Friday, January 17, 2003

Aids ideas that work

While Aids continues to ravage the African continent, the West African country of Senegal is showing remarkable resilience to the epidemic, reports an article from the Health Systems Trust.

Prostitution was legalised in this predominantly Muslim country in 1969, and today the government tolerates it as long as each prostitute registers with the state, is over 21 years old, and comes regularly to a centre run by the Ministry of Health for checkups, education and medical treatment.

This is a major reason why a mere two percent of Senegal's 10.5 million population is infected with the disease, compared to many of its neighbours, such as Botswana with a mind-boggling 39% infection rate, the World Health Organisation reports.

Aids spreads through small nucleus

According to the article, University of Notre Dame physicist Albert-Lszl Barabsi sought to demonstrate in his recent book "Linked: The New Science of Networks," that an epidemic like Aids spreads, to a large degree, from a very small number of individuals.

Most sexually active young men and women have only a handful of partners in a given year; but a few, including many prostitutes, have hundreds. These people bear the lion's share of responsibility for connecting everyone else, which means spreading the disease.

Educating one typical young man or woman about Aids might save five additional people. But educating and protecting a single prostitute might save thousands, or even more.

Starting small and spreading

The article reports that in the United States, epidemiologists traced much of the crisis in the early 1980s to Gaetan Dugas, the so-called "patient zero," a French-Canadian airline steward who had sex with thousands of men.

In East and Southern Africa, Aids probably first spread outward from the so-called "Aids Highway," where truckers would stop to meet with prostitutes as they drove their loads from South Africa to Kenya.

No ban on HIV prostitutes

Senegal is desperately trying to stop infections from spreading among people who could serve as hubs by regularly checking prostitutes for Aids and other sexually transmitted infections (STIs).

If they are HIV-positive, they have the option of government-funded treatment. If a prostitute is discovered to have an STI, she will lose her little green license card until she's finished treatment, largely because infection with one STI dramatically increases one's risk of contracting HIV.

This programme is similar to one in the state of Nevada in the USA, where prostitutes are tested and screened for Aids and other STIs before they are licensed to work. But where Nevada bans HIV-positive prostitutes from working, Senegal allows most of them to go back on the streets after undergoing additional Aids education.

Banning HIV-positive prostitutes, the government's reasoning goes, would both stop these women from coming in for checkups and increase illegal, unregulated prostitution.

Good success rate

According to Anton Meyer, the French doctor in charge of the prostitution programme funded by the Senegalese government and by international health organisations, the decision to try to keep the rate low in the core groups was a good one for Senegal.

The programme is working well, the report says. Fewer than 15 percent of the women who come to the centre test positive for HIV. Furthermore, all of the women at the centre know the stakes of the disease, quite an achievement on a continent where many people believe, for example, that sex with a virgin will cure Aids.

Educating even a few prostitutes about Aids helps spread information throughout the profession, even to those women who've never been to the clinic. "I try to give advice to as many others as I can so that they should come here if they want to stay healthy," says Khaly Sall, a Senegalese woman who has been working as a prostitute for 30 years, and has been coming in for government checkups almost since the very beginning - although she claims she's never had an STI.

"I know about the risk of Aids because I have seen friends who've had it. That's why I come here," says Veronika Igbinoria, a 22-year old Nigerian prostitute who came to Senegal two years ago and says she absolutely never has unprotected sex now.

"If a man comes up to me and says he doesn't need to use a condom because he is paying, I say, 'Do you know whether you have the sickness? Do you know me and whether I have it? You don't.'"

A few shortfalls in programme

There are problems, of course. Many prostitutes operate clandestinely for fear of stigmatisation, and those who are younger than 21 are unable to register or use the government clinics.

While some argue that legalized prostitution only encourages the practice, the question may be moot: There is just too much poverty and too little funding for law enforcement to make a dent in the number of women selling their bodies anyway.

Government action shows results

Senegal's prostitution programme is a major reason why the spread of Aids has slowed in that country, but it isn't the only reason, the report says.

A forward-looking government recognised the magnitude of the problem back in 1986 and Senegal's moderate Muslim and Christian leaders have worked together to improve education while organisations such as the US Agency for International Development (USAID) have thrown money, condoms, or both at the problem.

But many other countries have similar programmes and much higher infection rates. Even the Gambia, a tiny sliver of a nation surrounded by Senegal on three sides, has a higher rate of Aids infection.

Senegal has simply been smart and original in recognising that prostitution exists, that it feeds the epidemic, and that it's better to deal with this problem instead of ignoring it.

While African nations have watched average life expectancies fall by up to 20 years, Senegal is able to post a big sign next-door to where the prostitutes are sitting in the cool hallway: "Don't Let Us Reach Three Percent!"

— Health24

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Created: January 22, 2003
Last modified: January 22, 2003
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