Chapter 9 emphasizes the importance of helping marginalized people—notably, sex workers, so-called untouchables. Poverty often drives women into sex work. Gates recommends empathizing rather than judging these women. In 2003, the Bill & Melinda Gates Foundation launched Avahan (‘call to action’), an HIV prevention program. The program, which aimed to halt the spread of HIV across India, became one of the world’s largest HIV prevention projects. A single sex worker infected with HIV can spread the disease to hundreds of clients, including truckers, who then infect their partners and future children. Condom use is key to curbing HIV transmission, but many clients refuse to use them. In 2004, Gates traveled to Calcutta and met with sex workers, who spoke about the poverty, stigma, and violence they faced from their lovers and clients. They also voiced their desire to spare their daughters from having to do sex work.

How Empowerment Starts

Avahan’s goals changed after Gates and her staff spoke with sex workers. Before the trip, they aimed to promote condom use, STD treatment, and HIV tests—but they soon realized that their goals did not align with those of the sex workers themselves, whose primary concern was violence.