Wednesday, June 24, 2009

An Expression of Dirt and Dust

by Elizabeth Flock
June 24, 2009 7:05pm

On the streets of central Tehran, 1000 protestors continue to demonstrate, ignoring teargas, batons, and government warnings. Throughout the world, a graphic video of the murder of a girl named Neda, the face of the protests, goes viral. And from the highest legislative power in Iran, the Guardian Council, any annulment of the presidential election is ruled out.

Today, the most widespread street protests in Iran since the country’s 1979 Islamic revolution, sparked by the results of the presidential election between Ahmadinebad and Mousavi, rage on.

It started on the evening of June 12, after Ahmadinebad was announced the resounding winner, with 70 percent of the vote. Thousands of Iranians who had voted for Mousavi smelled fraud and took to the streets.

Kourosh Adib, a 32-year-old living in Tehran who supports Mousavi, writes to me from the city that night: “I just came back home. There is marshal law in Tehran, everyone in the streets, burning flames and riot police and plain cloth militia beating people up. We saw millions of people honking their car horns, waving flags, and shouting ‘Down with the dictator!’ And they have arrested most of the reformist political figures, and Mousavi, the righteous winner of the election, is under house arrest.”

While Ahmadinebad is known to be supported by members of the militia and government, part of the rural population, and the elderly, thousands of Iranian demonstrators are saying a 70 percent majority vote is just not possible. The Guardian Council admitted today that 3 million votes were ineligible, but maintains the overall election was valid.

It’s difficult to get facts straight because much of the communication has been cut off. On the night Adib first emails, cell phone and SMS are down and most Internet sites including Facebook and youtube are not available.

Maryam Aghdami, who is Iranian but now lives in the Netherlands, has cousins in Iran who have sent updates. But she says it is difficult to get information or know the truth because of the severe news censorship. “The society has been polarized, and this is exactly what the government wants. People cannot trust each other anymore to speak about political issues and even ask for help.”

As of today, email and messenger services were working only on and off. Some Iranians were able to get through to the outside world using anti-filter software. Others twittered to gather numbers for continuing demonstrations. (For example,

Today marks 11 days since the election results, the longest protests in the memory of the younger generations. “The streets are calm but heavy”, Adib writes today.

The streets are heavy with many things. Heavy with the death of Neda, the most publicly gruesome death of the number-not-known that have been killed. Heavy with the presence of militia and guards, many who are not Persian but were brought in from Lebanon or Palestine, “since it's never easy for an Iranian police to open fire on his fellow countrymen and women like that,” a cabdriver tells Adib. Heavy with a seemingly-fraudulent election that no one can really be sure of.

And heavy with the last word of the Supreme Leader, the Ayatollah Ali Khamenai, who said that Ahmadinejad’s victory was legitimate, and that the protests would now be stifled. The Iranian people do not question the Ayatollah.

At least not before. But on Saturday, the protesters turned their wrath from Ahmadinejad to the Supreme Leader himself. “These days the people are shouting ‘Down with Khamenai’,” says Adib.

Yet neither Adib nor a 27-year-old Iranian engineer living in Mumbai, who wishes not to be named for safety reasons, thinks the leadership will change. “They will NEVER back down from their initial statement, especially now that the big dictator has put his signature and support,” says Adib.

The engineer, who is moving back to Iran from India today because a work transfer, talks to me about going back to Tehran over the phone last night. Just listening to the lack of energy in his voice convinces me real change is impossible.

“It’s going nowhere. I’m not scared to go back there. I’m just sorry. This is my hometown, my home country. In the election, we were just choosing between bad and worse, and that won’t change. I won’t go to the street and fight with police. There is no point,” he says.

Last week, Ahmadinejad called those who did go to the street and fight police an “expression of dirt and dust”. Now, they have taken up the slogan: “You are the real dust, you are the enemy of this land.”

Enemy or not, Ahamdinejad looks set to remain their president. The Ayatollah and the Guardian Council have uttered the last word. And the demonstrations are already lessening.

It was a powerful step toward Iran’s democracy, but was there never any hope for the demonstrators?

The engineer pauses and thinks for a long moment, then says, “No, there wasn’t. Because they won’t stop until they control everything, even if they have to kill a lot people.”

