The Moment of Lift

by Melinda Gates

  Beyond our conversations, what struck me most about Gita and the other women I met was how much they wanted to touch and be touched. Nobody in the community touches a sex worker except to have sex with her. No matter what caste they’re from, sex workers are untouchable. For them, touching is acceptance. So when we hugged, they held on. I’ve seen this again and again when I’ve met with sex workers of all genders. We talk and take a photo and hug—and they won’t let go. If I turn to greet someone else, they hold on to my shirt or keep a hand on my shoulder. In the beginning I found it awkward. After a while, though, I melted into it. If they want to embrace a bit longer, I’m all in.

  So I gave lots of hugs, and I listened to stories—harsh tales of rape and abuse, and hopeful stories about children. As our time together came to an end, the women said they wanted a group photograph, so we linked our arms and took a picture (which would appear in the next day’s paper). I found that moment very emotional, and I was already on the edge. Then a few of the women started singing the civil rights anthem “We Shall Overcome” in Bengali-accented English, and I started to cry. I tried to hide it because I didn’t know how they would interpret my tears. For me, the contrast between their determination and their dire circumstances was both inspiring and heartbreaking.

  These women were our partners. They were the frontline defenders against AIDS in India, and we still didn’t fully understand how brutal their lives were. They faced constant violence from their lovers, from their clients, who were themselves poor and marginalized, and from the police, who would harass them, arrest them, rob them, and rape them.

  The brutality of their lives was a revelation even to our staff in India. In one case, members of our team met with four or five sex workers to have tea and conversation in a restaurant. Later that day, the sex workers were arrested because they had gathered together in a public place.

  Shortly after that, one Avahan worker drove out to a coastal road near the Bay of Bengal where the truckers stop, so he could learn about the lives of sex workers there. He met with a group of women for a few hours—sitting on a mat, drinking tea, and asking about the program, what helped, what more was needed. When the meeting was over and people were saying their good-byes, one of the sex workers started crying. Our team member was afraid he’d said something insensitive, so he asked one of the other women, “Did I do something wrong?” She said, “No, it’s nothing.” When he pleaded for an answer, the woman said, “She was crying because you, a respectable man, had come to meet her and talk to her politely as opposed to paying her for sex, and she thought it was such an honor that someone would come just to have tea with her.”

  Another story came from a partner of ours, a woman who was very devoted to improving the lives of sex workers in her area. She told us she was once at the bedside of a sex worker who was dying of AIDS, and the sex worker said, “Would you please fulfill my last wish?” “I’ll do whatever I can,” the woman replied. So the sex worker asked, “Can I call you Aai?” Aai in Marathi means “mother.” That was her only wish, to call this loving woman there at her deathbed “mother.” That’s how hard their lives are.

  How Empowerment Starts

  We hadn’t taken the realities of sex workers’ lives into account when we designed the Avahan program. We didn’t think we had to. We wanted sex workers to insist on condom use with their clients, get treated for STDs, and get tested for HIV—and we thought it was enough to tell them about the benefits and ask them to do it. But it wasn’t working, and we couldn’t understand why. We had never imagined that something might be more important to them than preventing HIV.

  “We don’t need your help with condoms,” they said, almost laughing. “We’ll teach you about condoms. We need help preventing violence.”

  “But that’s not what we do,” our people said. And the sex workers answered, “Well, then you don’t have anything interesting to tell us, because that’s what we need.”

  So our team held debates about what to do. Some said, “Either we rethink our approach or we shut this down.” Others said, “No, this is mission creep—we have no expertise in this area, and we shouldn’t get involved.”

  Eventually, our team met again with the sex workers and listened intently as they talked about their lives, and the sex workers emphasized two things: One, preventing violence is their first and most urgent concern; two, fear of violence keeps them from using condoms.

  Clients would beat up the women if they insisted on condoms. The police would beat them up if they were carrying condoms—because it proved they were sex workers. So to avoid getting beaten up, they wouldn’t carry condoms. Finally we saw the connection between preventing violence and preventing HIV. The sex workers couldn’t address the long-term threat of dying from AIDS unless they could address the near-term threat of being beaten, robbed, and raped.

  So instead of saying, “It’s beyond our mandate,” we said, “We want to help protect you from violence. How can we do that?”

  They said, “Today or tomorrow, one of us is going to get raped or beaten up by the police. It happens all the time. If we can get a dozen women to come running whenever this happens, the police will stop doing it.” So our team and the sex workers set up a system. If a woman is attacked by the police, she dials a three-digit code, the code rings on a central phone, and twelve to fifteen women come to the police station yelling and shouting. And they come with a pro bono lawyer and a media person. If a dozen women show up shouting, “We want her out now or there’s going to be a story in the news tomorrow!” the police will back down. They will say, “We didn’t know. We’re sorry.”

