Optimising the Public Health Benefits of Sex Work Regulation in Senegal: A Formative Study
Project Summary
Globally, there is strong evidence that reducing the transmission of STIs among female sex workers (FSWs) is a cost-effective strategy to reduce the spread of HIV/AIDS.
In West Africa, the HIV epidemic is concentrated among FSWs since 75% of HIV infections among men are attributable to sexual intercourse with FSWs. In Senegal, FSWs are up to 9 times more likely to be infected than the general population.
In 1969, in order to limit the spread of STIs, the Senegalese government legalised prostitution and regulated sex work activities.
As part of this policy, which is unique on the African continent, FSWs over 21 years old are compelled to register with a health centre and to attend monthly health visits to test for and treat STIs.
An official registration card is issued with the FSW's photograph in order to keep a record of the visits made to the appointed health centre. An up-to-date card gives FSWs the right to solicit clients and non-registered FSWs or registered FSWs who did not comply to their monthly health checks may incur a prison sentence of up to six months.
Despite its legal status, sex work is morally condemned by society members in Senegal and keeping sex work secret is a central preoccupation of Senegalese FSWs.
Carrying the registration card puts FSWs at risk of social exclusion if their sex work activity is discovered by their relatives and as a result, 80% of FSWs in Senegal and 57% in the capital city, Dakar, are not registered.
The low proportion of registered FSWs limits the impact of this public health policy on HIV transmission and explains why FSWs are still a main contributor in this concentrated HIV epidemic. In addition, registered FSWs have very low level of well-being because of the stigma attached to the current design of the registration policy.
Because the stigma attached to this policy is counterproductive to HIV prevention efforts, an intervention is needed to reframe registration in ways that better meet preferences of FSWs in order to achieve higher rates of registration and improved well-being of FSWs.
The study will aim to define a policy change that will allow to address the main barriers to registration and that will increase benefits of registration. The study will also provide evidence on the feasibility to evaluate the effectiveness and cost-effectiveness of this policy change in a future study.
Key Project Information
Principal Investigator: Aurélia Lépine
Dates: February 2020 to August 2021
Status: Complete
Partners: University of Grenoble Alpes, Erasmus University Rotterdam, London School of Tropical Hygiene and Medicine, Ministry of Health Senegal
Location: Senegal
Funding: MRC UK
Contact: a.lepine@ucl.ac.uk
UCL Institute for Global Health
Dr Aurélia Lépine - PI
Ms Fanny Procureur - Research Fellow
Ms Sandie Szawlowski - Research Assistant
University of Grenoble Alpes
Dr Carole Treibich
Ministry of Health Senegal
Dr Cheikh Tidiane Ndour
Mr El Hadj Alioune Mbaye
Ms Khady Gueye
Erasmus University Rotterdam
Ms Wally Toh – PhD student
London School of Tropical Hygiene and Medicine
Mr Henry Cust – PhD student
Publications
Aurélia Lépine, Carole Treibich and Ben d'Exelle. 2020. “Nothing but the truth: Consistency and efficiency of the list experiment method for the measurement of sensitive health behaviours”, Social Science & Medicine. In press.
Aurélia Lépine and Carole Treibich. 2020. “Risk preferences and HIV/AIDS: evidence form Senegalese sex workers”, Social Science & Medicine. In press.
Carole Treibich and Aurélia Lépine. 2018. “Estimating misreporting in sensitive health behaviours: Evidence from condom use of female sex workers in Senegal”, Health Economics, 28(1), 144-160.
Seiro Ito, Aurélia Lépine, and Carole Treibich. 2018. “The impact of becoming a registered female sex worker in Senegal on health and wellbeing”, Health Economics, 27(11), 1627-1652.
How has COVID-19 impacted female sex workers and their risky behaviours?
