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FEATURES/Cross Border | Jun 5, 2009 | 35979 views

How Bill Gates Blew $258 million in India's HIV Corridor

The purpose was noble, the money generous. But the software mogul's charity for HIV prevention in India has failed to make a lasting impact
How Bill Gates Blew $258 million in India's HIV Corridor
Image: Vikas Khot
ON THE EDGE: It's difficult to persuade customers to use condoms in Mumbai's Kamathipura, Asia's largest red light district, where HIV is rampant.

O

n a humid afternoon, former sex worker Fathima (name changed) welcomes a group of illiterate women — still in the trade and needing protection from HIV — into the Mukta clinic in Pune. As a “peer educator,” it’s her job to convey to them the message of safety. But the visitors shuffle tentatively as expensive-looking posters in English paper the walls around them.
Why would a clinic serving illiterate visitors use more English than Indian languages?

The answer lies in where that money comes from. The Pune clinic is part of a network one hundred-plus non-governmental organisations (NGOs) working under the umbrella of Avahan, India’s largest HIV prevention initiative. Avahan, or “call to action,” is a brain child of the world’s largest philanthropist: Bill Gates.

Gates had announced the 10-year, $100-million initiative to stop the spread of HIV/AIDS in India during his much heralded visit to the country in November 2002. This was to be the largest of its kind for the Bill & Melinda Gates Foundation.

The timing couldn’t have been more appropriate. After nearly two decades of piecemeal efforts to counter HIV, India was hurtling towards an AIDS epidemic. Millions of poor people exposed themselves to the dreaded virus due to a lack of awareness. Government agencies and NGOs didn’t have the money to preach safety or treat the infected. Gates showed his seriousness by later raising the budget to $258 million.

Seven years later, back at the Pune clinic, Fathima has counselled the women, given them the sheaths of safety and sent them back. It is time to worry about the future. The bad news is Avahan is ready to pack and go; and Fathima is set to lose her income. She doesn’t want to slip back into prostitution. At the age of 45, she doesn’t have much of a career there anyway.

When it started on the ground in 2003, Avahan set for itself three goals: Arrest the spread of HIV/AIDS in India, expand the programme from the initial six states to across the nation, and develop a model that the government can adopt and sustain so that the project could be passed on to it. More than five years later, Avahan hasn’t achieved any of these goals. Doubtless, the initiative has made a dent into the HIV/AIDS problem, but the impact is marginal for a bill of $258 million. And now Avahan is leaving, handing over the reins to the government-run National AIDS Control Organisation (NACO), which doesn’t want to inherit it. It is too expensive for the budget-starved establishment that is as nimble as a sloth. If NACO takes over, it will try to prune the costs of the programme. Salaries for peer educators will go.

A Five-Star Initiative

When Gates Foundation got down to work in India, the priority was clear. It decided to hire the best minds in business to run its initiatives using sound principles of management. Avahan was ready to spend what it takes to get the best bosses and started its search at McKinsey, the consulting powerhouse. The recruiters zeroed in on Ashok Alexander, who had spent 17 years turning Indian businesses into global challengers. “They made me an offer I couldn’t refuse,” Alexander recalls, sitting at his plush office in New Delhi. “I liked the ambitious arch of the HIV/AIDS programme and it was a chance for me to do something new.”

Soon, the 15-member team was in place. Ten of them had come from a private-sector background. The team members tackled HIV/AIDS much as they would a problem at McKinsey. Alexander’s office is papered with data and maps containing hundreds of coloured dots plotting the disease across the country. The argot is sheer B-school: Avahan is a “venture,” its HIV/AIDS prevention programme a “franchise,” the sex worker the “consumer.”

The classical business principles helped Avahan start on a big scale in six states simultaneously. But the lack of public health experience also led to a compromise on quality. Tejaswi Sevekari, director at Saheli, a sex workers’ collective for HIV/AIDS in Pune, remembers observing the kinks during her stint at Pathfinder International, an NGO that works with Avahan. Data collection and reporting were entirely in English and had no pictures. Five years later, the scene is the same; the project hasn’t fully given up on English though no “consumer” understands the language.