Spunky and Puffing

Scary pictures on cigarette packs, ever increasing taxes, zone restrictions... Governments across the world have tried many tricks to discourage smoking. But do they work?
by Elizabeth Flock | Jun 23, 2009

Say What You Like
Labels like Tobacco smoke can kill babies have been put on cigarette packs for years. But only some countries take note. In Canada, a study found they were widely read and the odds were 1:11 that the smokers would quit. But in China, 70 percent of consumers were numb to those labels. The tradition of gifting cigarettes as a sign of respect and love continued unabated.

Bring on Death
Smokers in India had better prepare to see the picture of a cancerous mouth tumour on the packs they buy. But it will be nothing compared to a brand called Death that achieved a cult status in the UK in the early 1990s. Even its skull and crossbones logo didn’t deter smokers.

Step Outside, Please
Bhutan is the only country to ban smoking lock, stock and barrel. France, UK and Germany banned it in public places. India did the same thing, though it’s not clear what is a public space. In Ireland, smoking actually increased after the smoking ban in 2004.

Made for Each Other
US kids in the 1960s were more likely to recognise Joe Camel than Mickey Mouse thanks to the barrage of cigarette ads. But things changed. By 2005, the WHO had cracked down on 168 countries with a treaty ban on tobacco advertising. But nowhere has smoking reduced for want of ads.

A One Rupee Fix
Taxation can control smoking in price-sensitive regions. But in India, while taxes have progressively increased on cigarettes, a pack of bidis is still just Rs. 4 – Rs. 5 and chewing tobacco Re. 1. Let the government keep raising taxes. One rupee can get you all the high you need.

One That Clicked
New York City saw a decade had passed with no decrease in smoking. Then the officials got into the act. Suddenly there were smoke-free workplaces, tobacco education, cessation services etc. etc. In two years, the city had 200,000 fewer smokers.

Whatever You Can Do, I Can Do Better

by Elizabeth Flock | Jun 9, 2009

Read it at Forbes

Andre Agassi vs. Pete Sampras (Tennis)
They were polar opposites, not unlike Federer and Nadal. They traded world No. 1 rankings throughout Whatever You Can Do, I Can Do Betterthe ’90s, and faced off in 34 matches. Their rivalry was often accompanied with a smile after the match. Their last match up? The 2002 US open in which Sampras won and then famously retired. But rumours are the Titans will butt heads once more this year.

Ayrton Senna vs. Alain Prost (Formula 1)
Never has there been a rivalry so bitter in Formula 1. Though Senna and Schumacher could have been big, the Brazilian died in a heart wrenching accident that changed the face of Formula 1 forever. The sport was then forced to re-introduce driver aids and the Grand Prix Drivers’ association was re-formed which has since advocated the “safety first” principle which has dominated the sport.
In 1988, Senna joined Prost at the McLaren team and their heated rivalry soon became a dangerous one. They’ve pushed one another into pit walls, forced their way past in corners, and even collided in 1989. Senna was known as the fastest man, while Prost was the smartest. The on-track rivalry continued until 1993, but despite a hostile Grand Prix, Senna and Prost actually embraced. Senna was killed in at the San Marino Grand Prix a year later.

Arnold Palmer vs. Jack Nicklaus (Golf)
When Nicklaus entered the scene, Palmer was the unquestioned “King” of the game. And he was wildly popular, as one of the first golfers to appear on TV. But Nicklaus soon proved to have more skill, and the rivalry between the two reached its pinnacle at the 1962 US Open at Oakmont. Jack Nicklaus overcame a 3 shot deficit toArnold Palmer to ultimately force a playoff, and beat Palmer 71 to 74.

Wilt Chamberlain vs. Bill Russell (Basketball)
There were only nine NBA teams for most of the ’60s, so Chamberlain and Russell squared off an incredible eight to 12 times a season. Russell’s Celtics always won, but Chamberlain was clearly the superior player with his offensive magic and strength. Try this on for size: in 1961-62, Wilt averaged 50.4 points per game, but the Celtics still beat the Philadelphia Warriors a depressing 8/12 games.
Muhammad Ali vs. Joe Frazier (Boxing)
They fought three times, each fight more nail-biting than the one before. Their opener at Madison Square Garden in New York City in 1971 is dubbed the fight of the century. Frazier won, by the way. But Ali didn’t give up. In the rematch, Ali dominated, and in the third fight - The Thrilla in Manila - he destroyed Frazier.

