission does not occur.

He says, “HIV treatment is so powerful that a person with HIV can stay alive for as much as the normal lifespan of any person in the.” But while treatment has transformed HIV medically, the doctor said society has not kept pace. “Currently, the major killer, if at all, we can call, is the stigma and discrimination.”

Also read: Unlicensed Injection Business Sparks Health Alert In Canada: How HIV & Hepatitis Spread Through Medical Procedures

4. People Should Not Wait For Symptoms

Another important point the doctor stressed is that HIV can remain clinically silent for years. But as the immune system becomes progressively weakened, the person becomes vulnerable to infections that would ordinarily be easier for the body to fight.

“Talking about symptoms, when virus multiplies initially, the person will have no symptoms. It takes two to four years, five or even 10 years' time. If you wait till you fall sick, then a lot of valuable time will pass.”

His message was therefore to test and start treatment before advanced immune damage occurs.

5. Prevention Should Go Beyond Awareness

When asked about prevention, the doctor divided it into pharmacological and non-pharmacological approaches. He emphasised upon safe sex and reducing exposure to multiple sexual partners.

The larger lesson from his interview is that HIV prevention cannot depend on a single intervention. It requires testing, treatment, condoms, PrEP and PEP where appropriate, harm-reduction measures, awareness and, perhaps most importantly, an environment where people are not afraid to seek care.

The Bigger HIV Challenge

India has made significant progress against HIV over the past several decades. The government has reported substantial reductions in new HIV infections since 2010, while the National AIDS Control Programme continues to focus on prevention, testing, treatment and reducing AIDS-related mortality.

But the Karnataka numbers have brought the concern of young people's vulnerability to infection. The biggest challenge is no longer simply whether HIV can be treated. It is whether people will get tested early enough, have access to prevention and treatment, continue taking their medicines, and be able to live without fear of being discriminated against.

In my years as an orthopaedic surgeon, I have operated on thousands of joints, ligaments, and bones. And if there is one pattern I have seen repeat itself more consistently than any other, it is this: two patients can undergo the exact same surgery, performed by the same surgeon, using the same technique — and walk away with completely different outcomes. The difference rarely lies in the operating room. It lies in what happens afterwards.

Most patients walk into surgery believing it is the finish line — the hard part, after which everything else is just optional maintenance. Physiotherapy gets treated as something to fit in "if there's time" or "if it still hurts." This is one of the most damaging misconceptions in orthopaedic recovery.

Surgery fixes the structure. It repairs the torn ligament, replaces the worn joint, sets the fractured bone. But it does not, on its own, restore function. That has to be rebuilt — deliberately, gradually, under guidance. And that rebuilding is physiotherapy's job, not the scalpels.

The numbers bear this out. Across orthopaedic procedures, roughly one in five to one in three patients fail to reach their expected functional milestones, and inadequate rehab is consistently among the top reasons why — alongside pre-existing stiffness and delayed rehab starts. A technically flawless surgery, followed by a half-hearted recovery, routinely underperforms a good surgery paired with disciplined rehabilitation.

What's actually happening inside the body

Three things happen to nearly every post-surgical joint, regardless of how well the operation goes. Muscles begin to atrophy almost immediately — the quadriceps around a knee can lose measurable strength within a week of reduced use, and rest alone does not reverse this. Only progressive, graded loading does, which is exactly what physiotherapy provides.

At the same time, as surgical wounds heal, the body lays down scar tissue. Left unmanaged, this tissue binds to surrounding structures, restricts tendon movement, and quietly steals range of motion — tightening further with time rather than loosening on its own. And joints that aren't moved regularly through their range begin to stiffen as the joint capsule tightens around them.

A joint essentially "learns" its new, restricted range unless someone deliberately and safely pushes it beyond that — which is precisely the judgment call a physiotherapist is trained to make.

Also read: Attention Ladies: More Than 5 Cups Of Coffee Linked To Lower Bone Density; Tea May Help

Why the body can't just heal its way back

Healing and recovery are not the same thing. Biological healing — wound closure, bone union, tissue integration — largely happens on its own, on a fixed timeline. But functional recovery — strength, coordination, the confidence to move and bear weight normally — requires the tissue to be used correctly while it heals.

Left alone, the body defaults to protection. It guards the operated area, recruits other muscles to compensate, and avoids the very movements it needs to relearn. Patients typically drift toward one of two extremes: under-loading out of fear, or over-loading out of impatience. Physiotherapy is what calibrates that loading correctly, stage by stage.

There is also a less visible disruption that few patients are aware of — the connection between brain and muscle. Pain, swelling, and immobilisation can cause a structurally intact muscle to simply stop firing efficiently, because the nerve pathways that recruit it have gone quiet from disuse.

Left unaddressed, the body compensates by recruiting other muscles instead — which can look like recovery on the surface while quietly setting up problems in neighbouring joints. This is precisely what targeted neuromuscular re-education in physiotherapy is designed to correct — retraining the brain to activate the right muscle, in the right sequence, again.

Also read: 6-Year-Old Australian Kid Dies From Rarely Seen ‘19th Century Disease’: Why Is Scurvy Still A Risk Today?

When patients stop too soon

The most common reason patients abandon physiotherapy early is what I call the "pain-free equals cured" mentality. Pain typically resolves well before strength, range, and control are fully restored — and once it's gone, patients read that as the finish line. Physiotherapy at that stage feels repetitive and effortful compared to the relief of simply feeling better, so motivation drops exactly when the harder, more important phase of rebuilding begins.