Avahan operated in a pyramid, with Alexander and his team overseeing the work of more than 100 NGOs. The lack of practical experience at the top manifested itself in different ways. When Avahan introduced sleek mobile vans to bring clinics directly to the brothels, the expensive-looking vehicles were sometimes met with intense suspicion. At the Mukta clinic, Dr. Laxmi Mali says sex workers initially thought the van was from the police or the government. They refused help.


False Moves
The early missteps are largely anecdotal. But in 2005, an internal evaluation showed a big portion of Avahan’s efforts had gone to waste. As many as 31,000 community members had been contacted by Avahan’s outreach programme, but only 11,000 actually visited the clinics. The Avahan executives had assumed the peer educators would already know what the prevention services were without explanation; the reality was they didn’t.

Avahan’s craving for scale also meant it overshot quite a bit. It started with a bang in six states, with 50 sites for truckers in the south. But by mid-2005, only 12 percent of truck drivers were even aware of their services, and only 7 percent took advantage of them. This forced Avahan to reduce the sites to 20. For similar reasons, Avahan’s 6,000 sexually transmitted infection (STI) centers were brought down to just 800.

Alexander’s team tried to fix the glitches. For example, Avahan tried to allay the fears of sex workers (such as those who had met the mobile van with suspicion) by hiring them to act as intermediaries between the programme and communities. An insider could be more persuasive. Good idea, but Avahan’s decision to pay them a salary has come in for criticism, because other NGOs can’t recruit sex workers as volunteers.

A series of evaluations published in the AIDS Journal in 2008 show that the jury is still out on the programme’s impact. The evaluations, funded by the Gates Foundation, were mostly on the methods of data collection. One study, which sought to determine whether Avahan was responsible for the decline in HIV prevalence in Karnataka, failed to prove that it played a key role.

Where Has All the Money Gone?

At the core of Avahan’s failure to make a serious difference to India’s fight against AIDS is the way it spent money. It was an expensive operation, never tired of throwing money at the problem. In a country where a branded condom sells for just 10 cents, what did Avahan spend on? It’s difficult to say because Avahan’s finances are largely opaque. Avahan’s outlets sell five million condoms a month and distribute another 10 million. Asked how so much could be spent on condoms, Alexander laughs, saying, “It’s a bit more complicated than that.” Probed further, Alexander says he doesn’t know the financials off-hand, nor can he give them later.

Travel would have been one drain. Jonty Rajagopalan, Avahan programme officer from 2006 to 2008, says she would take flights every month from her base in Hyderabad to her focus areas in Andhra Pradesh and Tamil Nadu, instead of being based in a focus area. Another large chunk: salaries. Alexander’s annual package is $424,894, the second-highest in the foundation globally, not including the presidents and operating officers. Avahan’s targeting intervention (TI) officers are also paid three or four times what a typical NACO TI officer is paid.

 

EXPENSIVE CURE: Avhan set up its first ever AC clinic in Kamthipura
Image: Vikas Khot
EXPENSIVE CURE: Avhan set up its first ever AC clinic in Kamthipura

Avahan’s marketing was done in style too. Eldred Tellis, head of Sankalp, an HIV/AIDS-focussed Mumbai NGO that has worked with Avahan, says he has seen a lot of money go into fancy publications on high-quality paper, reporting the programme’s work. Very little went to the people on the ground. Vijay Mahajan, chairman, Basix, a microfinance institution, comments on Avahan: “There is too much money and too many really smart people with too little coming out.”

An Uncertain Torchbearer

Knowing that it would have to inherit the project, NACO sent out evaluation teams to sites in four states to get some clarity on costs. NACO’s head, Dr. Sujatha Rao, says the evaluation threw up one clear message: Large parts of the programme are not sustainable by NACO. “We told them you can’t create a huge number of assets and then just leave and expect the government to take over everything,” says Rao.

But Alexander disagrees. “We are not perpetual funders. We try to be catalytic,” he says, ebulliently confident that the HIV/AIDS epidemic will soon be contained, with or without the foundation. Either way, it will have to be — Avahan is now repositioning, focussing on maternal and newborn health.
Ashok Row Kavi, consultant for UNAIDS and chairman of Humsafar Trust for gay and transgender health, says Avahan’s expectations were unrealistic. “They wanted HIV to disappear in five years. For that to happen, a lot of people would have to die.”