Bobby Fischer vs. Boris Spassky (Chess)
America’s Fischer dramatically confronted the Soviet Spassky on the chessboard at the tail-end of the Cold War and at a time when the Soviet Union had long held a stranglehold on the game. Fischer was a strident critic of the USSR style of playing, which often ended in a draw. After a month-and-a-half-long game, and 40 moves, the eccentric Fischer won, becoming the first American to become world champion in almost 100 years. And dethroned the East.

Chris Evert vs. Martina Navratilova (Tennis)
The physically powerful and outspoken Navratilova was the perfect foil for the feminine but overwhelmingly ambitious Evert. Though at first they seemed evenly matched, Navratilova increasingly dominated Evert on the court over time. Evert didn’t give up, but ambition eventually lost out to strength.

Friday, June 19, 2009

Can Roger Get His Mojo Back?

How Federer, arguably the greatest tennis player of all time, can overcome the Nadal hoodoo
by Elizabeth Flock, Shishir Prasad | Jun 5, 2009

Read it at Forbes

T hey will never forget you
Till somebody new comes along
Where you been lately
There’s a new kid in town
Everybody loves him, don’t they?
(New Kid in Town — Eagles)

Remember those National Geographic documentaries? “…And then the ageing alpha male ape / lion / zebra, Nabanga, is challenged to a fight by the younger, more aggressive Kiwanga. After a brutal contest, Kiwanga wins and becomes the new leader of the pack. Nabanga limps away into oblivion.”

This is that moment.

Roger Federer wept a few months ago. All things that were in his heart — the French Open, his personal fiefdom Wimbledon (where he was a five-time champ), and the Australian Open — were now firmly clenched between Rafael Nadal’s pearly teeth.
Time for the Fed to hobble off into retirement?
Apes have to follow the evolutionary script. Humans don’t.

Federer has to figure out a way to deal with his Hispanic nemesis, and do it qui­ckly. The French Open and Wimbledon are best places to unveil the new Federer.
Begin at the beginning then.

“Federer should realise this isn’t just a loss. This is dethronement,” says Vijay Amritraj, a Top Twenty player on the men’s tour in the ’80s. If Federer accepts that he is no longer the king the pressure comes off. Nadal becomes the man to beat, which leaves Federer more relaxed. Right now, Nadal is the Buddha with a tennis racquet. He has the confidence that comes from knowing you will win. “The winner is always relaxed,” says Dr. Gary Canivez, head of Apex Sports Psychology Services, and goes on to talk of Usain Bolt at the last Olympics: “He was effortless. You look at the other runners, and their faces show that they are straining. They are not efficient.”

Once Federer has reminded himself how to relax, the next step is to get over the feeling of loss. He has to grieve, yes. His rise to the top was so swift, and his domination of the courts so complete that he never really had to learn how to lose. Sure, there was the odd slip here and there, but no one doubted he was king. Not surprising, then, that the big match losses at Nadal’s hands have cut really deep.

But he must come to terms with losing, go beyond, and realise that this, too, will pass. Federer has always seemed to have a mature head on his shoulders, so much so that we often forget he is still a young man. He got married in April, and the changed priorities that come with that big personal step should help him move on.
Then he must rededicate himself to beating Nadal.
His win over Nadal at the Madrid Open in mid-May — on clay! — ending a five-match losing streak (which included three Grand Slam finals) would have done his confidence a lot of good. What’s more, it showed the world that the SuperSpaniard was human: It was Nadal’s first loss on clay in over a year, after 33 wins in a row.
Important as the mental conditioning is, Federer also has to improve his fitness. At his peak, he had the grace of a Nureyev. His anticipation was great and his timing exquisite. But opponents figure these things out, as they did with Martina Hingis, women’s world number one in the late ’90s. Players like the Williams sisters, Lindsay Davenport and Maria Sharapova were physically stronger and hit the ball much harder and faster. They figured out that they could blitz her with their speed and power, throwing her timing off. She never really recovered from that.
As the Federer-Nadal rivalry has intensified, Nadal, never a weakling, has become even stronger. In the ’09 Australian, Nadal in the fifth looked like he could go on for another five. Federer doesn’t have to get muscle-bound, but he must build up his stamina; everyone knows that when you’re tired, your timing suffers. For Federer, the touch artist, it’s crucial that his body is fully-tuned and cooperative, even if it goes to the fifth set.

