GUEDIAWAYE, Senegal, Dec 1, 2006 (AFP) - Senegal's bid to control HIV/AIDS has achieved one of Africa's lowest overall infection rates at less than one percent -- disguising a dangerous rise among vulnerable groups like sex workers and gay men.
Despite the fact that prostitution has been regulated since 1969 in this predominantly Muslim west African country, HIV prevalence is not only much higher but growing among these groups.
Today, HIV infection among legal sex workers in the capital Dakar has risen sharply to 21 percent compared with one percent two decades ago, according to Enda Third World, an international NGO based in Dakar.
And the rate is as high as 30 percent in the southern city of Ziguinchor in the Casamance region, an area where sufficient medical care is lacking, Enda said.
Typical is Lena Diouf, a 28-year-old Senegalese who entered the sex trade as a "clandestine" prostitute two years ago.
"I was the fourth wife of my husband, who couldn't support all of us. Finally his mother asked me and my three children to leave the family," Diouf said.
Without any trade skills or work experience, Diouf, dressed in a long red skirt and black sleeveless shirt, felt she had no other choice but to turn to the oldest profession.
Diouf lives in Guediawaye, a working-class suburb of Dakar, where she and six other sex workers gathered one night at the home of a friend. Most, like Diouf, said they were divorced with children.
A gynaecologist, Fall Marime Diop, arrived in a van outfitted as a mobile medical clinic. Diop and other doctors have been recruited by Enda to make nightly rounds to suburbs with high concentrations of illicit sex workers. They perform free medical exams, consultations and treatments and hand out condoms.
Senegal, with a population of some 12 million, is one of very few Muslim African countries to regulate the sex trade as a way to help prevent the spread of sexually-transmitted infections.
Since 1969, sex workers are required to register with public health clinics, where they are given photo identity cards and make monthly visits for medical checkups.
But the wildcard is those -- the vast majority -- who work outside this system. Enda estimates that more than 80 percent of Senegal's sex workers forego registering their status.
"I don't want to be officially identified as a prostitute for my kids' sake. I don't want them to be at a disadvantage because of me," said Mame Diarra Beye, 23, a mother of three.
Ndeye Sall, 29, a divorced mother of two said carrying a card identifying her as a sex worker would make her vulnerable to being "harassed by the police".
But even among legal sex workers, many are increasingly dropping the monthly checkups to avoid the stigma attached to the visits, therefore missing not only the opportunity of being monitored but also of receiving free condoms, said Fanta Diop, a program manager at Enda.
And buying condoms at a pharmacy itself carries shame in a Muslim country where abstinence and fidelity are preached by religious leaders, she said.
While the HIV prevalence rate for clandestine workers is unavailable, Diop said it was thought to be much higher than that for registered sex workers. According to a recent Enda survey of 613 illegal prostitutes in Dakar, 177 or 29 percent said they did not use condoms.
Another taboo contributing to rising rates is homosexual intercourse, which is forbidden among Muslims.
According to the latest annual report by the United Nations' AIDS program (UNAIDS), a study conducted in five Senegalese cities found 22 percent HIV prevalence among men having sex with other men, 94 percent of whom said they also have sex with women. Only half reported using condoms in the previous month.
Enda is also focussing on the "Petite Cote" beach resort coastline, where orphaned and street children have been identified as being vulnerable to sexual abuse by local and foreign tourists.
In Ziguinchor, where HIV prevalence is around 30 percent, a large weekly market brings merchants from Mali, Gambia and Senegal, which Diop said has contributed to a "very well-developed sex trade".
While 95 percent of prostitutes are Senegalese, Diop said sex workers also migrate from neighboring Gambia, Guinea-Bissau, Sierra Leone and Liberia.
Meanwhile, religious leaders -- in this country that is 94 percent Muslim -- are seen as a key in keeping the overall HIV rate low among the general population.
The Senegalese imams have been increasingly active in spreading a message of tolerance and acceptance of infected people, even if they are prostitutes or gay, allowing them to come forward to seek treatment.
Elhadj Ousmane Gueye, head of a Senegalese Islamic AIDS awareness organization, has been involved in an outreach campaign across the west African region to raise awareness about HIV/AIDS issues.
"Some imams didn't believe AIDS existed," Gueye said.
"But they have come around to understanding that it is a disease like any other, and to spreading the message that it is not a punishment from God, but that we must be careful," he said.
Still, he said the core of the imams' message remains "the three condoms": abstinence before marriage, fidelity during marriage and use of condoms if a spouse is sick.
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