Credit: AFP
Bill Gates is moving on. Moving on from the day-to-day control of his empire that produces US$1 billion in profit every month. He is moving on to spend more time to work in the largest philanthropic foundation in the world, one that he funds and runs with his wife Melinda.
The Bill and Melinda Gates Foundation has been running for six years - it now has assets of US$30 billion. And with Warren Buffet's recent contribution, this is set to double. It has made enormous investments in education and health.
Their vaccine initiative supplies existing immunisations to children in the developing world, while researching for an HIV vaccine and other new vaccines. Much of their investment in health has been in giving people access to advances in science and technology.
But perhaps one of the least known but most ambitious programs is their HIV prevention program in India. Called Avahan (sanskrit for "a call to action"), it started two and half years ago with an investment of US$200 million over five years, and a very bold aim to stem the HIV epidemic in India.
The Gates are not strangers to ambition, or to large-scale enterprises. This is the biggest HIV prevention program in the world, but it is highly focused on places and groups where infection rates are the highest. In India this means preventing infections among female and male sex workers and their male clients, and injecting drug users.
It is a program that Bill and Melinda Gates have shepherded, visited and in which they take an active interest. So the richest couple in the world are working with some of the least powerful, the most discriminated and violated groups in the world. This is what I would call "vertical solidarity".
It shatters a number of conventions. First of all it is run by Ashok Alexander, a former business consultant at McKinsey's. So it brings the world of private sector together with the public health sector. And not only is it working to prevent HIV infection among sex workers and injecting drug users but it is doing it in a way that improves their lives. HIV prevention and social justice - a case of needing one to get the other.
And it is operating at an unprecedented scale. Through a series of partnerships and grants with Indian and international groups it is working in 550 sites across six states in India, working with nearly 300,000 sex workers and drug users.
Two weeks ago, as part of the technical panel advising this program, I, and some others, visited a project in Mysore three hours west of Bangalore, India's IT hub. The project works with female and male sex workers who pick up their clients on the street and use local lodges to transact their business. It is tough work - they are at the bottom of the social pile and their lives are charged with abuse and violence.
We sat in a group - one woman with acid burns on her face and neck, one with burns on her right arm another with her front teeth missing. They described how the police beat their legs with a rod while they are tied down. Or how they have been beaten or raped by the innocently named 'rowdies' - thugs who see sex workers as objects without any rights to be human.
But they aren't beaten in spirit - they now have a safe place to meet together, they have friends - their community kitchen means they now can eat with others rather than by themselves - and many of them have a sense that they belong. They can get counselling, treatment and importantly they can get condoms and they can insist their clients use them.
They talk about the fact that they are treated with dignity and respect, and the way that they can now participate in normal community events and festivals - whereas before they had been centripetally forced to the margins of society.
They have embraced this prevention program in a very short time - they have scientifically worked out how many sex workers there are in Mysore, where they work, and they have peer educators (active sex workers themselves) who are responsible for working with 40 to 50 other sex workers.
They aim for them all to have at least one visit to the clinic very three months and to have constant access to condoms. Sexually transmitted infections are going down as condom usage and clinic attendance goes up.
They used to be frightened of the media - now they have the confidence to call press conferences to highlight their issues or to announce new programs. One worker describes the change in the attitude of the police - she used to be beaten now they offer her a chair and tea, and now they have the power to complain about the rowdies - they can fight back.
They have created their own organisation 6 months ago. As one sex worker said "we can think, we can decide, we are 'grown up'". They have enormous challenges to keep going - the huge burdens of ostracism and discrimination. One of the leaders, an HIV positive male sex worker described how difficult it is to get HIV testing and treatment. We could see the backhander of rejection slapped across his face.
For the program to be successful it needs similar programs in 550 sites where there is combination of well designed prevention services and sophisticated organisation of the sex workers, in a way that gives them the greatest possible control over their lives. It is a major logistical exercise and, as importantly, it requires huge attitudinal and cultural shifts.
Even if you have lots of money, it is still a gutsy decision to put US$200 million of your money into an enterprise like this. If it succeeds it is anticipated it will avoid over a million HIV infections, let alone avoiding the costs of treatment. So I can only applaud Bill Gates moving on to greater involvement in his and his wife's foundation. It might do many people a world of good.
Rob Moodie is the CEO of VicHealth, the Victorian government's health promotion initiative. He is also Cosmos magazine's regular "Diagnosis" columnist.
