The director of the Gates Foundation's largest public health project speaks with Condé Nast Traveler

The Bio
Claim to Fame: Director of Avahan India AIDS Initiative, the Gates Foundation's largest public health project. Produced: AIDS Sutra (Random House), by India's best writers. Approach: Help stop violence against sex workers, and then convince them to use condoms and be healthy. Takeaway: Meet new cultures with a totally open mind.

CNT: Has running the AIDS program in India changed you?

Alexander: I have seen an India I hardly knew existed—desperate poverty that you don't encounter in the more developed parts of India, or perhaps only view from the window of your car. We witness incredible heroism. The sex workers who are working with us encounter violence every day, and yet they continue fighting to survive that life and also serve their community. How many of us find time to volunteer like that despite the comforts of our lives? I call that leadership and heroism of the highest nature.

CNT: What success have you had?

Alexander: We have proved that prevention can be scaled up.

CNT: What were you up against?

Alexander: In India, we are dealing largely with sex workers and drug users who are highly mobile, marginalized, and face tremendous stigma. For most sex workers, HIV wasn't even among their top priorities. The priorities would be violence, violence, and violence.

CNT: So how did you tackle that?

Alexander: It seemed insurmountable. But we introduced a crisis response system. There's been a cell phone revolution in India—your average sex worker has a phone. If there's a problem, she now can put in a call to a crisis team, who arrive in less than 30 minutes. We get them a lawyer in the case of rape, and raise a hue and cry. There's been a clear decline in violence. In 2005, 43 percent of women in the program had experienced violence the month before. A year later, it was just 17 percent.

CNT: How has your business background helped you?

Alexander: This was a marketing challenge. Our "consumers" were hidden, and the question was how to aggregate them. The women wanted to get into a violence-reduction program, not a condom program. Most HIV programs are supply-side driven: You count treatments and how many condoms are distributed. In this case, the consumer wasn't interested in the product. We had to persuade the consumer it was in her interest to be strong and healthy.

CNT: Are business models helpful in aid work?

Alexander: It's a marriage that should have happened many years ago. Scaling up is second nature to business.

CNT: Do you have a favorite success story?

Alexander: In Mysore, we have an international learning site; the professors are all sex workers. When I first met Pratibha, she had lost her family, was HIV-positive and an advanced alcoholic. Now she is a senior faculty member.

CNT: Why did you publish AIDS Sutra, by Indian writers, including Salman Rushdie?

Alexander: We wanted to destigmatize the epidemic, to show that a sex worker might be an outstanding mother, for example. We wanted to show the heroism.

CNT: How do you view India's rise?

Alexander: I am of two minds. As an Indian, I am tremendously proud of the incredible economic growth. So many malls! The middle class are living a life that their parents could never have imagined. But for the people at the bottom of the pyramid, nothing is improving. I asked a sex worker how her life had changed. She said there are better cars passing on the road. Economists say that in 15 to 20 years, the workers' lives will improve. They shouldn't have to wait that long.