When it comes to public health innovations, Senegal rarely come to mind as a role model. But as the The Economist recently reported, the country is an outlier on the continent (and indeed much of the world) in treating sex work as a public health matter.
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 has its flaws: many sex workers face discrimination and are thus fearful of signing up for the initiative. It certainly does not help that police often extort prostitutes into giving them money or sex.
Yet Senegal’s low rate of HIV infection speaks for itself: at a mere 0.4%, it is far lower than the average in sub-Saharan Africa (4.3%) and below even Washington, D.C. (1.9%). While sex work is just one of several factors in the spread of HIV, regulating it has no doubt had an effect.
What are your thoughts? Is regulating sex work the way to go?