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A Stranger Truth: Lessons in Love, Leadership and Courage from India's Sex Workers
When Ashok Alexander left a high-profile corporate job to head Avahan, the Bill & Melinda Gates Foundation s programme to stem the growth of the HIV epidemic in India, he was plunged into an India far removed from the comfort zones he had lived and worked in all his life. It was a grinding place where women sold themselves for fifty rupees and fourteen-year-olds injected drugs. It was the shadow world of transgenders and of young gay men in a country that still criminalized same-sex love. It was the strange world of truckers, lonely journeymen along forgotten highways. Above all, it was a place where valiant battles for a barely decent life were being fought every day. During the ten years Alexander built Avahan, it grew to become one of the largest and most successful HIV prevention programmes in the world, credited with averting over 6.5 lakh new infections. Based on his experiences, A Stranger Truth compellingly brings alive the world of people most vulnerable to HIV/AIDS, and some of the unlikely heroes among them.
- GenresNonfictionIndiaFeminism
312 pages, Hardcover
Published November 30, 2018
15 people are currently reading
514 people want to read
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Displaying 1 - 19 of 19 reviews
January 20, 2019
I really liked reading this book especially because I know nothing about India's sex workers community and the country's HIV epidemic. The book was not only a 101 on one of the most discriminated and stigmatized communities in India but a moving portrait of the people in this community. Also, came to admire and respect the author Ashok Alexander - it was refreshing to see an elite Indian male be so open minded and willing to engage with sex workers.
Two minor cribs - first, thought that the book sometimes risked becoming a policy prescription ("Avahan is a model program" / "Community is the solution"); and two, Bill Gates got a little too much attention in some parts of the book (and while it could be argued that the author only worked with sex workers because of Gates Foundation, I still don't think it's justification enough).
All and all, highly recommend this book. Hoping it'll encourage more (accessible) books on India's public health system to be written.
Two minor cribs - first, thought that the book sometimes risked becoming a policy prescription ("Avahan is a model program" / "Community is the solution"); and two, Bill Gates got a little too much attention in some parts of the book (and while it could be argued that the author only worked with sex workers because of Gates Foundation, I still don't think it's justification enough).
All and all, highly recommend this book. Hoping it'll encourage more (accessible) books on India's public health system to be written.
January 26, 2024
Overall, really enjoyed this book! It details the author's first glimpse into public health and HIV prevention. At the crux of public health, in my opinion, is helping marginalized communities find their voice and creative solutions to their own problems. At the same time, it is key that those on the outside who aim to support these communities work to break down stigma in their own circles. I think this book beautifully depicted what I love most about public health and reminded me a lot of my first intro to public health which was an HIV/AIDS class about the social, political, economic aspects of this disease. I wish that the stories of the sex workers were highlighted more and the book was slow at times, but I would recommend this book to anyone interested in public health delivery, prevention programs, and learning more about India's most marginalized populations.
March 19, 2022
One realisation that keeps occuring is that the world is so much bigger than your life. That is what I felt after reading about this man's journey, a battle to prevent the spread of AIDS in India. The strength and courage of women you will come across here, in the face of adversity is astounding. In the end it all boils down to this: A little respect, support and trust can go a long way. A woman can do so much when she has her life in her own hands.
November 26, 2019
In 2003, Ashok Alexander left a prestigious job at the advisory firm McKinsey and Company to head up the Gates Foundation’s HIV/AIDS prevention program for India. He had no experience in public health and faced an HIV prevention challenge on a scale and of a nature that hadn’t been seen before. This book describes his experiences -- and sometimes those of others in Avahan (the Indian HIV Prevention program.) However, the emphasis isn’t on patting himself and his team on the back so much as pointing out the lessons they learned from the high-risk populations they served – mostly sex workers, but also their clientele, as well as intravenous drug users.
The nineteen chapters of this book are arranged into two parts. The first part (Ch. 1 thru 11) explores Alexander’s travels around the country to meet with various high-risk groups and learn about their needs. The second part (Ch. 12 thru 19) takes a deeper dive into the building of Mysore’s program, Ashodaya, which became a global educator on HIV prevention.
