Condom use prevents STIs among sex workers in Dakar, Senegal

A broad-based response keeps HIV prevalence low among pregnant women in Dakar, Senegal

 

Senegal contains the spread of HIV

In Senegal, social marketing of condoms, sex education campaigns, and improved treatment for sexually transmitted infections have helped keep HIV infection rates at a very low level. The government mounted a rapid response to the threat of HIV/AIDS, working with religious leaders and about 200 NGOs in wide-ranging efforts to contain the spread of the disease.

The West African country of Senegal is one of the few countries in sub-Saharan Africa to have succeeded in containing the spread of HIV from the outset. Since the first cases appeared in the country in the mid-1980s, infection rates have remained consistently low at under 2% -- largely due to the success of a nationwide campaign to modify sexual behaviour. This has led to a massive increase in the use of condoms and a delay in the age at which teenage girls first have sex.

Senegal was one of the first countries to mount a rapid broad-based response to the looming threat of a full-scale epidemic of HIV. Political leaders were quick to recognize that efforts to change sexual behaviour were the key to preventing the spread of HIV. And that to achieve this, they would need the support of leaders of the country's mainly Moslem and minority Christian religious communities.

Educational materials were designed and training sessions organized for religious leaders. The issue of HIV/AIDS became a regular feature of Friday service (Salat-al-Jumah) in mosques throughout Senegal, and religious leaders discussed the issue on TV and radio. Brochures were produced to ensure that AIDS education was incorporated into religious teaching programmes. And Christian religious leaders, including those of the Catholic faith, also developed a supportive approach to prevention -- providing counselling and psychosocial support and advocating tolerance and care. Although the issue of condom promotion -- especially outside marriage -- remains an ethical minefield for the country's religious leaders, they have had the courage to refer people to alternative service providers.

By 1995, about 200 NGOs were involved in HIV prevention and care services in Senegal, together with women's groups with a membership of about half a million. HIV prevention was included in sex education programmes at school and outreach services were provided for those outside the school system.

Within this supportive climate, prevention efforts have been targeted to both high-risk groups and to the wider population. Sex workers --who, in Senegal, must be registered and undergo regular health checks -- were urged to promote condom use among their clients. Many of the sex workers established support groups to safeguard their health in the face of AIDS. Prevention efforts were also targeted to men who regularly visit sex workers and to regular suppliers of casual sex. Weekly markets were visited as well as venues frequented by transport workers or migrant labourers -- both high-risk groups for HIV infection. Meanwhile, voluntary counselling and testing services were made available throughout Senegal.

Education campaigns were backed up by social marketing of condoms and concerted efforts to improve STI treatment services. The number of condoms distributed skyrocketed from 800 000 in 1988 to over 7 million by 1997. Condom use by men during casual sexual encounters rose from under 1% before the AIDS epidemic began to 68% by 1997. Meanwhile, in a 1998 study of condom use by sex workers, 99% reported using a condom with their most recent new client and 97% with their most recent regular client. In addition, 60% reported using condoms with men who were not clients.

HIV prevention efforts have also had an impact on the age at which teenage girls first have sex. In 1997, most Senegalese women in their early 20s did not have sex before they were 19 or older -- three years later than their mothers' generation.

The widespread change in sexual behaviour has contributed to a marked decline in the prevalence of sexually transmitted infections -- a key risk factor for subsequent infection with HIV. However, sex workers remain one of the most vulnerable groups. While less than 7% of sex workers in Dakar are infected with HIV, in some areas in the south of the country, as many as one in five sex workers have been found to be HIV-positive.

From the outset, the Senegal Government has made AIDS a health and development priority, with a particular emphasis on HIV prevention activities targeting youth and women. Since 1988, the government funding for AIDS has grown from US$ 100 000 a year to US$ 750 000 today. And Senegal is among the first countries in Africa to have established a national programme for STI control that is integrated into regular primary health care services. However, continued vigilance will be needed if Senegal is to maintain its low level of HIV infection rates.