Avahan acted as facilitator for vulnerable groups, says Ashok Alexander who stepped down as country director of the Bill & Melinda Gates Foundation and was the key driver of the HIV/AIDS initiative

Ashok Alexander, country director of the Bill & Melinda Gates Foundation who stepped down on Monday from his position after almost a decade of service has said he was happy having acted as a facilitator in creating a model of scaling up HIV prevention measures that made a lot of difference in the lives of those who were not protected against this dreaded disease.

Mr Alexander set up the office in 2003 and quickly brought his management experience to bear in driving the huge success of the foundation's HIV/AIDS initiative Avahan that worked with the high risk groups particularly those with different sexual needs like transgender, men having sex with men.

Avahan team worked at the grassroots level with female sex workers, injecting drug users, truckers and other such vulnerable groups who could carry or spread the disease, and created awareness among them on the need to protect themselves from infection. It was serious advocacy that actually brought some vulnerable sections on the table with the government to discuss their issue, Mr Alexander said. The only unfinished task, he feels, is the establishment of community based organisations to take the movement forward. “It is now for these vulnerable groups to take up the cause,” he added.

Talking to The Hindu he said there has been a definite change in the attitude towards the HIV affected people and vulnerable groups as far as stigma and discrimination are concerned. “What was once unmentionable can be discussed today,” Mr Alexander said adding that there was a virtual disconnect between those affected or the vulnerable groups like female sex workers, men having sex with men, transgender and those living protected and sheltered lives.

Attributing this change to the advent of anti-retroviral drug therapy (ART), Mr Alexander said it had happened with leprosy, tuberculosis and other such highly infectious diseases as well.

Mr Alexander set out to demonstrate that public health solutions can be tackled through rigorous business-led principles and the programme's success at reducing the Indian AIDS epidemic and building an HIV prevention model at scale owes much to his entrepreneurial approach. He has overseen Avahan's transition to full and sustainable government control and his work stands as a model for scaled up public health delivery.

“Ashok has been a driving force behind the success of the foundation's Avahan initiative,” said Bill Gates, co-chair of the Bill & Melinda Gates Foundation. “Avahan has demonstrated that it is possible to build an HIV prevention model at scale in India. The data the initiative continues to create will help HIV/AIDS prevention efforts not only in India, but around the world,” Jeff Raikes, chief executive officer of the Foundation said.

Recounting his initial days in the programme, Mr Alexander praised the female sex workers and described them as women of tremendous courage despite the adversities they go through in their lives and the pathetic conditions they live in. “They live as a community in a highly democratic manner though they are competitors,” he said.

After a short break, Mr Alexander now wants to go beyond HIV/AIDS and is seriously considering working on under-five children and maternal health which, he thinks, is in a bad shape in India. “I need not tell any woman in India to breast feed her child or wash hands. They know it, but it is just scaling it up.”