The long-term cost of this is real. In my practice, I regularly see stiffness that never fully resolves, chronic weakness that surfaces years later as instability or a limp, and compensatory strain in neighbouring joints — a hip overworking for an under-rehabbed knee, a shoulder overcompensating for a poorly recovered elbow.

Some of these cases eventually need a second procedure just to release stiffness that consistent physiotherapy could have prevented in the first place. These are not failures of surgery. They are failures of the recovery process that followed it.

The real answer to "I feel fine, do I still need physiotherapy?"

Feeling fine and being fully recovered are not the same thing — and that gap is exactly where physiotherapy does its work. Pain is often the first symptom to disappear and the last thing to reflect what's actually happening inside the joint. Strength deficits, altered movement patterns, and residual stiffness can persist long after pain is gone, only to resurface later as instability, re-injury, or early joint wear.

Stopping physiotherapy because the pain has gone is a bit like stopping antibiotics because the fever broke — the underlying process isn't necessarily finished just because the most obvious symptom has resolved.

Surgery and physiotherapy are not two separate stages of treatment. They are two halves of a single continuous process, and the outcome is determined by both. Surgery repairs the structure. Physiotherapy restores the function. Patients who understand this going in don't just heal better — they move better, for years afterwards.

GLP-1 drugs are set to become the “new statins of the world” and could transform metabolic health, said Wasim Hanif, Professor of Diabetes and Endocrinology at University Hospital Birmingham.

Speaking exclusively to HealthandMe, Prof Hanif discussed their growing use in obesity and diabetes, potential benefits, side effects and when patients should stop treatment.

GLP-1 Drugs Could Save NHS Billions

Even as the NHS is rolling out GLP-1 drugs, including tirzepatide (Mounjaro), for severe obesity, Prof Hanif said their kidney and cardiovascular benefits could also reduce the healthcare burden.

NICE recommendations cover tirzepatide and semaglutide for obesity and type 2 diabetes, with recommendations also expected for obstructive sleep apnea and MASH.

“I think these drugs will have a huge impact. These are going to be the game changers in metabolic health. These are the new statins of the world,” he said.

The only caveat, according to him, "is the cost, especially in the West".

"The cost of these medications is too high, but the hope is that within the next couple of years, once they become generic, they'll be used even more,” the professor told HealthandMe, on the sidelines of an event organized by the BMJ Group in New Delhi.

From GLP-1 To GIP And Glucagon

The Professor explained that the drugs have evolved beyond GLP-1 alone:

• GLP-1: Drugs based on glucagon-like peptide-1
• GLP-1 + GIP: Tirzepatide
• GLP-1 + GIP + glucagon: Retatrutide

US: Obesity And Diabetes Trends Falling

Prof Hanif pointed to growing use in the US and resulting health benefits.

“The total amount that the companies made with the use of these drugs in the United States was 43 billion dollars. Now we are actually seeing, for the first time, the trends of obesity and diabetes coming down,” he said.

He added that cardiovascular benefits are also expected to have a major impact.

‘Weight Losses We Never Imagined’

Prof Hanif said the drugs are producing major clinical improvements.

“For the first time in years I'm seeing my patients with diabetes achieve normal HbA1c once these drugs are used. Secondly, we are seeing weight losses we never imagined we would be able to get,” he said.

He also highlighted improvements in:

• Obstructive sleep apnea
• Cardiovascular health
• Heart failure.

Does Everyone Need A High Dose?

Recent research showed that GLP-1 drugs are showing benefits, even with lower doses. Prof Hanif said dosing depends on the condition and patient.

“For weight loss, yes, you need bigger doses, and that depends upon what your baseline weight is. So if your BMI is 40-45, you probably require a bigger dose, but if your BMI is less, you require a lesser dose,” he explained.

“For diabetes, you don't need the higher doses. With one milligram of semaglutide or five milligrams of tirzepatide, 80% of the patients get the decision,” he said.

“For cardiovascular protection, you don't need big doses. So it really depends upon — it's not that every person will need the topmost dose.”

GLP-1 Side Effects: What Does The Data Show?

Do these drugs have side effects? Prof Hanif said yes — but stressed that side effects occur with every medication. However, he pointed out to increasing "medical misinformation about GLP-1 drugs spreading rapidly through social media and websites in the US, Asia and India".

“Between 2007 and 2025, there were 1900 cases of pancreatitis reported or associated with GLP-1, with 19 deaths in the UK. Now how many patients were using these agents? Millions,” said Prof Hanif, who is also part of the board of the UK’s Medicines and Healthcare products Regulatory Agency (MHRA).

Comparing this with metformin, he added: “During the same period of time or even less, metformin caused 25 deaths.”

Hair Loss, Muscle Loss And Retinopathy

Prof Hanif said side effects associated with GLP-1 drugs do occur, but there are strategies to mitigate them.

“Hair loss is very — it does happen, but it's not that common. Loss of muscle mass happens, but it happens with any kind of weight loss.”

“There are mitigation strategies — how you do it.”

He also highlighted retinopathy, particularly among people with diabetes.

“We know if somebody's having proliferative retinopathy or having laser treatment, you don't use it. There are guidelines on that.”

He also warned against viewing GLP-1 drugs as lifestyle drugs, and buying them online and using them without appropriate medical oversight.

“So these drugs have to be used under medical supervision by people who know how to use these drugs, like any other drugs," Prof Hanif said.