|Acting Early to Prevent AIDS: The Case of Senegal (UNAIDS, 1999, 28 p.)|
|Senegals response to the advent of AIDS|
Registration of sex workers had been routine in Senegal for more than 15 years by the time AIDS arrived. Registered sex workers were required to have regular health checks, and STDs were treated if necessary. This meant that sex workers were in regular contact with the health services, and the spread of HIV infection could easily be monitored in this group.
It was immediately clear that sex workers were at extremely high risk both of contracting HIV and of passing it on to their clients. Preventive interventions centring on the promotion of condom use with clients were immediately put in place. Many sex workers began to join support groups to safeguard their health in the face of AIDS. Over 30 such groups have been established. Members attend talks, films and other information sessions about HIV and AIDS usually around five times a year. They also act as outreach educators for women who work in the sex trade but who have not joined support groups. These include women who have not registered as sex workers. It is hard to know exactly how many unregistered sex workers there are by some estimates there are as many again as there are registered sex workers. Little is known, too, about levels of infection or risk behaviour among these women. They will certainly become an increasing focus for future prevention efforts.
There are also renewed efforts to reach populations that may be regular suppliers or consumers of casual sex, whether or not in exchange for money. These include mobile populations such as migrant workers and transport workers. Locations where casual sex may take place, such as weekly markets, are also becoming targets for more active prevention efforts.
It has long been known that the presence of other STDs makes it easier to contract or pass on HIV infection. So regular and adequate treatment of STDs moved up the list of health priorities once the threat of an HIV epidemic became clear. The provision of STD services was strengthened both among sex workers and in the general population.
Senegal was one of the first countries in Africa to establish a national STD control programme, and one of the first to integrate STD care into its regular primary health services. In response to the threat of AIDS, the country undertook a massive training of health workers in the syndromic management of STDs. The quality of care improved greatly after the training compared with a baseline study before training. The provision of correct advice about future prevention as well as about partner notification rose even more dramatically.