When Ashok Alexander left consultant firm McKinsey to head the Bill and Melinda Gates Foundation in India, many things were different.

There was an air of denial in India on the prevalence of HIV/AIDS, and there was much stigma associated with it. On a personal level, Alexander recalls how working with McKinsey built in an “arrogance of a certain kind that misleads you into believing you can solve any problem.”

But all that was set to turn on its head as, from Day 1, he was exposed to a kind of life he had not known, despite being in his late 40s then, he says. “I had not seen this kind of grinding poverty and loneliness ...this ‘hole in the soul’ kind of poverty,” says Alexander, on the lives of people in marginalised communities. People lived in fear and poverty and seeing their condition, “I felt I was not equipped,” he says, of the situation that caused much despair.

He also felt “humbled” by the people working in these tough environments and it was from these backgrounds that communities of marginalised women and men emerged with the strength to stand up to goons, besides working for others in similar situations. Many of these “heroes” feature in Alexander’s book, A Stranger Truth (Juggernaut), set for launch in December. There is a “sea change” now from 15 years ago when marginalised communities were dis-empowered, faced much violence and there was no data to work with, he says. Then, people did not want to engage on the issue, the government contested HIV/AIDS incidence, saying the numbers were exaggerated. But, today, data is being culled by front-line workers and the programme to combat HIV/AIDS is a public health success story, he says.

The prevailing environment is more open and the change effected in certain provisions of Section 377 of the IPC has been momentous.

Over a period of 10 years, the Bill and Melinda Gates Foundation has been involved with one of the largest programmes with MSMs (men who have sex with men) and transgenders, says Alexander. The threatening environment some of them live in, particularly in smaller or mofussil towns in the country, does not go away despite changes with regard to some provisions of Section 377, he observes.

The environment where two men in a park holding hands “could be pounced upon by the police” or the stigma that makes them pay their way out of the situation — these are “terrible scenarios,” he says. Unfortunately they are still very real in small towns.

But the learning from women in the HIV/AIDs fight is to become a community or collective where you can stand up for yourself, he explains, and there the Section 377 decision provides a legal backbone. But more community mobilisation needs to take place for the decision to truly become a success, he says.

Alexander has “painful” memories too, from his many visits across the country. Like the young boy in Imphal he had to walk away from, as he had been discouraged from giving people personal money. “I cried that night, he was as old as my son,” recalls Alexander, hoping that the boy went on to get better.

But then there’s also the delightful story of the baby he brought to Delhi from Imphal who is today a national athlete, he says, proudly. Alexander had kept a meticulous diary of his visits with “graphic descriptions” and “there was a book waiting to be written inside me.” And the passage of time gave him the perspective, he adds.

Alexander now runs The Antara Foundation, focused on maternal and child nutrition, with a flagship project in Rajasthan.

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