To study the trends of the HIV epidemic and risk factors associated with HIV in a rural area of India. We utilized HIV prevalence among young pregnant women as an indicator of population trends in HIV infection. This was an observational study of pregnant women aged less than 25 years who were counseled and tested for HIV infection in a rural hospital between August 2007 and June 2011. Information on age, education, occupation, and community were collected prospectively from all of the women. The HIV prevalence in young pregnant women decreased from 1.22% in 2007 to 0.35% in 2011. Comparing the periods 2007-2009 and 2010-2011, a reduction in HIV prevalence was seen in all subgroups except in women from forward castes. Women whose job was not related to agriculture and women who had only completed primary education were more likely to be HIV-infected. These results indirectly indicate that the incidence of HIV infection is decreasing in this rural setting. However, an increase in the HIV prevalence in women from forward castes was observed. In rural areas, HIV testing of pregnant women who have only completed primary education or who are working in a field not related to agriculture should be encouraged, because of their higher risk of HIV infection.