Federer must also take a long, hard look at his game and jettison what isn’t working. Amritraj suggests that Federer improve his backhand slice defence on the Nadal forehand; they’re not deep enough, and he’s giving away easy points.
Champions, in such situations, come back with new weapons. “Mats Wilander,” says Amritraj, “took three months off from the tour in 1988 to develop a backhand slice. He came back and won the French, the Australian and the US open that year.”
For Federer, it is slightly easier. He already has all the shots. He just needs to get a good game-plan together, and stick to it.
Amritraj talks about the days when John McEnroe had him in knots. “I had beaten Borg four or five times and Connors a few times too, but couldn’t play McEnroe. I sat down with Roy Emerson, my coach, worked out a plan, wrote it on the back of a visiting card and kept it in my kit.” At every time-out, Amritraj would look at the card to make sure he was following the plan. And he did eventually beat Mac the Mouth.

So let’s talk tactics.
Nadal’s hitting zone is six feet behind the baseline. That’s because of the power and spin that his racket generates, not to speak of his famous biceps. “If I were to use the same racket and hit a shot,” says Amritraj, “it will still be rising as it hits the cheap seats.”
Federer needs to get him out of that zone, and the way to do that is to use the drop shot more often. He must keep Nadal always wondering when he’s going to drop one in the forecourt.
To make the drop shot work, though, Federer’s deadly forehand has to work much harder than it has been doing lately. “The forehand went down last year [at the French Open], and Roger went down,” says Luke Jensen, former world number 6 in men’s doubles. With the forehand working, Federer will neutralise Nadal’s forehand. And will make Nadal stay back to defend against it, which will provide opportunities for the drop shot. Not easy, of course, because Nadal is so darn quick.
But then Federer wasn’t king of the jungle for so many years for nothing.

While this story was being written, the unprecedented happened: Nadal suffered his first ever loss in the French Open. Federer owes Robin Soderling a hearty “Gra├žias,” for putting another dent in Rafa’s aura. Federer now has his chance to snag that elusive French title and bury the past. He’s not going to see Nadal across the net for at least another month. And that will be on his beloved Wimbledon grass.
Go Nabanga!


China’s largest city wants to be the new Singapore; but, beneath the sheen, the ghosts of its ribald, carousing past still lurk
by Elizabeth Flock | Jun 5, 2009

Read it at Forbes

The “Whore of Asia” swarms with three million inhabitants. In the French Concession, men lie dazed amidst clouds of opium smoke, their eyes needle points. Slatternly wenches tend to their pipes and their sexual needs. A hundred thousand prostitutes in white high heels click through the brothels; the prettier ones present themselves as high-class courtesans. Burlesque girls dance in jazz clubs before besotted crowds. On North Henan Road, in “The Wheel,” a notorious gambling den, young men lose more money than they make.

The Shanghai of history books was a profligate place. Historians tell of the 35,000 foreigners who ran it, supposedly respectable merchants whose not-so-secret debauchery became legend. They got rich, then squandered their gold in a thousand disreputable ways. They called themselves the Shanghailanders.

I knew Old Shanghai from high school books. I knew of it, too, from James Ivory’s The White Countess, a tale of mobsters, mansions, and money, of decadence and booze. I badly wanted to see it for myself.

Glitz and Gleaming Glass
I walk through the sparkling white halls of the new $2 billion Pudong International Airport. My nose is pressed to the taxi window as we cruise down freshly-built roads lit by futuristic streetlights.
The super-clean financial district glitters like Vegas. Sombre businessmen troop into the Grand Hyatt, which spears 87 floors into the night sky. Skyscraper competes with skyscraper all the way. The undisputed winner: The 101-storey Shanghai World Financial Center.

Money, clean money, is everywhere. Everyone moves to its inaudible beat — taxi drivers, window-washers, businessmen — not one out of step. Where were the hellraisers?

Old Shanghai was tamed in 1949, when the Communist Party ended drugs and prostitution by decree. Addicts were forced into rehab, opium den owners were hounded out, gaming tables were overturned. In their place rose an immaculate, luxuriant, global hub. The new Shanghai is a Singapore wannabe; it flaunts its wealth and the fact that it is squeaky clean.