Part one offers insight into bits of India that most of us never see. When I mentioned that the problem in India wasn’t just it’s large size, but also the peculiar nature of the environment, that can be seen throughout these chapters. What do I mean by the peculiar nature? In India, not only is prostitution rarely practiced in brothels, but sex workers are largely indistinguishable from the general population. The biggest portion of the group is women in saris who look like much of the female population. Also, the societal stigma is great, which creates all the more incentive to not let your work be known. For these reasons, just finding the at-risk population was challenging, they were dispersed and hid in plain sight. There were also problems of thinking that ranged from politicians who wouldn’t admit there was potential for massive HIV / AIDS in India because they insisted that Indians don’t engage in any of the “immoral” acts seen elsewhere in the world, to johns who honestly believed that drizzling lime juice on one’s manhood would prevent infections.
Among the most intriguing chapters in part one are those that reveal the issues with long-haul truckers (the single biggest demand-side high-risk population), intravenous drug-users in the golden-triangle adjacent states of the Northeast (i.e. Manipur and Nagaland,) and one that explained the unique cultural traditions of the transgender populations in India. There’s also a chapter (Ch. 6) that discusses the leadership traits that were found among the sex workers.
Part II, which dealt with the Mysore program, also had its fascinating elements. Two of the chapters discussed the life stories of two particular sex workers (one female and the other male) who worked in the Ashodaya program. There was also a chapter that dealt with the discussion of violence. That might seem like a diversion, but apparently violence and lack of prophylaxis go hand-in-hand, and had to be dealt with together.
The book has an Appendix of general information on HIV / AIDS and its occurrence in India. Other than that, a few maps and annotations are the extent of the ancillary matter.
I found this book fascinating -- if heartbreaking in places. As someone who’s lived in India for over six years, there was a great deal of insight offered into segments of the population of which I had little awareness. Even learning about the trucking industry (divorced from the sex work / HIV angle) was intriguing. I’d highly recommend this book if one is interested in the topics of: leadership, public health, or the unseen side of India. The author uses a narrative approach throughout to great effect.
The nineteen chapters of this book are arranged into two parts. The first part (Ch. 1 thru 11) explores Alexander’s travels around the country to meet with various high-risk groups and learn about their needs. The second part (Ch. 12 thru 19) takes a deeper dive into the building of Mysore’s program, Ashodaya, which became a global educator on HIV prevention.
Part one offers insight into bits of India that most of us never see. When I mentioned that the problem in India wasn’t just it’s large size, but also the peculiar nature of the environment, that can be seen throughout these chapters. What do I mean by the peculiar nature? In India, not only is prostitution rarely practiced in brothels, but sex workers are largely indistinguishable from the general population. The biggest portion of the group is women in saris who look like much of the female population. Also, the societal stigma is great, which creates all the more incentive to not let your work be known. For these reasons, just finding the at-risk population was challenging, they were dispersed and hid in plain sight. There were also problems of thinking that ranged from politicians who wouldn’t admit there was potential for massive HIV / AIDS in India because they insisted that Indians don’t engage in any of the “immoral” acts seen elsewhere in the world, to johns who honestly believed that drizzling lime juice on one’s manhood would prevent infections.
Among the most intriguing chapters in part one are those that reveal the issues with long-haul truckers (the single biggest demand-side high-risk population), intravenous drug-users in the golden-triangle adjacent states of the Northeast (i.e. Manipur and Nagaland,) and one that explained the unique cultural traditions of the transgender populations in India. There’s also a chapter (Ch. 6) that discusses the leadership traits that were found among the sex workers.
Part II, which dealt with the Mysore program, also had its fascinating elements. Two of the chapters discussed the life stories of two particular sex workers (one female and the other male) who worked in the Ashodaya program. There was also a chapter that dealt with the discussion of violence. That might seem like a diversion, but apparently violence and lack of prophylaxis go hand-in-hand, and had to be dealt with together.
The book has an Appendix of general information on HIV / AIDS and its occurrence in India. Other than that, a few maps and annotations are the extent of the ancillary matter.
