Dr. Fatim Louise Dia delivered a very comprehensive and illuminating presentation on public health, focusing on Senegal’s AIDs strategy. Senegal is definitely an outlier on Africa’s graph of AIDs occurrences and death from AIDS/HIV. Dia talked about how the Senegalese government has invested a large amount of money into preventing AIDS/HIV cases and was very effective when it first rapidly responsed to the HIV/AIDs crisis of the 1980s. Although Sengal is a very poor country, it has maintained a low HIV prevalence. 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 a low overall prevalence is 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. There was a rapid and consistent implementation of several measures such as: reinforcement of the national blood supply (which had been systematically tested for syphilis and hepatitis since the 1970 in order to prevent HIV transmission through blood transfusions); the provision of appropriate equipment and personnel trained in HIV testing to regional and national blood banks; HIV education programs; registration and regular medical checkups for commercial sex workers (harm reduction measures which allow access to condoms and health services in this high risk population); promotion of condom use in the general population (dissemination of millions of condoms through social marketing programs to the general population and free distribution to high-risk populations).
However, Dia talked about the challenges that remain: international funding for HIV prevention is about to be drastically reduced and the particular agency that finances the council that works on HIV prevention wants to decrease the budget in general and completely erase the council. Also, women with HIV with children do not always administer treatments to their children and go for checkups. It is difficult to achieve efficient patient followup. Moreover, even though anti-retroviral medication is free and available for those who have contracted HIV/AIDs, one still needs the resources to go to the hospital and buy certain things not included in this program. Not everyone has those resources. Some people would prefer to die than to be caught receiving such treatment for fear of the social stigma of having HIV/AIDs. In terms of public health in general, Senegal may be considered a success and a model nation for HIV/AIDs policies and prevention, but its general public health is not exemplary. This all leads to the question of why public resources are directed at certain initiatives and not other areas of impact.
Questions: 1. We talked about prostitiution in Senegal. It is not legal nor illegal – instead, it is illegal to receive services from a prostitute. This is not a particularly liberal policy – it was actually created so that prostitutes were safe from the law to service the Senegalese and French military back in the day. How is the sex industry today in Senegal? What services or protections exist for sex workers? Are “johns” actually apprehended by the authorities or is the law not strongly enforced on the ground?
2. Will agencies in Senegal seek for alternate sources of funding now that Les Fonds have declared that they want to drastically reduce Senegal’s allowance for HIV/AIDs prevention and treatment? What are some possible leads?
3. Question included in last paragraph.