Liberalization and HIV in Kerala

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Liberalization and HIV in Kerala

" The HIV/AIDS epidemic is a good illustration of the well-

established link between poverty and ill health; job insecurity can

indirectly affect people's susceptibility to diseases and infections

such as HIV. Working and living conditions can put people at a

higher risk for disease and infection: poverty-driven sex work and

migration are acknowledged socioeconomic risk factors for HIV. It is

also likely that the availability of food and access to health

services influence susceptibility to disease as well as the ability

to cope with ill health. Without good nutrition and health care,

people with HIV succumb to AIDS more quickly.

In this context, this paper by Sandhya Srinivasan and Mini Sukumar

explores the following questions: Has structural adjustment in

India, implemented since 1991, increased job insecurity and loss of

livelihood in the state of Kerala? Did structural adjustment put

some groups at higher risk of HIV? Did policy decisions reduce

people's access to care, especially through the public health

system? If so, what institutional pressures led to these changes,

and how were they received?... "

Kerala was chosen as a case study because its excellent health

indicators are acknowledged to be at least partly due to the state's

commitment to public services. However, structural adjustment

programmes (SAPs) have been linked to worsening living conditions

and health status, thus SAPs at the national level will have effects

at the state level. Second, Kerala is a state of migrants, and

migration has often been identified as a risk factor for HIV

infection. The state's reported low HIV prevalence, despite this

risk factor, merited further investigation.

The Kerala model, based on public commitment to social services,

survived frequent changes of state government and flourished despite

the low priority given by the national government to these issues.

However, several overlapping trends have combined to create what

appears to be a crisis. Some of these pre-date the introduction of

structural adjustment, but have accelerated since its implementation

in 1991.

Since the 1980s, the state of Kerala started having difficulties

paying for its social support schemes through the revenues it

generated. This contributed to the decline of the extensive public

health care system, forcing people to turn to the growing and

unregulated private health sector. Studies indicate that household

expenditure on health care has increased drastically with

liberalization, sometimes forcing families into debt.

SAPs at the national level are also believed to have affected the

livelihoods of various sections of the population, leaving people

impoverished and in debt, and forced to work in highly exploitative

conditions. Their situation is exacerbated by the Kerala

government's apparent reluctance to take action against violations

of labour laws. These conditions and the resulting sharp drop in

income could be pushing women into the sex trade, thereby increasing

their risk of contracting HIV. Some groups may be forced to migrate

to other states in search of work, which also puts them at a higher

risk. While earlier official figures show that HIV prevalence has

remained at a low level in Kerala, recent figures suggest a

significant increase.

The Kerala AIDS programme is independent of the health care

infrastructure, with separate funding and the involvement of NGOs

for implementation. Yet many components of the programme will have

to be implemented through the public health system. However, the

public services are inadequate, while the private services—to which

people with HIV are often forced to turn—are irrational,

discriminatory and expensive. There are no policies implemented to

protect the rights of people with HIV.

India is facing a growing AIDS crisis but, so far, Kerala does not

seem to have been as affected as other states. However, if the

latest official estimates suggesting that HIV prevalence may be a

growing problem in Kerala are correct, the deteriorating support

system, further weakened by the consequences of the national SAP,

may be unable to tackle the crisis as it affects Kerala.

(By: Sandhya Srinivasan and Mini Sukumar; United Nations Research

Institute for Social Development (UNRISD), Social Policy and

Development Programme Paper Number 26, April 2006)

http://topics.developmentgateway.org/hiv/rc/filedownload.do?

itemId=1064979

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