$258 Million for Condoms?
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| Image: © Vijay Mathur / Reuters | |
| Ashok Alexander, director of the the Bill & Melinda Gates Foundation's Indian HIV-prevention project | |
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Q. Please tell me about how you started. Why did you decide to leave McKinsey and join Avahan?
A. They made me an offer I couldn’t refuse. I was 17 years at McKinsey but I liked the ambitious arch of this HIV/AIDS program. McKinsey and the Gates Foundation know each other quite well. I joined at the end of 2002, and I officially started April 1, 2003.
Q. How did you build your team?
A. Most of the people came and found me and AVAHAN. People were all in good jobs, but they got excited about this ‘venture’, and it was exciting enough for them to go. Alkesh Wadwani was a senior manager at McKinsey, and set his career aside to start with this venture. It was a chance at doing something new. There were two other McKinsey people. I have a team of 15. Ten are from the private sector, five are from technical backgrounds. For example, one has an MD in infectious diseases. From the private sector they are from consumer products, IT, and banking.
Q. When you started Avahan in 2003, where did you start first?
A. We wanted to do HIV/AIDS prevention, and be highly focused on the high-risk groups. This includes sex workers, truckers, and injecting drug users. These are the highest risk groups. In a large country, people often prevention with school children, etc, but we are more focused on those who are most vulnerable. This was our focus from the beginning. We looked at the situation and the context. The first program was in 2003. Our first programs were launched simultaneously in many places. Mysore was one of the first, it was featured in the Wall Street Journal. There were no condoms there, and a lot of sex work was going on. We started with such scale and speed, there was no first.
Q. Avahan works in partnership with many NGOs across India. How do you find them?
A. We give different grants, identify organizations and ask for proposals. Sometimes, we pick the organization. In, Karnataka there was one large NGO so we didn’t create another—the University of Manitoba is there. We started everywhere at once in six states to test the prevalence of HIV. The coverage was inadequate. The notion of coverage…the number of sex workers without reliable quality services. We said the fire is burning here so we went here.
Q. Can you explain your structure?
A. All our work is done through NGOs. It’s like a big pyramid. We fund 20 large NGOs and 140 grassroot organizations through them. They set up the clinics. The programs are run by the NGOs. They deal with the local doctors, and refer sex workers to them. 280 some clinics. 650 sites. A site means we are working in a district for intervention. There are four-six towns within a district. A site may not have a clinic, but there is a referral arrangement there. It’s really all about making sure people wear condoms.
Q. What is the total amount granted the Gates Foundation towards Avahan?
A. $258 million have been given total in the first five years.
Q. How can you spend $258 million on just condoms?
A. When I took the job I thought I would just be encouraging people to wear condoms. But it’s a little more complicated than that (laughs). It’s not a lack of awareness. If you meet a sex worker, she will educate you about how to use a condom. Yet it is often not used. Often the client doesn’t want to, or he is drunk, or whatever, so the crux is not just telling how to use a condom. Also, we are working on the issue of violence, beating up a sex worker. $258 million…well, a lot is on condoms and telling people about it. I can’t recall exactly how much. 10-20%, maybe, on monitoring, evaluation, but we use sex workers to do this as well so doesn’t cost as much.
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