Senegal has all the ingredients for a major AIDS epidemic. In spite of this, it has managed to control the spread of AIDS by addressing multiple vectors of infection. For example, religious leaders in the nation have taken a proactive stance to help their congregations prevent the spread of AIDS. It is also required that all sex workers to be tested on a monthly basis to make sure that they are not infected.
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FRED DE SAM LAZARO: Senegal has many of the hallmark conditions of African nations that have been ravaged by AIDS: low income, high illiteracy and some traditional customs that can spread the AIDS virus. Yet this West African nation has found ways to stave off the HIV scourge.
In this sketch, Mustafa marries his late brother’s wife. In Senegal’s polygamous society, men often marry their brother’s widow or widows. Now he’s just been told he has AIDS. The moral of the story: find out how your brother died.
Education and awareness campaigns like this skit in the small town of Louga are one factor that has helped Senegal block an AIDS epidemic; on a continent where HIV infection has topped 30 percent in many nations, Senegal’s rate is about 1.4 percent.
Experts also cite a number of religious and cultural influences, as well as government programs. Even though the government spends barely a dollar per person each year in public health, this former French colony had health screening programs in place before AIDS arrived.
Targeting the commercial sex trade
Perhaps most importantly, they targeted the commercial sex trade, traditionally the epicenter of an HIV outbreak. In a program that started way back in 1969 to control sexually transmitted diseases, Senegal began requiring its commercial sex workers, or prostitutes, to register in places like the polyclinic here in Dakar, and to come in for regular medical check ups. That program is now key to monitoring the spread of HIV in the country.
About one thousand women are registered at this clinic in the capital, Dakar. Each is issued an ID card, or carnet, according to Dr. Antoine Mahe.
DR. ANTOINE MAHE: So every month she has to come in for examination/and if its okay, she has a stamp on her carnet. If the police goes to her on a case of prostitution, she has to show a card, and the policeman checks the regularity of her visits.
FRED DE SAM LAZARO: Mama Bambera became a sex worker eight years ago; she says the registration program has been a huge help, both in health care services and information.
MAMA BAMBERA (translated): This is a really good thing. I have learned how to protect myself. I did not know anything about AIDS. Now I am able to get information and to pass it on to people with whom I work, and my family members.
FRED DE SAM LAZARO: The system isn’t foolproof. There’s an unknown number of unregistered sex workers, particularly in rural areas. Still, veteran HIV researcher Doctor Suleyman Mboup says the surveillance is paying off. The rate of HIV infection among registered prostitutes is a relatively low 15 percent, and it has remained steady since the early 90s.
DR. SULEYMAN MBOUP: I am military by training, I am colonel in the army and I think that even in any war, you need to know first your enemy and we have been able to document very early. If you see this population as I mentioned, you can document very drastic decrease of rate of infection, both SDI or HIV. In this population we was able to document very high knowledge of this population and some behavior change, very high rate of usage of condom.
FRED DE SAM LAZARO: Senegal may tolerate prostitution but this is still a conservative, overwhelmingly Islamic nation. Some say that could be a reason why HIV hasn’t spread as widely here as it has elsewhere on the continent. The Imam at Dakar’s grand mosque says the most important statistic is that Senegal is 95 percent Muslim.
IMAM ELIMANE NDIAYE (translated): Islam is a religion that prohibits sexual deviance; it does not allow taking liberties with your sex life. As a Muslim, you are obligated to choose your wife and stay with her.
FRED DE SAM LAZARO: But experts say Senegal’s religious leaders went beyond their admonitions based on scriptures. Unlike counterparts in other nations, they acknowledged the threat of HIV, often from the pulpit. And they joined the government in the early 90s in declaring AIDS prevention a national priority. As a result, ordinary Senegalese, workers at the port of Dakar like Ousmane Sarr, have been bombarded by AIDS awareness campaigns. But Sarr insists he’s guided much more by religious principles.
OUSMANE SARR (translated): My primary consideration is for my religion, which as I said, does not permit me to take liberties with my sex life. So why should I be so frivolous to go from one woman to another? And also there is this danger that we have been made aware of.
FRED DE SAM LAZARO: Sarr is 30, has just one wife but says he may marry again as he becomes more financially secure. Islam sanctions polygamy, but it also demands fidelity of each spouse. The Muslim religion also bans alcohol consumption, which is often associated with casual sex. In addition, Muslim men are circumcised. Studies show circumcised males are less likely to get HIV.
AIDS seems a distant problem
FRED DE SAM LAZARO: However, some experts are concerned that rural areas, where more than half the Senegalese live, remain vulnerable to an outbreak. People here are less likely than their urban counterparts to talk frankly about sex, and they have more economic hardships and fewer resources. In villages like Niomre, about 100 miles north of the capital, Dakar, people pride themselves on living by Islamic family values. AIDS seems a distant problem. For example, many women we spoke to had never seen a condom, except in an advertisement.
WOMAN (translated): Only on television. You see, we have good family values, being faithful to our husbands is protection enough for us; we are loyal to each other.
FRED DE SAM LAZARO: The concern among health workers, however, is that many men in this village fit into a classic high risk group for HIV in Africa. Many travel away for extended periods in search of work…prime customers for the commercial sex industry. That’s what happened to “Amadou”, who said an affair with an undocumented sex worker he met in a marketplace led to his infection. And although his wife has tested HIV negative, Amadou feels condemned as a social pariah.
AMADOU (translated): This is very difficult. This is a taboo here. If I went to see the Imam or a fellow Muslim, they would say, okay this guy was coming here in the mosque, praying with us, but he was a hypocrite; he engaged in bad behavior, shame on him!
FRED DE SAM LAZARO: Religious leaders say they’ll continue to preach the Koranic prohibition against adultery as the best prevention. However, they insist that doesn’t condemn those with HIV.
IMAN AHMED MANDAME NDIAYE (translated): When I meet someone who rejects people with AIDS, I remind them that they cannot be sure that the person contracted it by cheating on his wife. There are many other ways to catch AIDS, so we have to be careful. We also have to take into account that, according to the Koran, God is most merciful. If a person repents, God will forgive, so who are we to not give assistance to such a person?
FRED DE SAM LAZARO: One worry among public health workers is that aside from fictional drama or TV spots, most people in Senegal have never personally met anyone with AIDS.
YOUNG MAN (translated): I’m not sure what the hype is all about, because you hear so much about this but I have never met anyone ill with this disease, so you wonder if it is real.
FRED DE SAM LAZARO: Public health workers worry about the potential for complacency, a worry that most parts of Africa, overwhelmed by AIDS would gladly trade.