I found this book fascinating -- if heartbreaking in places. As someone who’s lived in India for over six years, there was a great deal of insight offered into segments of the population of which I had little awareness. Even learning about the trucking industry (divorced from the sex work / HIV angle) was intriguing. I’d highly recommend this book if one is interested in the topics of: leadership, public health, or the unseen side of India. The author uses a narrative approach throughout to great effect.
April 30, 2020
The author left a job with McKinsey to take up the Bill and Melinda Gates foundation HIV preventive program in India. The book is his personal journey from the corporate world into the very different world of sex workers.
I read about this initiative and this book when I read Melinda Gates book last year and was really keen to get a copy. There was only the hardcover edition and sold only in India so I had to wait till my trip last month to get hold of one.
Finally finished it today and I have to say I was a tad disappointed. Since the project is credited with averting the HIV epidemic in India I would have really loved to get more detail on how it worked in different districts, not just the Ashodaya operation in Mysore (though that was fantastic)
The first part is about how he went about understanding the situation - how is sex work carried out in India? what are the challenges faced by these people? why aren't they concerned about AIDS? The sex work is mostly invisible, only in some areas (big cities or towns) will you find brothels but majority of it is distributed, on the streets or in lodges or their homes or the highways. Many of the sex workers are not easily identifiable, they look like ordinary housewives. Many practice it in upmarket conservative looking areas. So how do you get them together to talk about safe sex? Especially when most are afraid of the stigma with being identified as a sex worker. Why do they do it? Majority of them through poverty or twists of fate that made them end up selling their bodies to feed themselves or their families....A lot of it offered for the cost of 1 AUD...
In the second we hear in more detail about how the program was implemented in Mysore. We meet the people who spearheaded the Ashodaya program, how they listened to the sex workers and what they needed before rolling out the HIV preventive measures. The sex workers wanted (1) to reduce the violence they are subjected to in their daily lives (2) have a safe place to go to before they started work (3) a health clinic. The funding allowed the program to provide (2) and (3) and the issue of violence was tackled by the sex workers themselves coming together to crisis response teams and through advocacy. By listening to them and supported their needs the Ashodaya program could indirectly achieve their HIV preventive objectives along with uplifting their community. Their work is cited as a model program with many NGOs from different countries visiting them to understand how they achieved their results. The community formed it's own co-operative society and they also have a board of members leading them looking after and advocating for the community. Some members have been invited abroad as trainers or speakers at UN , WHO or other countries looking into HIV prevention.
Found this website -> http://www.ashodayasamithi.org/
Bill and Melinda Gates and their family and their work sound awesome. Really grateful for their efforts in tackling problems across the globe, they are making a difference.
And these words from the book are so true for India - a single good person in a position of authority could make a big change in an otherwise rotten system. (part where DCP of Mysore, Vipin Gopalakrishnan issued identity cards of Ashodaya sex workers to keep them safe from police violence)
I read about this initiative and this book when I read Melinda Gates book last year and was really keen to get a copy. There was only the hardcover edition and sold only in India so I had to wait till my trip last month to get hold of one.
Finally finished it today and I have to say I was a tad disappointed. Since the project is credited with averting the HIV epidemic in India I would have really loved to get more detail on how it worked in different districts, not just the Ashodaya operation in Mysore (though that was fantastic)
The first part is about how he went about understanding the situation - how is sex work carried out in India? what are the challenges faced by these people? why aren't they concerned about AIDS? The sex work is mostly invisible, only in some areas (big cities or towns) will you find brothels but majority of it is distributed, on the streets or in lodges or their homes or the highways. Many of the sex workers are not easily identifiable, they look like ordinary housewives. Many practice it in upmarket conservative looking areas. So how do you get them together to talk about safe sex? Especially when most are afraid of the stigma with being identified as a sex worker. Why do they do it? Majority of them through poverty or twists of fate that made them end up selling their bodies to feed themselves or their families....A lot of it offered for the cost of 1 AUD...
