Social Policy and Development Programme Paper 26: Liberalization and HIV in Kerala

Sandhya Srinivasan and Mini Sukumar investigate the links between structural adjustment programmes in India and HIV/AIDS in Kerala state. India is facing a growing AIDS crisis but, until recently, Kerala seemed less affected than other states. The latest official estimates suggest that HIV prevalence may be growing in Kerala, however, and the authors point to a deteriorating support system, further weakened by the consequences of national structural adjustment programmes.

The "Kerala model", based on long-standing public commitment to social (including health) services, survived frequent changes of state government and flourished despite the low priority given by the national government to these issues. However, under structural adjustment, several overlapping trends have combined to create what appears to be a crisis.

Kerala has faced growing difficulties in paying for social support schemes. This contributed to the decline of the extensive public health care system, forcing people to turn to the growing and unregulated private health sector. SAPs at the national level are also believed to have affected the livelihoods of various sections of the population, leaving more people impoverished and in debt, and forced to work in highly exploitative conditions. These conditions and the resulting sharp drop in income could be pushing women into the sex trade, thereby increasing their risk of contracting HIV, or forcing some groups to migrate to other states in search of work, which also puts them at a higher risk.

The Kerala AIDS programme is independent of the public health care infrastructure, with separate funding and the involvement of NGOs for implementation. Although many components of the programme must be implemented through the public health system, public services are inadequate, while the private services—to which people with HIV are often forced to turn—are irrational, discriminatory and expensive. Policies to protect the rights of people with HIV are also lacking.

Unless these conditions change, the authors argue, it may be increasingly difficult to tackle the HIV/AIDS crisis in Kerala.

Sandhya Srinivasan is a freelance health writer, executive editor of the Indian Journal of Medical Ethics, Mumbai, India, and a consultant on health and population for the website www.infochangeindia.org. Mini Sukumar is a lecturer at the Centre for Women’s Studies, University of Calicut, Kerala, India.

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