New Shanghailanders, affluent foreigners who swarmed back over the last ten years, meet over power breakfasts at five-star hotels, take pictures in the afternoon from polished observation decks. Mostly, they meet in Xin Tian Di, in the old French Concession, where opium once ruled. They buy expensive Chinese suits, sip wine and avoid Shanghai cuisine. Xin Tian Di is modelled after the Old Shanghai. The buildings are styled like shikumen, brick houses built in the 1860s influenced by Western and local tastes.

The Underbelly
At night, we stroll between Xin Tian Di’s brick buildings, watching the rich go by. From a bar called Luna, we hear the reverberations of a band named Friction. We follow the sound of the bass inside.

A group of hippyish, seemingly drug-addled Filipino musicians pound out Pink Floyd and Deep Purple. The lead singer, in a tight black tanktop, sings in a voice that’s Janis Joplin turned Eartha Kitt. Foreigners in business suits sing drunkenly along. They are in love with her.

The waitresses wear tight clothes, white costumes that call to mind fantasy air hostess uniforms. An ordinary-looking Chinese girl in a very short skirt beckons my friend. He talks to her for a while and then, to the sound of throaty classic rock, they kiss. She asks him if he wants to go somewhere. It is then he realises she is a prostitute.

At the karaoke bar, the only women present are the karaoke girls, who talk to you, sing with you, and then offer a dance for money. They are polite, they allow a kiss, nothing else. When the song is over, you’re done too.

The night is waning; we amble out. A group of young American and European business types stroll with us through silent streets to Fuxing Xi Lu; a dusty door that leads to an unlit tunnel. And then we are in an old bomb shelter, listening to the beats of an international DJ our expats all seem to know. I am tipsy; I go to wash my face. Wannabe-punk teens are popping bright-coloured pills — Want one? There is an opium haze in the air. But the club-goers at The Shelter are more interested in a powder they call “China white.” As I order another drink, I see needle-eyed people taking heroin in the shadows; I remember that it’s a derivative of opium, only more potent.

We decide to go. I am secretly relieved.
We emerge into the gray morning. The expats, suits crumpled, leave; their night isn’t over, though. I remember the books that say China is a nation of gamblers and always will be; because — take your pick — it is also a nation of the poor hoping for a miracle, or because it lacks a national game, or — my favourite — because Confucius said card games would win the favour of the gods. Whatever the reason, gambling never disappeared.

Even at this unholy hour, thousands of people are betting behind closed doors, my friend tells me. Send out a whisper and you will be led to the nearest den. They play cards, the pebble-counting Fan-Tan, the Domino-like Pai Gow, and Mah Jong.

Now swollen to 20 million, Shanghai is everything China’s ruling party wants it to be. Its skyscrapers attract flocks of tourists. The streets are clean and the metro lines extend tentacles of fresh, fast train cars, ever widening the city. Elite housing communities spring up, nestled between skyscrapers. Well-heeled merchants gather in these places and in Xin Tian Di.
Beneath this veneer, Old Shanghai still lurks. It is there, in the exposed legs of the karaoke girl, in the click of the mahjong tiles, in the powder of opium’s more dangerous cousin. It is there — as doped up, lusty and greedy as it always was.

How Bill Gates Blew $258 million in India's HIV Corridor

The purpose was noble, the money generous. But the software mogul’s charity for HIV prevention in India has failed to make a lasting impact
by Elizabeth Flock | Jun 5, 2009

O n a humid afternoon, former sex worker Fathima (name changed) welcomes a group of illiterate women — still in the trade and needing protection from HIV — into the Mukta clinic in Pune. As a “peer educator,” it’s her job to convey to them the message of safety. But the visitors shuffle tentatively as expensive-looking posters in English paper the walls around them.
Why would a clinic serving illiterate visitors use more English than Indian languages?

The answer lies in where that money comes from. The Pune clinic is part of a network one hundred-plus non-governmental organisations (NGOs) working under the umbrella of Avahan, India’s largest HIV prevention initiative. Avahan, or “call to action,” is a brain child of the world’s largest philanthropist: Bill Gates.

Gates had announced the 10-year, $100-million initiative to stop the spread of HIV/AIDS in India during his much heralded visit to the country in November 2002. This was to be the largest of its kind for the Bill & Melinda Gates Foundation.

