Profile of Ashok ander. The High-flier who leads AIDS crusade in India for Bill Gates

[Guest guest]

High-flier leads AIDS crusade in India for Bill Gates

Wed Feb 2,12:41 AM ET South Asia - AFP

South Asia - AFP

DHARMAPURI, India (AFP) - Smiling and hands pressed

together in greeting, Ashok sits

cross-legged under the tent-covered roof of a house

before dozens of women to talk about sex.

That's a big change for the former highly-paid

McKinsey & Co. director used to restructuring steel

companies.

He quit that job in 2003 to run a five-year 200

million dollar fund called Avahan (duty call), the

India AIDS (news - web sites) initiative of the

Seattle-based Bill and Melinda Gates Foundation (news

- web sites).

The meeting is one of seven in two days with sex

workers across southern Indian areas with the highest

rates of HIV (news - web sites) infection, the virus

that leads to Acquired Immune Deficiency Syndrome

(AIDS).

, 50, isn't squeamish, hugging eunuchs and

listening to stories of poverty, rape, beatings and

extortion.

It's all part of a crusade to increase condom use and

cut sexually transmitted and HIV infections in six

high-risk Indian states.

At least five million people, or one in every eight

people known to be infected with HIV worldwide, live

in India, the largest number outside South Africa.

India with more than one billion people can add

hundreds of thousands of adult cases yearly with an

infection level of 0.9 percent, according to official

figures. Places like Karnataka state's Belgaum

district, with a population bigger than Ireland, has

an infection rate of 4.5 percent.

starts with a briefing by the head of a

program the foundation gave a 17 million dollar grant

to in December 2003.

" We are mobilizing women to care about their health

and have a local strategy of where to target, like bus

stands -- the high risk areas, " says Canadian Dr.

Blanchard, Karnataka Health Promotion Trust

director.

Information from touts and sex workers feeds maps of

sites where work can be concentrated. Bangalore,

India's high-tech capital, doesn't have a red light

district which makes it difficult to reach sex workers

and customers, Blanchard says.

talks about " a cyclone of death " among poor

people in the worst infected areas in India. He's not

alone in that assessment.

The CIA (news - web sites)'s National Intelligence

Council estimated in 2002 that India could have 20 to

25 million AIDS cases by 2010, more than any other

country.

" There is a very clear notion of where the foundation

wants to go in India, " says. " AIDS was

chosen because it is on a trajectory to kill the most

number of people in developing countries. We need to

do this on a war footing. "

-- An elite son of India --

Ashok is the son of P.C. , chief of staff to

late prime minister Indira Gandhi, a former governor

of Maharashtra state and a member of the upper house

of parliament.

He's a master chess player, a graduate of Delhi

University's prestigious St. 's College and the

Indian Institute of Management with stints in Hong

Kong and New York in management consulting before

opening McKinsey's India office in 1992.

In Bangalore, he has dinner with cricket star Rahul

Dravid who does public service ads for Avahan

promoting condom use.

" People like us have taken a lot out of the system and

it's time to give something back, " says.

" Rahul was happy to do that. "

His elite contacts were important for clients paying

McKinsey large fees, but they didn't prepare him for

understanding how HIV is cutting a swathe through

India's poorest.

" I always knew it was a problem, but didn't understand

how big it was, " says. " The easiest part, I

thought, would be to get corporate India to help. "

Indian Oil did help with its nationwide network of

petrol stations and working with Avahan to get

truckers tested for sexually transmitted infections.

Still, he says companies in India are ignoring the

epidemic.

" The fact is ... we're not a philanthropic society. "

As well, many believe HIV/AIDS isn't a problem because

the country is sexually conservative, adds.

The previous Hindu nationalist government played down

the AIDS problem in 2002 and 2003. Ads promoting

condom use were changed to emphasize abstinence and

faithfulness and the Gates Foundation accused of

spreading panic.

" It's a complete myth the society is sexually

conservative. People are having good fun -- and

driving the epidemic, " says.

