HIV/AIDS in Senegal
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Although it is one of the poorest countries in the world, with a per capita annual income of less than $600 in 2003, Senegal is considered one of the world’s success stories in HIV prevention. While other sub-Saharan African countries are experiencing the worst epidemics in the world, Senegal has maintained one of the lowest HIV-prevalence levels on the continent, with HIV prevalence stable at under 1% of the adult population since 1997. With a “concentrated” epidemic, the general population in Senegal has remained relatively free of AIDS, though vulnerable populations have significantly higher prevalence; among commercial sex workers, for example, prevalence is around 17%.
Senegal’s success at maintaining low overall prevalence has been attributed to the confluence of a number of factors, including strong political leadership, early involvement and leadership among religious leaders, conservative cultural norms regarding sexual practices, and a comprehensive strategic approach implemented early in the epidemic. A widely cited study by the Joint United Nations Programme on HIV/AIDS (UNAIDS) attributes Senegal’s success at maintaining low prevalence among the general population to the country’s rapid and consistent implementation of the following measures:
- Creation of a Safe Blood Supply. Reinforcement of the national blood supply, which had been systematically tested for syphilis and hepatitis since the 1970s, to prevent HIV transmission through blood transfusions; and the provision of appropriate equipment and personnel trained in HIV testing to regional and national blood banks.
- Registration and Regular Medical Checkups for Commercial Sex Workers. Mandatory registration and quarterly health checkups for commercial sex workers allow these individuals to access treatment for curable sexually transmitted infections and provide a means for the dissemination of HIV/AIDS educational materials to this high-risk population.
- Promotion of Condom Use. Dissemination of millions of condoms through social marketing programs to the general population and free distribution to high-risk populations such as commercial sex workers, health care patients with sexually transmitted infections, youth, and the military have made condoms widely available. By 1997, condom use among men who have casual sex had risen from virtually zero, at the start of the epidemic, to nearly 70%. A 2001 behavioral surveillance survey found that 99% of registered sex workers used a condom with their most recent non-regular partner.
Senegal’s success at containing HIV/AIDS, widely praised and studied, provides valuable lessons for other countries in the region. Containing the epidemic, however, requires ongoing effort. Challenges to continued success include population movement across borders, high HIV prevalence among commercial sex workers, and the need to reach young people approaching sexual debut.
Senegal responded rapidly to the first emergence of HIV/AIDS in the mid-1980s, establishing the Programme National de Lutte contre le SIDA (National Program for the Fight against AIDS) in 1986, renamed as the Conseil National de Lutte contre le SIDA (National Council for the Fight against AIDS) in 2002. The national program quickly undertook significant measures to prevent HIV/AIDS transmission, including condom promotion; sentinel surveillance to determine the scope and spread of the epidemic; confidential counseling and testing; education of sex workers; and integration of HIV into sex education.
From the start of the epidemic, the government worked actively to involve religious and community leaders in HIV/AIDS prevention. In 1995, a national conference resulted in a proclamation of support for HIV prevention activities and a partnership between health care providers and Muslim and Christian religious leaders in the fight against AIDS. This approach combines outreach programs targeting high-risk populations with condom promotion and other prevention efforts, while simultaneously, through the participation of religious leaders and faith-based organizations, reinforcing the traditional sexual norms that have protected Senegal from a widespread HIV/AIDS epidemic. Muslim religious leaders, in particular, have been at the forefront of the national response, preaching about HIV/AIDS in mosques and incorporating AIDS education into religious teaching programs. Both Muslim and Christian organizations provide care and psychosocial services and promote tolerance.
The government’s 2002–2006 strategy continues to emphasize a multisectoral approach that includes the participation of government ministries, the private sector, and religious and civil society organizations, as well as persons living with HIV/AIDS. Priority action areas include prevention, blood safety, sexually transmitted infections, mother-to-child transmission, and social mobilization. A sentinel surveillance survey conducted from late 2004 to early 2005 will provide new information on the state of the epidemic.