e-journal

Liberalization and HIV in Kerala

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Summary.
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.

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Informasi Detail

Judul Seri

Social Policy and Development Programme

No. Panggil

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Penerbit

Geneva : United Nations Research Institute for Social Development (UNRISD)., 2006

Deskripsi Fisik

Social Policy and Development Programme Paper Number 26 April 2006

Bahasa

English

ISBN/ISSN

10208208

Klasifikasi

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Tipe Isi

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Tipe Media

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Tipe Pembawa

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Edisi

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Subjek

ILMU SOSIAL

Info Detail Spesifik

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Pernyataan Tanggungjawab

agus

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