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Srinivasan, Sandhya and Mini Sukumar
Liberalization and HIV in Kerala
United Nations Research Institute for Social Development (UNRISD), April 2006, 34 pp

Social Policy and Development Programme Paper Number 26. Reproduced with UNRISD's kind permission.


"The link between poverty and ill health is well established, and the HIV/AIDS epidemic illustrates this connection. Working and living conditions can put people in situations of higher risk for disease and infection. For example, poverty-driven sex work and migration are acknowledged socioeconomic risk factors for HIV (Collins and Rau 2000). Thus, job insecurity can indirectly affect people’s susceptibility to disease, including HIV infection. It is also likely that the availability of food and access to health services influence susceptibility to disease as well as people’s ability to cope with ill health. Without good nutrition and health care, people with HIV succumb to AIDS faster. In this context, the following questions are explored: Has structural adjustment in India, implemented since 1991, increase job insecurity and loss of livelihood in the state of Kerala? Did structural adjustment put some groups at a 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 policies (SAPs) have been linked to worsening living conditions and health status, thus structural adjustment will have affected the state. Second, Kerala is a state of migrants, and migration has often been identified as a risk factor for HIV infection (Collins and Rau 2000). The state’s reported low HIV prevalence, despite this risk factor, merited further investigation. The ideas presented in this paper are based on interviews with public health specialists, health activists and government officials1 as well as selected published material."

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