In the second we hear in more detail about how the program was implemented in Mysore. We meet the people who spearheaded the Ashodaya program, how they listened to the sex workers and what they needed before rolling out the HIV preventive measures. The sex workers wanted (1) to reduce the violence they are subjected to in their daily lives (2) have a safe place to go to before they started work (3) a health clinic. The funding allowed the program to provide (2) and (3) and the issue of violence was tackled by the sex workers themselves coming together to crisis response teams and through advocacy. By listening to them and supported their needs the Ashodaya program could indirectly achieve their HIV preventive objectives along with uplifting their community. Their work is cited as a model program with many NGOs from different countries visiting them to understand how they achieved their results. The community formed it's own co-operative society and they also have a board of members leading them looking after and advocating for the community. Some members have been invited abroad as trainers or speakers at UN , WHO or other countries looking into HIV prevention.
Found this website -> http://www.ashodayasamithi.org/
Bill and Melinda Gates and their family and their work sound awesome. Really grateful for their efforts in tackling problems across the globe, they are making a difference.
And these words from the book are so true for India - a single good person in a position of authority could make a big change in an otherwise rotten system. (part where DCP of Mysore, Vipin Gopalakrishnan issued identity cards of Ashodaya sex workers to keep them safe from police violence)
April 7, 2019
As a development worker, researcher rarely do you come across a book that not only details and describes the lives of the people it touched and transformed but also evaluates and documents the approaches that enables programme growth and evolution. Ashok Alexander portrays the moving world of sex workers, transgenders and MSM (male to male sex) and also devotes a chunk of the book on how Avahan, a flagship program of Bill and Melinda Gates Foundation in the early 2000s. Ashok, a former McKinsey staff, is in charge of this program to tackle HIV and AIDs in India. What was initially thought to be a condom-distribution program transformed in to a community mobilised and led initiative, which, as Ashok puts it the Foundation and donors worldwide came to acknowledge was the way forward to tackle the spread of HIV. Ashok, at the outset describes the vast differences between the worlds of corporates and development, interspersing data and facts, and challenges with examples and anecdotes of lives, stories and humanity of the sex workers in India in the first section of the book. The latter part describes one unique program in Mysore, Ashodaya which was run, managed and benefited sex workers in Karnataka. This book must be made compulsory reading for enthusiasts who pass out with masters in development from the likes of social science and management institutes in the region. But it must also be read by anyone who has an interest in knowing about the complexity and fluidity of gender, development and how programmes in India can proceed without the traditional measurements of success.
September 29, 2024
In 2003, Ashok Alexander left a thriving corporate career at McKinsey & Co. and took on the task of setting up the Bill and Melinda Gates Foundation’s India AIDS Initiative. Under his guidance the Initiative soon became the world’s largest privately sponsored HIV prevention program. When Alexander dived head first into this project, he had very little idea about both HIV and the insurmountable odds he was soon to be up against. But as he navigates his way through the labyrinthine series of obstacles and unfortunate events, we, as readers, not only learn to cheer for him but also become voluntary members of his team accompanying him on his voyage. This is a complex story about India’s public health but at the same time an intimate journey of self-discovery. It’s an odd fusion, but precisely what makes the book all the more enjoyable.
April 7, 2020
What a lovely, lovely read! This is easily one of the best non-fiction read. Having worked at the grassroot level, I understand the challenges of scaling up public work. Avahan did exceptional work of preventing spread of HIV in India which was declared an epidemic in 2003. The organization did some incredible work under Ashok Alexander. One truly understands the power of collective through this book. More power to the sex workers of India and people who commit to causes of the community!
November 7, 2019
I thought this book would be more about the lives of sex workers in India and while it does have a significant focus, it is I think, ultimately a leadership type book - at least the entire second part of the book.
The author was some big-wig at McKinsey Company (and he lets you know it!) and he takes the reader through his journey of being hand picked by the Gates Foundation (and meeting Bill and Melinda) to lead their foundation's work in the early 2000's on countering the spread of HIV in India (which at that time was growing in leaps and bounds and was marginally being addressed by the government of India).
The first section of the book is by far the better part - it tells the stories of the sex workers, the drug users, the primary targets for HIV prevention - we get to hear their stories, their lives, what it is like being a sex worker or a child of a drug user in India. I found that fascinating.
