According to a United Nations estimate, Manipur has 0.23% of India's population but accounts for more than 8% of the total HIV cases in India.
So what measures are being taken to tackle the crisis.
At the Gilead's Balm Care Centre for recovering drug addicts in the town of Churchandpur, inmates are chained up to keep them from escaping.
Officials in Manipur say in the last decade more than 300 people have died from Aids and around 17,000 people are infected with HIV. But NGOs say the real figures are several times higher.
Ruth does not know yet if her baby has contracted HIV
More than 70% of the state's HIV infections are caused by sharing needles.
This is in sharp contrast to the rest of India where more than 80% of the infection is through unprotected sex.
But now the HIV virus is spreading from drug users to their sexual partners and children too.
Not far from the Gilead's Balm Care Centre, Ruth and Jinthang play with their seven-month-old baby.
They sound like any happy family, but this family has a secret - both Jinthang and Ruth are HIV positive.
Although the baby has so far tested negative, doctors say they will only know for sure when she is 18 months old.
Jinthang tells me he is a heroin addict, and he contracted HIV through the needles he shared with his friends. Then he passed it on to Ruth.
Churchandpur is 70km (45 miles) from the state capital, Imphal, and
Ruth and Jinthang are both members of the newly-formed Manipur Network of Positive People in the town.
The organisation has no funds, but it provides its members with a place to meet and discuss common problems.
Being close to the border with Myanmar, Churchandpur falls directly along the route of the heroin trade from the so-called Golden Triangle and has one of the highest concentration of HIV cases in India.
Rattled by the growing numbers of cases, the people of Churchanpur have called for desperate measures, hence the chains.
In an open courtyard at the Gilead's Balm Care Centre, a group of men sits around staring listlessly at the ground.
Some of them have chains with big locks around their ankles.
The director of the centre, Pauthan Kam, says 20% of the 100-odd men here are HIV positive.
Mr Kam defends chaining his patients: "Here in Churchandpur, the majority are drug addicts, and drugs are easily available, so if they get free for even 30 minutes or so, they succumb.
"So we put love chains around their ankles to help them overcome the suffering. It's not against human rights."
Despite the questions raised by human rights groups about the methods involved, this rehab centre seems to find favour with many who are desperate to kick the addiction.
One young man, who prefers to remain anonymous, told me he had been taking heroin for 10 years now.
Pauthan Kam insists his methods are not against human rights
It costs his family 1,200 rupees ($25) a month to keep him at the Gilead's Balm Care Centre.
He told me: "The course is very hard in the beginning, but the faith helps in healing. This is my third time at a de-addiction centre."
He admitted that if there were no chains around his ankles he would not be here.
"I would have run away a long time ago. The beginning is very tough. Cold turkey, withdrawal symptoms are hard to deal with," he said.
Normal methods have failed
Several such centres have sprung up in Churchandpur in recent years because conventional methods appear to have failed.
In another part of the centre several women, all heroin addicts, sit in a hall listening to their counsellor.
All the women are HIV positive.
One mother of five told me she was estranged from her husband.
She said she shared needles with her friends and had multiple sexual partners after her separation.
She is one of many living in this rehabilitation centre, which is run by an NGO, the United Voluntary Youth Council.
They can stay here for three months but once they leave most return to their old drug-addled lives.
Dinesh Singh, the project director, has worked with 250 women so far.
People are taught the truth about HIV
He said: "Eighty per cent of these women come from the poor strata, they have low literacy, and history of high family crisis.
"Most of them are separated from their near and dear ones. Even after recovery, they are not readily accepted by the family or society. So most of them relapse. The relapse rate is as high as 80% at the centre."
Mr Singh said he did not see much hope for Manipur unless the authorities did something to stop the smuggling of heroin.
The virus is slowly but surely spreading its tentacles. And so far, Manipur seems to be losing the battle.