  That was the plan, and that’s what the sex workers did. They set up a speed-dial network, and when it was triggered, the women came running. It worked brilliantly. One sex worker reported that she had been beaten up and raped in a police station a year before. After the new system was in place, she went back to the same police station and the policeman offered her a chair and a cup of tea. Once word of this program got out, sex workers in the next town came and said, “We want to join that violence prevention program, not the HIV thing,” and soon the program spread all over India.

  Why was this approach so effective? Ashok Alexander, then head of our India office, put it bluntly, “Every man who’s a bully is scared of a group of women.”

  We thought we were running an HIV prevention program, but we had stumbled onto something more effective and pervasive—the power of women coming together, finding their voices, and speaking up for their rights. We had begun funding women’s empowerment.

  Empowerment starts with getting together—and it doesn’t matter how humble the gathering place is. The scene of empowerment for Avahan was community centers—often just small, one-room structures built of cinder blocks where the women could meet and talk. Remember, these women had no place to gather. If they met in public, the police would round them up and put them in jail. So when our team redesigned the program around violence prevention, they began to rent space and encourage the women to come and talk. The community centers became the place they could get services. They could get condoms. They could meet each other. They could take a nap. They weren’t allowed to stay overnight, but in daytime hours, many of them would lie on the floor and sleep as their kids ran around. In some places, the team put in a beauty parlor or a space for playing board games. The centers became the place where things happened. And the idea came from the women themselves.

  The opening of the first drop-in center was “the most beautiful thing I’ve ever seen,” according to an early Avahan team member. Five women walked in, afraid they were going to be drugged and have their kidneys harvested. That was the rumor. Instead they were welcomed and told, “Just talk to each other. Drink three cups of chai and then leave.” That’s how empowerment began at Avahan—people on the outermost margins of society, excluded by everyone, coming together to talk, drink tea, and lift each other up.

  Bill and I knew about the program’s shift to viole
nce prevention, but we were in the dark about the community centers, and this still makes me laugh. Ashok would come meet with us in Seattle and give us reports, but we didn’t get the full story until Bill and I went to India together in 2005. Ashok was briefing us, explaining what we were about to see, and he started talking about these community centers, tiny spaces where sex workers could gather and talk. I remember saying to Bill after the briefing, “Did you know we were funding community centers?” He said, “No, did you know we were funding community centers?”

  We had given Ashok the money, and he’s a smart businessperson, so he set a strategy and tacked against it. He did everything he said he was going to do, and some things he never mentioned. And thank goodness for that, because the honest and embarrassing truth is that if he had come and presented the idea of community centers to us at the foundation, I think we would have said no. We would have seen it as too remote from our mission, which was to work on innovations and depend on others to get them out. Helping distribute condoms was already a big step away from our self-image as innovators who counted on others for delivery, but to work on violence prevention through empowerment nurtured in community centers—that would have been too radical for us, at least until we saw their value on that trip to India.

  On that visit, Bill and I met with a group of sex workers. There is a photo of that event hanging prominently at the foundation office—Bill and I sitting cross-legged on the ground taking our place in the circle. At the start of our meeting, I asked one of the women, “Please tell us your story.” She told us about her life. Then another woman told us how she got involved in sex work. Then a third woman shared a story that brought silence to the room, broken only by the sounds of sobbing. She told us she was a mom, she had a daughter, the father was not in the picture, and she had turned to sex work because she had no other options for income. She was making every sacrifice to create a better life for her daughter, who had lots of friends and was doing well in school. The mother had constantly worried, though, that as her daughter got older, she might find out how her mom made money. One day, exactly as the mother feared, her daughter’s classmate announced to everyone at school that the girl’s mother was a sex worker, and her friends began mocking her viciously and continuously in the cruelest ways. A few days later, the mother came home and found her daughter dead, hanging from a rope.

  I shot a look at Bill. He was in tears. So was I, and so was everyone else in the room—especially the women whose wounds were opened up by this story. These women were in agony, but they were also full of empathy, and that eased their isolation. By coming together and sharing their stories, they gained a sense of belonging, and the sense of belonging gave them a feeling of self-worth, and the feeling of self-worth gave them the courage to band together and demand their rights. They were no longer outsiders; they were insiders. They had a family and a home. And slowly they began to dispel the illusion that society imposes on the disempowered: that because they are denied their rights, they have no rights; that because no one listens to them, they are not speaking the truth.

  Brené Brown says that the original definition of courage is to let ourselves be seen. And I think one of the purest ways to let ourselves be seen is to ask for what we want—especially when no one wants us to have it. I just fall silent before that kind of courage. These women found that courage with the help of each other.

  The impact of Avahan grew way beyond the accomplishments of that first group of women, and the story was not just about how inclusion and community empowered a group of outcasts. It was about what those outcasts did for their country. I’ll give you two examples.

