Fading HIV fear puts rising STI cases among Kerala youth in sharp focus
HIV is no longer the word that frightens young people in Kerala. For a generation that has seen the virus transformed from a feared death sentence into a manageable chronic condition, it no longer carries the deterrent power it once did.
But this fading fear is posing a new public-health challenge. Changing sexual behaviour, gaps in awareness and growing substance use are increasingly putting young people at risk of sexually transmitted infections (STIs), health officials said.
According to the Kerala State AIDS Control Society (KSACS), the number of people seeking care at the 23 District STI/RTI Centres (DSRCs) has been rising steadily. However, these figures do not capture the full picture, as Kerala does not have routine STI surveillance across public and private hospitals. STIs also rarely figure in formal public-health conversations.
On World Sexual Health Day (September 4), experts said Kerala needs more open conversations with young people about sexual health, safe practices, consent and healthy relationships. Equally important is ensuring that young people know where they can seek confidential testing, advice and treatment without fear of judgement.
KSACS data compiled up to December 2025 show that attendance at DSRCs rose from 41,417 in 2023-24 to 63,129 in 2024-25. Another 51,243 people visited the clinics during April-November 2025 alone.
The proportion of DSRC clients undergoing RPR screening for syphilis also increased, from 55% in 2023-24 to 70% in 2024-25 and 79% during April-November 2025. The increase in screening means more infections are being detected; officials caution that the figures cannot by themselves be taken as evidence of a corresponding rise in prevalence.
Of particular concern is the increase among younger clients. Among those aged up to 19, clinic attendance rose from 1,547 in 2023-24 to 2,255 in 2024-25, with another 1,910 recorded during April-November 2025. The proportion of newly detected HIV infections among those aged 15-24 also rose from 10% in 2022-23 to 15% during April-October 2025.
A senior Health official said there has been a change in societal attitude towards casual sex. "The earlier message of abstinence that we used to give youngsters no longer works. Many youngsters are sexually active today and our only message to them is to remain safe, because their health is at stake," the official said.
Being safe goes beyond HIV prevention. Condoms significantly reduce the risk of many STIs, including HIV, gonorrhoea and chlamydia, but do not eliminate the risk of infections such as syphilis, HPV and genital herpes, which can spread through skin-to-skin contact. HPV and hepatitis B vaccination, regular testing, timely treatment and reducing exposure to multiple or unknown partners are also important.
Consent and communication also need to be part of sexual-health messaging. Being safe means being able to say no, respecting a partner's decision and discussing protection before sex.
Substance use among young people is another concern for sexual-health professionals, who say intoxication can increase risky sexual behaviour and impair the ability to make informed decisions.
V. Sam Prasad, who heads AHF India Cares, an NGO working in HIV, stressed the importance of testing. "One of the most important messages we can give youth today is that testing matters, even without symptoms. Many STIs cause no symptoms, so someone can have and transmit an infection without knowing it. Testing becomes particularly important after a potential exposure or when starting a new sexual relationship."
Kerala's STI clinics are seeing a range of infections, with syphilis emerging as a particular concern. Doctors also report a resurgence of gonorrhoea, which is increasingly encountered in clinical practice.
KSACS data show that clients found reactive for syphilis on screening increased from 1,206 in 2023-24 to 1,455 in 2024-25. Another 1,121 were recorded during April-November 2025.