India has 146 million dollars available annually to

fight HIV and AIDS, or about 29 cents per person,

compared to one dollar eighty-five cents in Uganda.

Avahan estimates India needs to spend at least one

billion dollars a year.

Even the current funding isn't wholly spent each year

and India caps money from foreign donors by insisting

money come through its hands, though an exception was

made for the Gates Foundation.

For instance, the US Agency for International

Development gives 13.5 million dollars to India for

HIV/AIDS programs, compared to 27.9 million dollars

for Kenya.

" A major part of my job is to ask what do we have to

do to make our case better " for India to spend more

money, admits.

- Eunuchs wear white jamsine flowers in their hair --

Sex workers place a splotch of vermilion on

's forehead in Bangalore and a suburb called

Dodda Ballpur in Karnataka as well as Dharmapuri and

Krishnagiri in Tamil Nadu state.

Five feet nine inches tall, trim with a moustache,

wears Docker pants, a button-down shirt and

hard sole black shoes and sports a Rolex watch. The

women and eunuchs he meets dress in red, green and

blue nylon saris with bangles on their wrists and

ankles and white jasmine flowers in their hair.

In Dooda Ballpur, sex workers who ply their trade at

the inter-state bus stop show how to slip condoms on

unsuspecting clients -- one blindfolded places a

condom on an eight-inch long black phallus, another

pops a condom in her mouth and slips it on orally.

claps vigorously.

" Talking to sex workers initially was pretty

difficult, they treat outsiders cautiously and I

didn't know which questions I could ask -- a bit

nervous to ask how much they got paid, how many times

they had sex, what kind of sex. But after some time,

this is no problem, " says.

Condom use is important, he insists, because HIV

infection can rise 100 times from people who have open

sore sexually transmitted infections.

This message came across to eunuchs who adopted him as

a brother in a ceremony that included a bath, 200

rupees (in cloth) and touching their guru's feet.

" I was highly honored. It was a great privilege they

trusted me, " says.

The acceptance of the program helps steer people to

sex disease clinics. The plan is to have 3,000 of the

so-called Key Clinics in the worst affected areas.

" The clinics are non-judgmental -- we do a sight exam

and use a color code to hand out medical packs for

those infected -- such as white discharge means red

pack. "

Taking the stigma out of sex work could bring a sea

change in willingness to use condoms and seek medical

help, he says.

" But still it's the million dollar question if that

will stem the rise. "

Plight of sex workers

At the next stop, 's management skills are

tested.

" It's grassroots and you have to adapt all the time, "

says meeting eunuchs who want loans for

emasculation operations -- he tells them it isn't

possible.

Still it was important to understand about men who

have sex with men. Sharp variations in sexual

preferences can show in infection rates among

receivers or givers or double deckers, a term for

people who do both.

Sex workers can earn 300 rupees with several customers

on a good day (seven dollars), compared to 50 rupees

(1.16 dollars) in construction jobs such as carrying

bricks on their heads.

" People from around the world used to come to me to

learn about India and I thought I knew a lot. It's

very humbling to realize that I don't know my own

country. I now realize there are two India's and you

need to understand both, " says.

" I had no idea of the plight of the sex workers... I

have enormous respect for them. "

notes India has a goal of cutting poverty to

14 percent from 26 percent by 2010 and curtailing the

spread of AIDS is crucial.

" There's a study that says that if AIDS isn't

curtailed, the goal could be cut by two to five

percentage points as wage earners in families fall

sick and die. "

En route for an evening flight to New Delhi, suddenly

he tells the driver to stop so he can get a soft

drink. " I'm diabetic, " he says.

Revived, he discusses strategy with program manager

Padma Chandrasekaran who suggests handing out free

lubrication for male sex workers.

" So it's eight rupees (18 cents) a pack for KY Jelly,

but we can use cheaper lubrication, " Chandrasekaran

says.

is concerned if cheaper lubrication is safe

and asks how it could be tested. " That's a big issue, "

he laughs.

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forwarded with greetings from: Phi Huynhdo <huynhdophi@...>