The timing couldn’t have been more appropriate. After nearly two decades of piecemeal efforts to counter HIV, India was hurtling towards an AIDS epidemic. Millions of poor people exposed themselves to the dreaded virus due to a lack of awareness. Government agencies and NGOs didn’t have the money to preach safety or treat the infected. Gates showed his seriousness by later raising the budget to $258 million.

Seven years later, back at the Pune clinic, Fathima has counselled the women, given them the sheaths of safety and sent them back. It is time to worry about the future. The bad news is Avahan is ready to pack and go; and Fathima is set to lose her income. She doesn’t want to slip back into prostitution. At the age of 45, she doesn’t have much of a career there anyway.

When it started on the ground in 2003, Avahan set for itself three goals: Arrest the spread of HIV/AIDS in India, expand the programme from the initial six states to across the nation, and develop a model that the government can adopt and sustain so that the project could be passed on to it. More than five years later, Avahan hasn’t achieved any of these goals. Doubtless, the initiative has made a dent into the HIV/AIDS problem, but the impact is marginal for a bill of $258 million. And now Avahan is leaving, handing over the reins to the government-run National AIDS Control Organisation (NACO), which doesn’t want to inherit it. It is too expensive for the budget-starved establishment that is as nimble as a sloth. If NACO takes over, it will try to prune the costs of the programme. Salaries for peer educators will go.

A Five-Star Initiative
When Gates Foundation got down to work in India, the priority was clear. It decided to hire the best minds in business to run its initiatives using sound principles of management. Avahan was ready to spend what it takes to get the best bosses and started its search at McKinsey, the consulting powerhouse. The recruiters zeroed in on Ashok Alexander, who had spent 17 years turning Indian businesses into global challengers. “They made me an offer I couldn’t refuse,” Alexander recalls, sitting at his plush office in New Delhi. “I liked the ambitious arch of the HIV/AIDS programme and it was a chance for me to do something new.”

Soon, the 15-member team was in place. Ten of them had come from a private-sector background. The team members tackled HIV/AIDS much as they would a problem at McKinsey. Alexander’s office is papered with data and maps containing hundreds of coloured dots plotting the disease across the country. The argot is sheer B-school: Avahan is a “venture,” its HIV/AIDS prevention programme a “franchise,” the sex worker the “consumer.”

The classical business principles helped Avahan start on a big scale in six states simultaneously. But the lack of public health experience also led to a compromise on quality. Tejaswi Sevekari, director at Saheli, a sex workers’ collective for HIV/AIDS in Pune, remembers observing the kinks during her stint at Pathfinder International, an NGO that works with Avahan. Data collection and reporting were entirely in English and had no pictures. Five years later, the scene is the same; the project hasn’t fully given up on English though no “consumer” understands the language.

Avahan operated in a pyramid, with Alexander and his team overseeing the work of more than 100 NGOs. The lack of practical experience at the top manifested itself in different ways. When Avahan introduced sleek mobile vans to bring clinics directly to the brothels, the expensive-looking vehicles were sometimes met with intense suspicion. At the Mukta clinic, Dr. Laxmi Mali says sex workers initially thought the van was from the police or the government. They refused help.

False Moves
The early missteps are largely anecdotal. But in 2005, an internal evaluation showed a big portion of Avahan’s efforts had gone to waste. As many as 31,000 community members had been contacted by Avahan’s outreach programme, but only 11,000 actually visited the clinics. The Avahan executives had assumed the peer educators would already know what the prevention services were without explanation; the reality was they didn’t.

Avahan’s craving for scale also meant it overshot quite a bit. It started with a bang in six states, with 50 sites for truckers in the south. But by mid-2005, only 12 percent of truck drivers were even aware of their services, and only 7 percent took advantage of them. This forced Avahan to reduce the sites to 20. For similar reasons, Avahan’s 6,000 sexually transmitted infection (STI) centers were brought down to just 800.

Alexander’s team tried to fix the glitches. For example, Avahan tried to allay the fears of sex workers (such as those who had met the mobile van with suspicion) by hiring them to act as intermediaries between the programme and communities. An insider could be more persuasive. Good idea, but Avahan’s decision to pay them a salary has come in for criticism, because other NGOs can’t recruit sex workers as volunteers.

A series of evaluations published in the AIDS Journal in 2008 show that the jury is still out on the programme’s impact. The evaluations, funded by the Gates Foundation, were mostly on the methods of data collection. One study, which sought to determine whether Avahan was responsible for the decline in HIV prevalence in Karnataka, failed to prove that it played a key role.

