Saint Louis, Senegal — Senegal prides itself on its success in keeping the HIV/AIDS prevalence rate in the country at a comparatively low one per cent of the adult population. But there is one sector of the community, where the government's campaign has an uphill battle ahead: prostitution accounts for the highest number of HIV/AIDS cases in Senegal.
The sex trade, in this predominantly Muslim country, is flourishing and is officially 'tolerated' by the authorities. The registration of commercial sex workers in Senegal was routine fifteen years before the first AIDS' cases were identified here in 1986. But not all prostitutes are registered.
The United Nations AIDS agency, UNAIDS, acknowledges that "it is hard to know exactly how many unregistered sex workers there are. By some estimates there are as many again as there are registered sex workers." Therein lies a huge problem for Senegal.
The West African nation is a busy regional crossroads and migration has become almost an industry for the Senegalese. Tens of thousands of (mainly) men travel outside the country, many as economic migrants. They return home for visits, some having been infected with the AIDS virus, HIV. In their turn, they infect their steady or casual sex partners back home, or so the story goes.
Those mostly likely to pass the virus on in the same way are the prostitutes.
Ngone, 28, is a registered sex worker in Senegal's second city, Saint Louis. She is required to have regular medical checks and has been on the books of the Sexually Transmitted Diseases (STD) Health Centre in the city since 1990, when she started selling sex for money.
Looking older than her years, dressed in flamboyant, colourful, tight clothes and stiletto heels, and sporting an obvious wig, Ngone's facial skin looks raw and bleached, indicating that she uses harmful skin lightening creams. She has her own health card and her medical notes at the centre, which identify her as a prostitute.
Like many women in Senegal who are forced to sell their bodies out of desperation, Ngone told reporters she was driven to prostitution by poverty. "Because I don't have enough money, I took to the streets as a means to earn my living and make ends meet."
And like several other prostitutes who shared their story with allAfrica.com, Ngone said she would abandon prostitution in a heartbeat if she could find something other than her body to sell - clothing, doughnuts - anything that would earn her enough money to live a decent life. She lamented that no such opportunity had come her way.
So, although she was married for 18 months, she still finds herself on the streets, looking for paying customers. Alternative employment to the sex trade is constantly on Ngone's mind and high on her list of priorities. "But, right now I can't get out of it, otherwise you can't eat and I'd have to steal or do something like that, and that's not good."
Volunteer groups such as AWA (the Association for Women at risk from AIDS) and SWAA (the Society for Women against AIDS in Africa), are trying to find other jobs for prostitutes in Senegal, but they lack the resources. They distribute literature, offer advice on HIV/AIDS and the identification of sexually transmitted diseases and provide education on condom usage.
Ngone insists that her clients use condoms; but she says it can take some cajoling, convincing certain customers to oblige. "I talk to them. Sometimes someone will tell me, 'I don't know what they (condoms) are'. I tell them that my advice is to use condoms. I tell them, 'you are young, take care and protect yourself, because there are lots of diseases around. If you don't use condoms, you can catch sexually transmitted diseases. It's not just AIDS'."
The sex worker says she often doubles condoms for extra protection and to avoid them tearing. She gives the thumbs up to her preferred brand, appropriately called 'Protection', which is popular in Senegal.
Millions of dollars have been spent on Senegal's AIDS prevention programmes and awareness campaigns, including the promotion of condoms. Health officials say that between 1988 and 1997, the use of condoms increased from 700,000 to 8 million. Free condoms are supplied on demand .
Ngone says she refuses offers of more money for unprotected sex, but adds that men continue to ask: "Yes, often. There are some guys who keep trying. They say, 'I can give you so much,' and I reply, 'hey why are you offering me that?'" She told allAfrica.com that, so far, she has always tested negative for HIV, but worries that she may become infected. "Of course I'm afraid, because you cannot cure AIDS."
She stocks up on free condoms whenever she goes for her check-up at the clinic in Saint Louis, normally every other week. And she is grateful for the care she receives there. "When I come here, I have a health card and support. If they find that I have a (sexually transmitted) disease, after a consultation and a test, they hold onto my card and give me a prescription for medication which I buy. Though it may be rather expensive, I still buy it."
The UN says Senegal was one of the first countries in Africa to establish a national STD control programme, and among the pioneers on the continent to integrate STD care into its regular primary health services, in response to the threat of AIDS.
Dr Ibra Ndoye and Professor Souleymane Mboup, both medical doctors and AIDS specialists at the forefront of the battle against the disease in Senegal, have identified prostitutes as both a vulnerable and a high-risk group for contracting HIV and passing it onto their clients. But Mboup, a scientist who was instrumental in the isolation of the HIV2 strain, stresses that because of Senegal's long practice of registering commercial sex workers, "when HIV/AIDS came, it was easy to organize this core group of people, evaluate them, document them and train them."
Training is important. The UN says that many prostitutes in Senegal have joined support groups to safeguard their health, attending talks and other information sessions about HIV and AIDS. "We have been shown films and had things explained to us - where AIDS comes from and how you can catch it from so many sources of infection," says Ngone.
Some sex workers also act as outreach trainers and educators for other women in the sex trade, especially for those who may not have registered.
Asked if she thought other sex workers were as well informed as she was, Ngone said: "Yes, there are other girls who are also registered and they know what's what. But there are so many prostitutes that are not registered who do the rounds of the nightclubs and so on. There are so many, hundreds even, and lots of them don't even know what a condom is, you know."
Marieme Sall, who runs the government-funded STD centre that Ngone attends in Saint Louis, agrees with her patient about the unknown number of prostitutes who work underground. "There must be loads of them, loads. I don't know how many, because we don't see them here, but there are lots of 'clandestine' sex workers." Forty-two prostitutes are registered at her clinic.
Sall hovers between despair and hope as she advocates more sex awareness and health education for these women. Her message to the commercial and casual sex workers who have slipped through the net in Senegal is, "Come to the Centre. Come here to be treated, that's how it should be."
To Ngone and other registered prostitutes, Sall says: "If you have friends you know are sex workers, then do encourage them to register and pop into the clinic for treatment of their sexually transmitted diseases and for (HIV) tests. Bring them along. That's what health education is all about, that's the role of this government programme."
Other articles in the series: