World AIDS Day 2018: A new book speaks of HIV positive sex workers, their fight for agency

In 2003, when the HIV epidemic was at its worst in India, an estimated 2.6 million people were infected. Today, 2.1 million people are HIV+ in the country, with a prevalence of 0.22 percent. The first overseas subset of the Bill and Melinda Gates Foundation, Avahan, was a key player in HIV prevention in India, credited by the Lancet with preventing an estimated 6,06,000 HIV infections from 2003-2013. Avahan’s founder and director, Ashok Alexander spoke to Firstpost about his ten years with the foundation, and his book A Stranger Truth. The book is published by Juggernaut and chronicles Alexander’s journey from the corporate to the social sector, and the communities—mostly led by female sex workers—that he learned to appreciate and organise with along the way. Although Alexander refuses to call his book an ethnography, the stories in it are drawn from the diaries he kept during his time at Avahan, suggesting a method more meticulous than simple reminiscence. He also wants his role in the book to be of a guide, leading the readers through a journey of community activism that focuses on the work of female sex workers. “What struck me was how powerful these women were when together in groups as small as 12. It still makes me wonder and gets me excited that very marginalised, very poor, very disempowered women can actually come together and solve tough problems,” says Alexander. The book is divided into two parts. The first, titled ‘Far Far Away’, touches upon Alexander’s first few years establishing Avahan. The second, titled ‘Learning to Fly’, tells the story of Avahan finding its feet by facilitating the uptake of condom usage and community activism with the sex workers in the field. Alexander admits in the book that the initial years of Avahan were a complete culture shock for him, as he was quite out of depth.

“When I left McKinsey, it was not just a step out, it was two steps out, because I went from a kind of poverty we glimpse to an India I didn’t know existed,” says Alexander.

The Bill and Melinda Gates Foundation didn’t impose their organisational framework on their Indian office, which allowed Avahan’s team to interact extensively with sex workers and the MSM (men who have sex with men) population in the field. Nonetheless, the first couple of years were a struggle for Alexander and his colleagues. In part, this was because his team was primarily made up of McKinsey employees, who approached HIV from a corporate perspective, looking at immediate eradication rather than facilitating behavioural change. “We had no tolerance to say, well why don’t we talk about your culture and decide?” he says. [caption id=“attachment_5650261” align=“alignnone” width=“825”]  Ashok Alexander and the cover of his book, A Stranger Truth[/caption] Over time, Alexander, along with his colleagues, realised that they had to approach the issue with humility and respect for the grassroots. He spent a minimum of four days in the field every week, to understand and build relationships with sex workers. The rest of his team basically lived on the field for the first three to four years of Avahan. While they all learned how to speak to communities in that time, Alexander admits he never developed patience—he couldn’t afford it when HIV was at its peak—and at times bluffed threats of withdrawing funding to ensure results. “But it all sorted itself out, and I learned something, and I daresay they learned something,” he adds. Alexander wrote a version of the book in 2007, but never finished it because the story felt incomplete to him. He didn’t have the perspective then, in the middle of his travels and work, that he says he has now. Time and perspective have resulted in a book that is grounded in empathy, which Alexander hopes will shake the apathy out of our cushy lives. “I want the reader to feel a range of emotions. I don’t want to speak for other people, so let me speak for myself, sitting in South Delhi, walking through malls, sitting in a car. It’s an emotionless experience. [In the field] I was discovering feelings which, if I’m honest, I really didn’t have before,” he says. Empathy doesn’t develop without immense pain, Alexander warns. His book reflects this belief, particularly in the first half, with Alexander completely inundated by the volume of suffering that he encounters at first, and unable to cope with a lack of guarantee about the work being done. At one point in the book, Alexander meets a young man called Antheim, who doesn’t have the means to continue his treatment, and who Alexander cannot help personally without violating the ethics of public health. Heartbreakingly, he says in the book, “I tell myself Antheim is still alive, and he is healthy. But I have no way of knowing if that’s true.” Antheim’s story illustrates the helpless guilt of a public health worker struggling with the sheer depth of a problem as vast and stigmatised as HIV. In that moment, the reader is compelled, for a second, to understand the vast difficulty and pain involved in not only coping with, but working to eradicate HIV. There are several incidents like Antheim’s scattered across the first half of the book, dangerously tipping it towards a voyeuristic experience of poverty and suffering. However, the second half saves face, literally, by focusing entirely on the activism done by sex workers and those on the field to reclaim their agency, and bring about behavioural change in their communities. The journeys of two sex workers-turned-activists is highlighted in separate chapters, dictated by the workers themselves. “They’re really just more different from each other than people like us are different perhaps,” says Alexander. Both workers mentioned in the book are employed by Ashodhya, a program started by Avahan in Mysore in 2003. The first sex worker and activist is a woman called Kavita, who went from struggling with alcoholism, abuse and being HIV+, to becoming an internationally known activist and public health worker. The second sex worker is Shahid, who is queer and for whom Ashodhya has provided the space to be ‘out’ and to provide for his family, as well as live healthily with HIV. Both Kavita and Shahid continue to practise sex work to this day. Their stories negotiate with power and knowledge, sex and sexuality in a way that facilitates a more nuanced understanding of the field that Alexander wants us to see.

Including their voices in the book shows the extent to which sex workers can exercise agency, in a field where they can be so easily exploited.

Writing the book was a cathartic release for Alexander, as it gave him an opportunity to reflect on the work done. He proudly claims in the epilogue that Avahan and related communities’ efforts made HIV one of the two health conditions to meet the Development Millenium Goals of the UN in 2015. More importantly, he was relieved to see the sustainability of the process, with HIV prevalence lower in India at 0.22 percent than in the USA. He explains that organsiations working in the development sector usually don’t focus on solutions that can be effective once the organisation has been dissolved or leaves. With Avahan, that isn’t the case, because sex workers were able to disseminate the information on STIs and organising even after the organisation was dissolved. When asked about how he expects his book to be received, Alexander suddenly becomes bashful and unsure. He has never written a book before, but for him, doing things outside of his comfort zone is really important. He hopes that people will see the book not only as a story of activism to fight HIV, but a narrative of the adventure that lies ahead when one decides to go beyond their immediate surroundings. “I feel like there’s an adventure to be had inside every person, which means you’re getting out of your comfort zone. I think one should have an attitude towards life such that the minute you get into your comfort zone, you should be planning to get out of it. Otherwise, you’re ready to fail,” he signs off.