NACO’s annual budget is Rs. 1,100 crore ($225 million), none of it spent on Avahan currently. Rao just can’t find enough money to continue the project. “We can never offer a replicable model. And if we are unable to sustain the programme, all of their effort will be for naught,” she says, shaking her head.
When probed about the difficulties of handing over the massive programme to the government, Alexander says the transfer is going just fine. Kavi differs; he says that the transfer discussions between NACO and Gates Foundation are “running into a brick wall right now. Costs need to be brought down, but they can’t figure out how.” He also fears Avahan’s now-experienced MBA-graduate TIs, facing shrinking salaries, will depart. The question of running air-conditioned clinics like Avahan doesn’t even arise.


The biggest hole in quality will arise where it can hurt most. Hussain Makandar, HIV counsellor at the Mukta clinic, is worried about condoms; the ones from Avahan lubricate; the ones from NACO break and the sex workers stop using them.
Alexander insists that only a 10th of the project will transfer to the government this year and the rest will happen slowly over the next five. “We’re doing a transition programme. We’re not saying, ‘here’s the programme, and we’re off.’” But NACO and Mukta officials, among others, are confused over the timeframe.

So, the final report card on Avahan:

Goal 3: Develop a model for HIV prevention that can be implemented by the government sustainably. NACO’s resounding vote: Not achieved.

A FAILED GESTURE: Though the jury is still out, critics have called Avhan's HIV/AIDS venture a squandered opportunity to do good
Image: Eric Thayer/ Reuters
A FAILED GESTURE: Though the jury is still out, critics have called Avhan's HIV/AIDS venture a squandered opportunity to do good

Goal 2: Expand the programme nationwide. Avahan could not go beyond the six states it started with. Not achieved.

Goal 1: Arrest the spread of the disease. The number of Indians living with HIV/AIDS has been officially corrected from 5.1 million to 2.4 million. This was a statistical change, not an improvement in health. Impact not known.

Back in the great Indian sex bazaar, prostitution is a growth industry and condom an exception. “New faces keep coming in every month (to the brothels),” says Dr. Mali. “Twenty percent of the people we now see are infected, the same as when we started.”

This article appeared in the Forbes India magazine issue of 19 June, 2009
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Comments (32)
Dr Prakash Kudur Jan 13, 2011
I know this prog. since last 5 yrs. It is based on a very sound principle of social mobilisation, empowerment, reduction in stigma.
Monica Rana Nov 17, 2009
Spending great amount of money does not help always though Avahan took good initiative for a noble cause but lacked experience and could not implement things on ground level. They started off well but somewhere they did not involve people who could have really helped them reaching out for their objective. In Indian public health sector, involvement of those who are part of that dreaded disease is required so that they earn something out of it and motivate other people to take preventions by giving their own example.
Rajesh Dahol Nov 16, 2009
For programs for poor, infected and abandoned categories one need to have people who understand the ground reality. Rather than providing CONDOMS, if Avanhan had started providing jobs to the prostitutes by developing small scale industries they would have done a better job. Mckinsey consultants are not implementors, they are more like Advisors. Programs like Avahan needed strong Public Health implementors who can dirty their hands at the ground level.
Bob Wheeler Jul 26, 2009
If you hired high priced leaders who don't understand the situation you get some of the results they got. A good Public Health leader who understood AIDS/HIV better might have helped the project to better success. Focus groups working with all the "consumers" might have been more beneficial because they would have understood the problem and listened to potential solutions from those most effected.
UK researcher Jul 24, 2009
Ms. Flock, this article lacks nuances and sources. The way public health (or other development) projects are funded and implemented is certainly a worthwhile discussion--but your sweeping, unattributed claims de-legitimatize your argument. I've worked with a number of HIV/AIDS efforts in India--and if you think Avahan is bad, you should see the rest, including NACO. Public health is not easy, changing sexual behaviours is not easy, evolving stigma is not easy. Don't oversimplify this discussion.
Samantha Jul 19, 2009
It is funny that people think it is strange that Bill Gates' projects can fail. Powerfully funded projects have been happening for 50 years. New film addresses why these egotistical western aid agencies don't get into the details: www.whatarewedoinghere.net
George Swamy Jun 24, 2009
Allow me to introduce myself I am George Swamy Project Director of John Paul Slum Development Project (JPSDP) working in the slums of Pune since 1993, for the upliftment of the community in the fields of Community development in general and health in particular,