  First, many years ago, about the same time that Bill and I made this trip to India, we were exploring different approaches to fighting AIDS, and we got super excited about a new possibility—that the drugs effective in treating AIDS could also work in preventing AIDS. We helped fund drug trials to test the idea, and the trials came back with spectacular findings: Oral prevention drugs can cut the risk of getting HIV through sex by more than 90 percent. The AIDS community’s highest hopes were fulfilled. Then they were dashed.

  The approach required healthy people to take pills every day, and the at-risk groups just didn’t do it. Getting people to take up any new health behavior, no matter how effective, is frustratingly difficult. People have to be engaged, informed, and highly motivated. Tragically, AIDS activists and funders and governments and health workers just could not get people to take the drugs. Only two groups, worldwide, were an exception: gay white men in the United States … and women sex workers in India.

  A study showed that 94 percent of Indian sex workers took the drugs faithfully and continuously. That level of compliance is unheard of in global health—and the study attributes it to the strong networks created by the women in Avahan.

  That’s the first example. Here’s the second. In 2011, the British medical journal The Lancet published an article showing that the intensity of the Avahan work correlated with lower HIV prevalence in a number of India’s most populous states. In the years since, it’s been well documented that sex workers’ insistence on condom use with their clients kept the epidemic from breaking more widely into the population. These empowered women became indispensable partners in a national plan that saved millions of lives.

  In a country where no one would touch them, these women touched each other, and in that small society of acceptance, they began to discover and recover their dignity, and from their dignity came the will to demand their rights, and in asserting their rights, they were able to protect their lives and save their country from catastrophe.

  Finding Our Voices

  More than ten years after Avahan led me on a path of women’s empowerment, I was in New York City moderating a panel on women’s social movements. One of my guests was the amazing Leymah Gbowee, who shared the 2011 Nobel Peace Prize with Ellen Johnson Sirleaf and Tawakkol Karman. Leymah was recognized, along with Ellen, for launching a women’s peace movement that helped bring an end to the Liberian civil war.

  Sometimes when I’m in the middle of the work—even when I think I know what I’m doing—I find that I really don’t have a deep understanding of the forces at play until after the action is over. Then, sometimes years later, I look back and say, “Oh!! I get it.” That’s what Leymah offered me that day—not just an understanding of her peace movement, but how its principles helped explain the success of Avahan and so much more.

  Leymah told us that she was living in her country as a 17-year-old when the first of two civil wars broke out there. After the end of the first war and before the start of the second, she studied peace activism and trauma healing and came to believe that “if any changes were to be made in society, it had to be by the mothers.”

  She was invited to Ghana to attend the first-ever meeting of the Women in Peacebuilding Network, which included women from nearly every West African nation. Leymah was named coordinator of the Liberian Women’s initiative, and after the second civil war broke out, she began working around the clock for peace. One night, after again falling asleep in her office, she awoke from a dream where she’d been told, “Gather the women and pray for peace.”

  She went to the mosques on Friday, the markets on Saturday, and the churches on Sunday to recruit women for peace. She gathered thousands of Muslim and Christian women, led demonstrations and sit-ins, defied orders to disperse, and eventually was invited to make the case for peace to Liberian president Charles Taylor, with thousands of women demonstrating outside the presidential mansion. She won a grudging promise from Taylor to hold peace talks with the rebels in Accra, Ghana.

  To keep up the pressure, Leymah and thousands of other women went to Accra and demonstrated outside the hotel that was hosting the talks. When progress stalled, Leymah led dozens of women inside the hotel, and more women kept coming until there were two hundred. They all sat down in front of the entrance to the meeting hall and sent a message to the mediator that the men would not be al
lowed to leave until they had a peace agreement.

  The mediator, former Nigerian president Abdusalami Abubakar, gave his support to the women and allowed them to maintain their presence and their pressure right outside the hall. The activists were given credit for changing the atmosphere of the peace talks from “circuslike to somber,” and within weeks, the parties had an agreement and the war was officially over.

  Two years later, Ellen Johnson Sirleaf was elected president of Liberia, becoming the first woman elected head of state in Africa.

  Many years later, when Leymah sat down with me in New York, I asked her why her movement was so effective. She said, “We women in these communities are the nurturers of society. And it was upon us to change it.”

  By 2003, she said, Liberia “had gone through over fourteen warring factions and made more than thirteen peace agreements. We said to ourselves, ‘The men have done the same thing over and over. We have to bring some sense to the process. Instead of starting a women’s warring faction, let’s start a women’s peace movement.’”

  Then she told us an astonishing story about what that meant.

  “There was one Muslim woman who had lost her daughter in the war,” Leymah said. “She was part of our movement. She was feeding a fighter who had multiple gunshot wounds when he recognized her and said, ‘Sit me up.’ So she sat him up and he asked her, ‘Where’s your daughter?’ She said, ‘Oh, she died.’ The fighter said, ‘I know.’ She said, ‘How did you know?’ He said, ‘Because I killed her.’