Where Has All the Money Gone?
At the core of Avahan’s failure to make a serious difference to India’s fight against AIDS is the way it spent money. It was an expensive operation, never tired of throwing money at the problem. In a country where a branded condom sells for just 10 cents, what did Avahan spend on? It’s difficult to say because Avahan’s finances are largely opaque. Avahan’s outlets sell five million condoms a month and distribute another 10 million. Asked how so much could be spent on condoms, Alexander laughs, saying, “It’s a bit more complicated than that.” Probed further, Alexander says he doesn’t know the financials off-hand, nor can he give them later.

Travel would have been one drain. Jonty Rajagopalan, Avahan programme officer from 2006 to 2008, says she would take flights every month from her base in Hyderabad to her focus areas in Andhra Pradesh and Tamil Nadu, instead of being based in a focus area. Another large chunk: salaries. Alexander’s annual package is $424,894, the second-highest in the foundation globally, not including the presidents and operating officers. Avahan’s targeting intervention (TI) officers are also paid three or four times what a typical NACO TI officer is paid.

Avahan’s marketing was done in style too. Eldred Tellis, head of Sankalp, an HIV/AIDS-focussed Mumbai NGO that has worked with Avahan, says he has seen a lot of money go into fancy publications on high-quality paper, reporting the programme’s work. Very little went to the people on the ground. Vijay Mahajan, chairman, Basix, a microfinance institution, comments on Avahan: “There is too much money and too many really smart people with too little coming out.”

An Uncertain Torchbearer
Knowing that it would have to inherit the project, NACO sent out evaluation teams to sites in four states to get some clarity on costs. NACO’s head, Dr. Sujatha Rao, says the evaluation threw up one clear message: Large parts of the programme are not sustainable by NACO. “We told them you can’t create a huge number of assets and then just leave and expect the government to take over everything,” says Rao.

But Alexander disagrees. “We are not perpetual funders. We try to be catalytic,” he says, ebulliently confident that the HIV/AIDS epidemic will soon be contained, with or without the foundation. Either way, it will have to be — Avahan is now repositioning, focussing on maternal and newborn health.
Ashok Row Kavi, consultant for UNAIDS and chairman of Humsafar Trust for gay and transgender health, says Avahan’s expectations were unrealistic. “They wanted HIV to disappear in five years. For that to happen, a lot of people would have to die.”

NACO’s annual budget is Rs. 1,100 crore ($225 million), none of it spent on Avahan currently. Rao just can’t find enough money to continue the project. “We can never offer a replicable model. And if we are unable to sustain the programme, all of their effort will be for naught,” she says, shaking her head.
When probed about the difficulties of handing over the massive programme to the government, Alexander says the transfer is going just fine. Kavi differs; he says that the transfer discussions between NACO and Gates Foundation are “running into a brick wall right now. Costs need to be brought down, but they can’t figure out how.” He also fears Avahan’s now-experienced MBA-graduate TIs, facing shrinking salaries, will depart. The question of running air-conditioned clinics like Avahan doesn’t even arise.

The biggest hole in quality will arise where it can hurt most. Hussain Makandar, HIV counsellor at the Mukta clinic, is worried about condoms; the ones from Avahan lubricate; the ones from NACO break and the sex workers stop using them.
Alexander insists that only a 10th of the project will transfer to the government this year and the rest will happen slowly over the next five. “We’re doing a transition programme. We’re not saying, ‘here’s the programme, and we’re off.’” But NACO and Mukta officials, among others, are confused over the timeframe.

So, the final report card on Avahan:

Goal 3: Develop a model for HIV prevention that can be implemented by the government sustainably. NACO’s resounding vote: Not achieved.

Goal 2: Expand the programme nationwide. Avahan could not go beyond the six states it started with. Not achieved.

Goal 1: Arrest the spread of the disease. The number of Indians living with HIV/AIDS has been officially corrected from 5.1 million to 2.4 million. This was a statistical change, not an improvement in health. Impact not known.

Back in the great Indian sex bazaar, prostitution is a growth industry and condom an exception. “New faces keep coming in every month (to the brothels),” says Dr. Mali. “Twenty percent of the people we now see are infected, the same as when we started.”$258-million-in-indias-hiv-corridor/852/1