How Mizoram is easing the sexual health conversation with a youth-friendly café

Thangzuala (name changed) life seemed completely normal until she experienced persistent fever, diarrhea and infections late last year. Concerned about rapid weight loss, the 24-year-old man typed his symptoms into his phone.

When HIV came up as a possible cause, he panicked. Clinics, helplines and next steps are also listed in the search results. But he wasn’t sure where to start – or, indeed, whether to even start. “How could this happen to me,” he recalls asking himself. “For me, HIV was a disease of sex workers and drug users. I was afraid of being called immoral.”

He was struggling with the idea of ​​visiting a testing center when he came across an Instagram post by the Mizoram State AIDS Control Society (MSACS) about a new health and outreach centre, called SPOT or ‘Safe Space for Open Talk’. The liberating sound of its name, along with the promise of free HIV services, was an instant attraction, but what attracted her more were the accompanying sights: The place didn’t look like a clinic.

The next day, Thangzuala found himself in the basement of the Mizoram Deputy Commissioner (MUP) headquarters in Aizawl, where he discovered a lively café that not only offered liquor and snacks, but also free HIV and STI testing, condoms, counseling and support.

Before long, Thangzuala was answering the counselor’s gentle questions at a leisurely pace. For the first time since his turmoil began, he was at peace without attracting attention. Finally, encouraged by the counselor’s offer to accompany him, he agreed to visit a testing center.

anti clinic

Opened on 9 February this year, SPOT is rewriting the rules for engaging with young people on sexual health. In its cozy, intimate setting – with a graffiti wall, TVs, karaoke and fun games – young people can feel at home, even among the condom dispensers and counselors.

Mizoram’s picture-postcard landscape has long belied a staggering public health challenge. One of India’s smallest states – the second smallest by population and fifth smallest by area – Mizoram has the country’s highest HIV prevalence, currently at 2.75% of the population, and the highest incidence with new cases at around 0.9%, according to the India HIV Projections 2025 Technical Report.

Between April 2025 and January 2026, Mizoram recorded 1,478 new cases – 955 men and 523 women, including 86 pregnant women. “What is of particular concern is that the majority of people testing positive are in their most productive years,” says Dr. Jane Rinsangi Ralte, project director of MSACS.

The situation is further complicated by the influx of cheap drugs across the open border with Myanmar, part of Southeast Asia’s drug-producing Golden Triangle; extremely low condom use; and ‘serial monogamy’, where multiple monogamous relationships in a lifetime increase the risk of HIV transmission.

At one time this epidemic was almost entirely driven by intravenous drug use. That has now fallen to about 27%. About 70% of new cases are due to sexual transmission.

Shadows outside, humans inside

It is against this grim backdrop that SPOT has emerged as a first-of-its-kind, people-centric health initiative, created through a partnership between MSACS and AHF India Cares, the India program of the AIDS Healthcare Foundation, a US-based non-profit. SPOT is not a clinic trying to mimic a café, but rather a social hub that aims to normalize conversations and care around sexual health and sexually transmitted infections (STIs).

“In a state where adult HIV prevalence is almost 13 times the national average, we need to look beyond incrementalism,” says Lalrinpui, Mizoram’s health and family welfare minister. He has revived the NACO-mandated Legislative Forum on AIDS in Mizoram and raised ₹20 lakh through MLA contributions to help those who are not able to travel to ART (antiretroviral therapy) centres. “Unfortunately, the age group most affected is also the most reluctant to seek help,” she says.

The Minister believes that innovation must become the cornerstone of public health to destigmatize services. “New models like SPOT, combined with rights-based national and international principles and frameworks, bridge the gaps left by traditional systems,” she says. “The initial response to SPOT represents a great opportunity for us to institutionalize innovative approaches to provide clinical outcomes with dignity and comfort. We aim to scale up such cafes across Mizoram. They can also be replicated across India, keeping local cultures in mind.”

Prevention can only work if youth do not feel limited to a statistic. “It is unrealistic to expect them to go to traditional health facilities that will leave them feeling judged,” says Dr. V. Sam Prasad, country program director, AHF India Cares. “SPOT meets youth where they already are – socially, emotionally, culturally – to help them manage their health with confidence and dignity. For young adults in Mizoram, this can make the difference between meaningful engagement and being left behind.”

In this way the café becomes more than just a setting. “It is important to come out of the closet to replace stigma with empathy. This is where SPOT can play an important role,” says Henry Zodinliana Pachuau, professor of social work at Mizoram University and co-author of several national and global studies on HIV/AIDS and STIs in Mizoram. “Amid the state’s growing café culture, SPOT provides the right encouragement for young people to not only talk openly about STIs, but also benefit from vital guidance on healthy behaviors and harm reduction services like syringe distribution and opioid replacement therapy.”

The name SPOT was intentional. “In the Mizo language, ‘spot’ refers to illegal places where people go to drink alcohol or consume drugs,” explains Dr. Ralte. “We wanted to change that negative connotation.”

In just a few weeks since opening, SPOT has welcomed dozens of youth, many as young as 10, who come after school or college, between work shifts, during a date, or while hanging out with friends. They look for life-critical answers, mental health support, relationship advice and free condoms – in a discreet environment, free from tedious appointments and explanations.

Just like in real life, curiosity often starts this way. For example, a 10-year-old girl wanted to visit with her parents to understand how SPOT can help children her age deal with stress and confusion.

With all my heart, no judgment

“For me, SPOT feels like the safe space I didn’t have when I first found out I was HIV positive,” says Vanlalruati Kolni, activist and founder of Mizoram’s Positive Women Network. She was one of the earliest Mizo women to publicly disclose her HIV positive status in 2003. “I have lived through the brutal regime of fear and shame that living with HIV can break people to such an extent that they lose even the desire to ask for help,” she adds. “The spot humanizes the challenges that ignorance and suffering pose to young people. This is what is needed in the fight against HIV/AIDS – compassion, courage and caring without judgment.”

SPOT has a great company in town that is inventing new ways to pierce the shroud of austerity, like the giant 30-foot building. Condom billboards – Aizawl’s first – and the unique ‘Love Brigade 2.0’ campaign, where two-wheeler taxi riders wear condom jackets and distribute free protection. Still, Dr. Ralte says, finding space for SPOT was difficult. “We wanted a central location, but most people were hesitant to rent space to us. Eventually, Laltanpuia, owner of the Aizawl Art Gallery, offered us about 400 square feet of space below the gallery and with the support of MUP the project became a reality.”

Dr. Ralte says SPOT will soon launch dual-kit HIV and syphilis testing. “There is already a growing demand to introduce blood testing as well.”

SPOT wants a positive diagnosis to be the beginning of care, not the end of hope. “We can’t turn people away from certain tasks, but we can certainly give them safer alternatives,” Dr. Ralte concluded.

The author is an independent journalist and commentator.