Herewith I wish to state my experience working under the Avhan project in Pune:

JPSDP is working with the Non Brothel Based FSW with the Technical and Financial Support from AVAHAN thru Mukta Project in this Mukta Project all the I.E.C materials are produced in the Marathi, the Peer educators are using Pictorial method of Reporting system. Under this project we have empowered ‘n’ number of Peer educators, Some of my Peer educator have become Resource persons and are engaged in training other peers.
Under this project ‘n’ number of FSWs have been treated for STI, under this project FSWs are empowered in such a way that they are negotiating with the clients for safe sex.

I personally feel that Avahan project is doing a good job in India
vilas chaphekar Jun 22, 2009
Vanchit Vikas had a clinic , however it focused on basic health facilities
Dr. Laxmi Mali Jun 22, 2009
We had a clinic for Fsw€™s , however it focused on basic health facilities
Binu Thomas Jun 21, 2009
It seems that Avahan has got all its friends and partners to come out in support of it. Your article is absolutely right. I had written to Ashok Alexander (he's the son of former governor and Indira Gandhi right hand PC Alexander) couple of years ago about how the money being poured in by the Gates Foundation will corrupt NGOs. Alexander's reply was mainly waffle. Gates is doing tremendous harm by pouring more money into programmes than they can reasonably absorb and in the process damaging, rather than helping, efforts to fight poverty and disease.
Dr.Laxmi Mali Jun 20, 2009
We had a clinic for Fsw’s , however it focused on basic health facilities
Dr.Nilesh Ahirrao Jun 20, 2009
Myself Dr.Nilesh Ahirrao [Project Director] MUKTA Project Nandurbar -

1] We are the Avahan partners since 2005.
2] As we are the best observers and
closely monitoring the Avahan project.
3] The project has achieved a remarkable
change in the Community
4] The IEC material published is in local
language and is user friendly too !
5] The project is closely monitored and
evaluated with standard formats
provided to us.
6] The social/psychological change in the
targetted population can be measured.
7] The Avahan is a Public-Private
Partnership Model (And it is working)
8] The article is written with a superficial
information collected from very few
informants.
Thanks !
Dr. Khurshid Bhalla Jun 18, 2009
I have worked with the Avahan project in Maharashtra since five years. First of all, let's admit upfront that like any other project, Avahan too has its limitations and challenges. However, I would like to clarify or correct some of the statements in this article, with complete honesty:

We also have posters in regional languages in the clinic. However, English is still the most commonly used language for medical literature in India, and some posters are used for their illustrations, and explained in the clinic by the Paramedics.

Avahan is not “ready to pack up and go.” We have just begun Phase II of the project, which will be extended and funded till 2012.

Right from the beginning, Peer Educators in Avahan have been paid the same honoraria as the Government funded projects, so as to prevent any discrimination when the Avahan funding withdraws. NACO will continue to pay them the same honorarium.

Besides Peer Educators, the project also encourages unpaid volunteers called “saathis”, who work to spread awareness and knowledge among their own community. Many of them are encouraged to become members of various committees, and start managing their own affairs.

CBO are being formed at district levels. By the end of Phase II, the community itself should be able to handle their own funding and provision of necessary services, with technical support from the local NGOs.

In Phase II, NGO budgets have already been pruned this year so as to match the standards of the NACO program, to prevent funding problems when NACO takes over.

Pictorial data collection tools have been developed and widely used by peers and other community volunteers in the program. Some of these tools have been presented and acclaimed at international conferences. Peer Educators, who are illiterate, use these charts with ease to track their beneficiaries. However, reporting systems and evaluations are done in English, and the NGO staff is trained repeatedly to achieve proficiency in reporting and documentation.

Saheli, quoted in the article, is not an NGO, but a sex worker’s collective, and they did find it difficult to maintain the standards for reporting and accounting. However, they employ other staff as Project Coordinator, Accountant, Field Officers and Outreach Workers, who are expected to fill in the monthly reports.

The mobile clinic is not meant for sex workers who are in brothels. The same is used in Pune to reach groups of sex workers who are mostly street and slum-based and MSM who cruise all over the city. It was viewed initially with suspicion or trepidation, but within a few months, has been widely accepted by the community. At present, the mobile clinic does 3 shifts a day from 10 am to 11 pm, and many sex workers and MSM prefer to report to this clinic for their health check-up.

