Gates Foundation Bets It Can Stem India's AIDS Crisis

By 2008, the Bill and Melinda Gates Foundation aims to stop the spread of AIDS in six hard-hit Indian states and then take the effort nationwide. With the help of strategic allies including trucking and oil companies and sex workers, the foundation hopes to take AIDS prevention messages to truckers along their routes and to prostitutes at working venues and clinics. Secretary of Health J.V.R. Prasada Rao is a board co-chair of the Gates project in India.

The foundation has enlisted Transport Corp. and Indian Oil Corp. to allow a chain of 50 clinics set up at highway truck stops to target drivers, who are among the biggest clients of prostitutes. The clinics will be co-managed by Population Services International, a nongovernmental organization with STD control experience. At the truck stops, "there will be banners, condom supply, demonstrations, health check-ups," said Ashok Alexander, Gates's local project director.

Many prostitutes were initially wary of the Avahan community center in Mysore, Karnataka. Therefore, Gates doctors James Blanchard and Sushena Reza-Paul, from the University of Manitoba, got prostitutes on board as guides, data collectors and recruiters of patients. Sex workers circulated among their peers with invitations to drop in for refreshments and to take part in a lottery, with a sewing machine or food processor as prizes. Clinic staff offer sex workers free condoms, AIDS education and basic health checks. The foundation pays 100 rupees (US$2.23) for a three-hour shift of prevention teaching.

A clinic survey of Mysore's sex trade allowed it to hone and target its prevention message, one that can often lose out to financial needs. Sex without a condom can quintuple a prostitute's fee to about 500 rupees (US$10), said Chandan, a prostitute who moonlights for the foundation. In addition, many workers are married. Condoms can be used by police as evidence of prostitution, and some workers fear the discovery of condoms by families or spouses.

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