The second part of the book is more about the author and his organization implementing change. I did think it was interesting, but only because I took a lot of leadership courses during my time studying for my MBA and this section is in line with those types of books. I found the solutions novel and certainly this book is one I would suggest to NGO's working in India as well as to junior level leadership consultants - that sometimes the answer is not some fancy idea you come up with but instead comes from the people who are most affected, let them essential solve their problems but you provide the tools and safe space.
I'm glad I read the book, again as I am currently living in India, it opens my eyes to things I see passing on the street and didn't know what was really going on, but I was hoping the book was less leadership and more non-fiction accounting of Indian sex workers.
Would recommend for business students, those living in India like me, who want to understand better the hidden culture of their temporary home.
The author was some big-wig at McKinsey Company (and he lets you know it!) and he takes the reader through his journey of being hand picked by the Gates Foundation (and meeting Bill and Melinda) to lead their foundation's work in the early 2000's on countering the spread of HIV in India (which at that time was growing in leaps and bounds and was marginally being addressed by the government of India).
The first section of the book is by far the better part - it tells the stories of the sex workers, the drug users, the primary targets for HIV prevention - we get to hear their stories, their lives, what it is like being a sex worker or a child of a drug user in India. I found that fascinating.
The second part of the book is more about the author and his organization implementing change. I did think it was interesting, but only because I took a lot of leadership courses during my time studying for my MBA and this section is in line with those types of books. I found the solutions novel and certainly this book is one I would suggest to NGO's working in India as well as to junior level leadership consultants - that sometimes the answer is not some fancy idea you come up with but instead comes from the people who are most affected, let them essential solve their problems but you provide the tools and safe space.
I'm glad I read the book, again as I am currently living in India, it opens my eyes to things I see passing on the street and didn't know what was really going on, but I was hoping the book was less leadership and more non-fiction accounting of Indian sex workers.
Would recommend for business students, those living in India like me, who want to understand better the hidden culture of their temporary home.
June 13, 2020
Fascinating glimpse into the world of Indian Sex Workers. The book essential gives the reader a 'real' sense of the every day challenges for these people. With HIV infections rapidly increasing, the Bill & Melinda Gates foundation employed the author to undertake a HIV prevention programme. Little did Alexander understand the complexity of the problems to be faced , nor I.
The first lines grab you 'Don't step on the people having sex...'
You suddenly realise that this is not your home, your comfort zone, but the reality for thousands of women & men.
The book does not delve deeply into the processes adapted by 'Avahan', but more of an insight into the people's own ability to empower themselves when given the opportunity & underlying support.
It is not for us to be judgemental of any persons 'lot'. Life decisions are more often made based on a change of circumstance and the need to support self and family. It is too easy to stigmitise people and ignore or carelessly forget the social/economic reasons for such 'choices'.
Books such as this gives us a real chance to rethink our own and other people's lives.
Even if you were not interested in the programme itself, reading the short interviews will have you crying one moment and your admiration the next. Their honesty is astounding.
The first lines grab you 'Don't step on the people having sex...'
You suddenly realise that this is not your home, your comfort zone, but the reality for thousands of women & men.
The book does not delve deeply into the processes adapted by 'Avahan', but more of an insight into the people's own ability to empower themselves when given the opportunity & underlying support.
It is not for us to be judgemental of any persons 'lot'. Life decisions are more often made based on a change of circumstance and the need to support self and family. It is too easy to stigmitise people and ignore or carelessly forget the social/economic reasons for such 'choices'.
Books such as this gives us a real chance to rethink our own and other people's lives.
Even if you were not interested in the programme itself, reading the short interviews will have you crying one moment and your admiration the next. Their honesty is astounding.
December 21, 2020
The author has described his journey from being a high level consultant in one of the top consulting firms to leading a successful HIV prevention in the remote corners of India.
The author was pulled out from a lucrative job in Mc Kinsey to lead the HIV programme in India by none other than Bill Gates.
HIV was threatening to infect millions of Indians, thanks to their proclivity to have unprotected sex with commercial sex workers of all genders. The trucking fraternity was one which was threatened the most from a male perspective and of course the CSW were the most threatened from a female perspective.