It is creditable that 31,000 community members have been contacted by the Avahan program in 2005, just after a few months of its start-up! At least that number of High Risk individuals have been provided with condoms, and made aware of the risks associated with unsafe sexual encounters as early as that.

It is also creditable that 11,000 community members have visited clinics. We have clinical services ranging from project-owned clinics to local doctors to Government hospitals and dispensaries. The focus is to provide access to medical services which are most convenient for the widely scattered and remotely located communities. All these services are provided free to the sex workers and MSM, but we do intend to start charging nominal fees with a view to slowly inculcate the habit of paying for services. This would also help when the program is eventually transitioned to the government, where the community would be expected to pay a nominal amount for their health service needs. Similarly, the private providers, who are part of the program, will charge a fee for their services.

Financial systems of each NGO are transparent, and a close watch is kept on every Rupee spent by the program.

The program now advocates the use of the free Government condoms, which are explained to be of equally good quality. Access to free condoms is being ensured at all times.



Bill Gates and his family visited this very same clinic, and met the sex workers himself. He heard first hand the difference that his Foundation has made in their lives. His efforts are blessed by all of us associated with this project.



In five years, I too have seen the empowerment of these women. At the start of the project, I did not imagine that I would see any change in the short span of five years. But we can see it in the fact that they can now walk with their heads up; they can look you in the eye; they trust society, which had so far shunned them. The HIV Positive people among them are opening up, willing to admit their status, willing to report to Government clinics for free ART. You can sense the change that has been wrought, only if you had seen them four years ago. One visit by a journalist cannot capture the depth, the agony, the challenges or the success of this humanitarian program.
Anandkumar patil Jun 18, 2009
In India Maharashtra state Avahan prog.has played major role prevention of HIV/AIDS issue.
In this prog.focus on prevention of STI,HIV/AIDS.also focus on strengthning of community.
By this prog. FSW
Dr. Bhavana Joshi Jun 18, 2009
I think that this article has been written one sidedly. Any impact of an intervention should be measured accurately depending upon qualitative as well as quantitative outcome. The Avahan Programme is in itself an intervention not only to provide health services to the targeted population but also to empower the community to oversee their own problems and find solutions for them. The project has achieved remarkable success in this aspect. I feel, the article has been written on the basis of some observations and interviews. The writer should have gone in depths of the project, then and then only, the real facts could have been surfaced. The Avahan project has brought about tremendous change in health seeking behaviour of the targeted population as well as the awareness about preventive measures. I have seen these changes in their behaviour in a so called "backward' area of Marathwada in Maharashtra. The project has also been successful in bringing about private-public partnership in provision of health services in form of positive involvement of private practitioners and government officials. The advocacy has brought about changes in attitude of the stake holders about the sex workers and they are more sensitized towards their problems and welfare, as now they consider them as part of their own society. These changes in target population and in society do not occur as a magic but need constant efforts which is being done by Avahan project.
Reilly Nelson Jun 18, 2009
The reason that this article was written in a negative manner is because there are many negative aspects of the Gates Foundation that needed light shed on the them. Thank god somebody has the guts to stand up to this corporation and report the truth. This was a wonderfully written article, and I am glad that somebody got past the hype and to the heart of the matter. Well done Forbes!
Prasad Pawar Jun 17, 2009
The Avahan Programme has certainly played a major role in the HIV/AIDS scenario in India. Targeting the most vulnerable was the best approach. The spread of the dreaded disease is many fold, through the At High Risk Population. Visible changes are seen in the behaviour of the vulnerable population. These changes (Correct and Consistent use of condoms with all clients including the regular partner, Medical Examination on a regular basis, and establishment of PLWHA support group to assess various Govt. services like ART Treatment,Reduction in harassments of the target population by various elements in the society, Empowerment of the targeted population in terms of looking beyond intervention activities.)

