Its HIV prevalence rate is lower even than Washington, DC
VIOLENCE against women, anti-prostitution laws and poor health-care systems all make sub-Saharan Africa an appalling place to be a sex worker. Criminalised by many African states and exploited by corrupt officials, many women are forced into the world of organised crime. Worse still, they have been at the forefront of the continent’s ongoing AIDS epidemic. One study in 2013 found that in 16 African countries, an average of 37% of sex workers were HIV positive. Yet one African country does things differently. Senegal is the only place in Africa where sex workers are regulated by the state. Identification cards confirm the women as sex workers and give them access to some free health care, condoms and education initiatives. Why is this small west African state so different?
The Senegalese system has its roots in the country’s colonial legacy. French legislation that regulated prostitution in order to prevent the spread of sexually transmitted diseases was kept on the books after independence in 1960, when many other Francophone countries dropped it. In the 1980s Senegal responded to the HIV epidemic sweeping across the continent by establishing a range of policies to counter the threat, and to target vulnerable populations. One measure involved revamping the regulation of sex work, which under the French had required sex workers to register with the authorities. The system was reinforced after the HIV epidemic and the authorities tried to get as many women as possible to sign up.
Today, the law enshrines a woman’s right to work in the sex trade if she is over 21. Health check-ups are mandatory every month a woman wants her sex worker identity card to stay valid (women found without one can be arrested or fined). If a sex worker contracts HIV, she will not have her license revoked completely, and so will not be forced underground. Such women are given free antiretroviral drugs that decrease infectiousness and prolong life. Crucially, once they are on the treatment they are allowed to continue practising. The country’s different approach means that between 2002 and 2016 the prevalence of HIV among sex workers fell by 21 percentage points to an impressive 7%.
The system is far from perfect. Senegal’s regulated system is a long way from, say, Sweden’s decriminalised model. Many sex workers do not sign up to the initiative because they face discrimination and marginalisation. Many also fear that registration could count against them in future. NGOs say police officers often abuse their power, demanding sex and money from prostitutes. The fact that the system only caters for women is another flaw, with no apparent acknowledgement many sex workers are male. Nonetheless, in comparison with other African nations, Senegal’s system is impressive and has contributed to low HIV prevalence rate of 0.4%. The average in sub-Saharan Africa is 4.3%. In Washington, DC the rate is 1.9%.