The state of the CSW comes out, as expected, to be very pathetic. Not only did they have to face the fear of contacting HIV AIDS, they had to put up with social ostracism and live in the fear of the police and their male live partners.
The task was challenging and required a lot of meticulous planning and that is exactly what Ashok Alexander did. The result is for everyone to see. Thanks to actions taken by the author and his team with funding and guidance from the Microsoft CSR team, India has avoided an HIV AIDS pandemic.
The author has traced his growth from a naive person who had limited understanding of how the commercial sex work happens to leading an operation to ensure that they are safeguarded from all the dangers they were facing.
A fascinating read.
The author was pulled out from a lucrative job in Mc Kinsey to lead the HIV programme in India by none other than Bill Gates.
HIV was threatening to infect millions of Indians, thanks to their proclivity to have unprotected sex with commercial sex workers of all genders. The trucking fraternity was one which was threatened the most from a male perspective and of course the CSW were the most threatened from a female perspective.
The state of the CSW comes out, as expected, to be very pathetic. Not only did they have to face the fear of contacting HIV AIDS, they had to put up with social ostracism and live in the fear of the police and their male live partners.
The task was challenging and required a lot of meticulous planning and that is exactly what Ashok Alexander did. The result is for everyone to see. Thanks to actions taken by the author and his team with funding and guidance from the Microsoft CSR team, India has avoided an HIV AIDS pandemic.
The author has traced his growth from a naive person who had limited understanding of how the commercial sex work happens to leading an operation to ensure that they are safeguarded from all the dangers they were facing.
A fascinating read.
November 28, 2025
Ashok Alexander’s A Stranger Truth offers a clear look at HIV prevention in India. The stories from Vizag’s streets and the strength of sex workers who lead their communities with humor and selflessness really stay with you. What struck me most was Alexander’s humility. Even after reaching top levels as a McKinsey partner, he connected with sex workers by seeing their humanity and treating them like any important person he met at the top of the corporate ladder. The book also shows how Avahan, the precursor of the Gates Foundation’s India office, which he led, was handed over to the government to keep it running long-term. It’s rare to see a an individual not seeking credit for himself at the behest of a highly successful program and display long term thinking for the good of a vulnerable community instead. This mix of compassion and practical solutions makes the book an truly inspiring read. And I don’t use that word lightly.
May 3, 2020
Wonderful book considering that book has a world wide audience an appt description of what is happening... So to start with the book sweeps of the rug beneath your feet in first chapter when you look at the whole problem at hand seriously you don't know where to start in that case but then it goes into travel and experiences and a bit rather in detail and to much detail i guess but good thing is atleast it has a part two into parts and i personally would have better appreciated the book of it could have a chapter describing the while program solution discovery and implementation instead of describing in middle the solutions like an epilogue of sorts which describes the solution and the thinking behind it on the high same medium level so that reward readers can see how to solve such problems...
December 14, 2018
An amazing story of India’s little known success in HIV prevention & control, at a time it was threatening to become a serious public health crisis. It is a seemingly unlikely story of making a mission impossible possible by empowering some of most exploited segments of India’s population. It’s a story of hope from despair, of compassion and creating trust and of leveraging the power of community. Ashok Alexander tells this story from the point of view of the project proponent leading the intervention and also from those at its heart - the invisible community most of us readers are shut out from. Despite the subject this is surprisingly easy read. Strongly recommended.
February 18, 2020
Met the author at Bangalore literary fest and honestly couldn't wait to get my hands on the book.I'm glad I wasn't disappointed! Loved how the entire read was personal and always came with the background story of the character,something that really helped build a connect with the reader.Opened up great perspectives of what simple ideas can transform into and how such a stigmatized group was given a chance to build their own solutions with great support from the organisation!
December 13, 2018
Amazing read, takes you through a dark underbelly of the society which we tend to overlook
June 15, 2019
Very well written book.
May 5, 2020
A superb book. An eye-opener, written with a lot of empathy and humility and without any judgement.
May 30, 2020
The story dives deeply into lives of sex workers which in most of the times is tangled and complex. This books contains parts that brings goosebumps and tears in eyes.
Displaying 1 - 19 of 19 reviews