The impact of any programme should be also measured in terms of the qualitative changes that have been brought about. Any lasting social change takes years to show results on the ground. I am sure Avahan Programme would also show such results in years to come.
Prasad Pawar Jun 17, 2009
The Avahan Programme has certainly played a major role in the HIV/AIDS scenario in India. Targeting the most vulnerable was the best approach. The spread of the dreaded disease is many fold, through the At High Risk Population. Visible changes are seen in the behaviour of the vulnerable population. These changes (Correct and Consistent use of condoms with all clients including the regular partner, Medical Examination on a regular basis, and establishment of PLWHA support group to assess various Govt. services like ART Treatment,Reduction in harassments of the target population by various elements in the society, Empowerment of the targeted population in terms of looking beyond intervention activities.)

The impact of any programme should be also measured in terms of the qualitative changes that have been brought about. Any lasting social change takes years to show results on the ground. I am sure Avahan Programme would also show such results in years to come.
sandeep Palande Jun 17, 2009
This article is written in negative manner and this not giving the Positive Picture .

We are implementing this Project with FSWs and there is continuous monitoring and evaluation process .Their are set indicators in the Project which are based on not only condom distribution but beyond that .eg. reaching to the different type of sex workers ,making them aware of HIV/AIDS issues, providing STI treatments and creating spaces for community members .
This project is really helpful for overall empowerment of the FSWs to handle their issues and to bust their self esteem .
This project has helped FSWs to access HIV/AIDS testing and treatments ( ART ).
Looking at progress of five years we strongly felt that we have positive impact on prevention of HIV/AIDS .


Thank you ,

Sandeep Palande
Naushad Hasan Jun 17, 2009
I have been associated with Avahan Program since October 2006 and found it very specific and goal oriented project.

Earlier the community (Target Group) was not at all concerned about their health but because of rigorous work of organization their attitude is changing towards health. One can see their health seeking attitude. In the beginning the target group was reluctant to do health check up but now they are voluntarily undergoing medical examination. The number of new STI infections is going down in Maharashtra among high risk behaviors.

This program has taught them that condom is life saving device and now they are insisting on consistent use of condom with their clients and regular partner. It has enhanced their condom negotiation skills because of various strategies used by program. And importantly, this program has generated massive awareness on HIV/AIDS among various stakeholders and this has resulted their involvement in this prevention efforts.

There are some professional needs to be oriented on public health to understand programs and write quality reports.
Sanjay Bachcha Jun 17, 2009
I am Sanjay Bachcha, Project Coordinator, GVM- Mukta Project feel that the support provided by Bill Milenda and Gates Foundation really helped in reaching out the 1650 FSWs and 430 MSM from Beed district. Although it is very difficult to reach out to privately operating FSWs but we could make it possible with rigorous efforts under Avahan initiative. With the help of this initiative we could educate and motivate FSWs for their regular health check up, STI treatment and regular condom use with their clients and regular partner. I can see there is change in the treatment seeking behavior and safe sex practices of the community members.
Suhel Jamadar Jun 17, 2009
We feel that the article can be one side of the coin. As we implement the Pathfinder Mukta Project.

In Maharashtra Pathfinder Mukta Project was started to work with sex workers and MSM. It works to arrest HIV//AIDS, Condom promotion. It provides quality treatment and medicine for STI’s and empowerment of the communities.



While implementing the program we have experienced that we may not be able to see impact at large level. But we can say depending on our experiences that the changes are happening within the sex workers and msm communities. These changes are very small but making a large difference in the life of sex workers and MSM.



It may be like accessing regular STI services, fight for the rights to be treated as human beings or to access Govt. or Non governmental services with dignity. Empowerment resulted into reduction of sex workers harassment by police, goonda, Regular Partner etc. all these helps to reduce the vulnerability of sex workers towards HIV/AIDS and these changes will be there forever. Its not that the funding is over and the things will get stop.



In the Pathfinder Mukta program Peer educators use data collection tools like Hot spot mobilization Chart, Peer educators Palm book and all these tools are in the local languages and with pictorial formats, all the peer educators use it at their ease. In regards to IEC material PE’s are using STI flipbook which is named in Hindi as “ Sharir Salamat to…” , another Marathi flip book which talks about basic health education” Posters which imparts messages about health, empowerment, HIV/AIDS are in Marathi.



These are the things which we felt to be discussed after reading the article.
Sanjay Damodharrao Bachcha, Project Coordinator, Gramin Vikas Mandal - Mukta Project, Beed. Jun 17, 2009
I am Sanjay Bachcha, Project Coordinator, GVM- Mukta Project feel that the support provided by Bill Milenda and Gates Foundation really helped in reaching out the 1650 FSWs and 430 MSM from Beed district. Although it is very difficult to reach out to privately operating FSWs but we could make it possible with rigorous efforts under Avahan initiative. With the help of this initiative we could educate and motivate FSWs for their regular health check up, STI treatment and regular condom use with their clients and regular partner. I can see there is change in the treatment seeking behavior and safe sex practices of the community members.
Narayanan Jun 17, 2009
I am public health professional in india. I know the strategies and technology being used by Avahan in HIV prevention among High risk behaviors so advanced and quality of tracking individual audience is fantastic. In country like India is culturally sensitive people are not open up to talk about these issue. But avahan created a platform to community those who are behind the screen to come forward to talk about their issues and empowered them to address the same.

The way of avahan initiative is empowering community as well as local Non governmental organization those who are working in remote towns to provide quality of services is fantastic and unique model.

In avahan working states there are studies shows that STI prevalence has come town among high risk behaviors, Avahan has trained large number of health care providers in remote areas and strategic location where key populations are there. An Avahan initiative has providing unique and evidence based model in HIV prevention in culturally Sensitive County.

This article shows that there some sector needs orientation on public health
Dr. Rajendra Patil (Godavari Mukta Project, Jalgaon.) Jun 17, 2009
I am working with sex worker community from past five years though this Avahan efforts, so the community are able to receive the services from governments and other existing sources, there are community member these who are really backward area, so there is no source the getting information and services even through they have create a enabling environment with support of external community to access condom and other health services in district level, all the community member gather and formed sex worker collective to ensure the rights and advocate for the larger issues.
Pravara edical Trust Jun 17, 2009
Pravara Medical working in Nashik for last 4 years with sex workers in Nashik. This was first of this knd of intervention working very closely with brothel based sex workers.With mobilisation work the NGO gained faith of the sex workers
Bharat Kurhade, Gramin Samassya Mukti Trust, Yavatmal Jun 17, 2009
In the Yavatmal district we are working with FSW and MSM population for redusing STI infection and control HIV previalance. Our community had formed there CBO, with the help community members. Community had given regular treatment at our project clinic, PP's Clinic, Rural Hospital, PHC's also, they are using proper condom with regular partner and client also. Community members also link there committee with local and district level goverment and given active participation in the program as like preparing ration card, voter ID card, residential proof, birth certificate etc. and solving their community issues with the help of local leaders, govt. officers, police etc. Community impowred to solved their own problems and community has impowred to approch to local authirity to ensure their rights .
Bindumadhav Khire Jun 17, 2009
I am the Project Director of MSM Intervention Project run in Pune and PCMC funded by Pathfinder International.
Our MSM community has hugely benefited by the intervention. More and more MSMs are now aware of safe sex issues. More MSMs are being registered. More condoms are being distributed to the MSM population (even in far flung areas). They are also more open now than they were a couple of years ago to undergo external genital examination and get tested for STDs like Syphilis. So far no SACS has had the resources till now to fund MSM projects on the required scale. Pathfinder has done a commendable job in working with MSMs. We hope we will have continued support from them. We also hope that Pathfinder and NACO will find ways and means in which these programs will eventually be taken over by NACO so that the valuable work currently done can continue in the future.
outsourcerer Jun 16, 2009
You say:

Why would a clinic serving illiterate visitors use more English than Indian languages?

Since when did "literacy" start meaning "a greater probability of not knowing English than not knowing Indian languages"?

It seems that the terms "literacy" and "not knowing English" are being used interchangeably.

That sentence could have been better phrased as

Why would a clinic serving non-English speaking use more English than Indian languages?
Shiv Chandra Mathur Jun 13, 2009
This is another blatant example which shows that organizations without any public health capacity influence their full clout on the governance system
while the potential available within the country is never given its due place.
We wish that all State Government in this country recognize Public Health as a specality and do not permit the unqualified people to prevail over the projects.
Romesh Bhattacharji Jun 9, 2009
Using English by the NGOs working for the Bill?
C.Rajan Babu,IRS., Feb 19, 2010
Pl see our web page www.gtpf.net
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