(December 2000) Senegal's AIDS community turns out in force when the local women's association, called AWA, holds its board meetings. UN advisors, medical personnel, representatives from nongovernmental organizations, and the National AIDS Program come to honor the women for their frontline position in the fight against AIDS.
AWA is an association for sex workers who, since 1993, have carried out an ambitious AIDS awareness program in towns across Senegal. Armed with educational brochures and wearing T-shirts with their stylish logo — a pair of hands with painted nails and bangles beating a pink tam-tam with "HIV" on the drumhead — the women have taken their message about AIDS prevention to the streets.
Knowledge of Nightlife Helps Anti-AIDS Campaign
In bars, nightclubs, brothels, and lorry parks (truck stops), they engage people in animated debates, persuading skeptics that AIDS really does exist and that condoms can prevent the virus. Passing around large, color photos of genitalia with obvious signs of sexually transmitted infections (STIs), they describe signs of the most common STIs and demonstrate correct condom use.
Using street theater and their hard-won knowledge of local nightlife, AWA members informed more than 20,000 people about HIV and STIs and distributed more than 180,000 condoms during a three-and-a-half year period, from January 1997 to July 2000, according to Marième Soumaré, a social worker and co-founder of AWA.
One hot afternoon in August, as two AWA members prepared for the annual board meeting, they talked about the organization. One woman said, "We are rejected by everyone. Your parents beat you, people on the street attack you." Another woman interjected, "But the Minister of Health is a member of AWA and our banner is up there with all the others on International AIDS day."
Sex Workers Organize Through STI Clinics
AWA (a translation of "Eve") grew out of an AIDS prevention campaign at Dakar's Polyclinic. In 1993, clinic staff began regular sessions to inform sex workers about AIDS and STIs. Inspired by their new knowledge and with the support of clinic staff, the women requested additional training so they could pass on the information to their clients and to the clandestine sex workers who are not registered with the local STI clinic.
Madina Bambera, a former sex worker who is now a board member of AWA, was among the first set of trainees. She said, "I saw my friends die and women in bars were still taking risks so … now I go around to talk to them."
Membership in AWA has given Bambera a new sense of purpose. No longer just another sex worker on the run-down streets between the main market and the lorry park, she now has special status in her neighborhood. Her in-depth knowledge of AIDS and close ties with Dakar's medical establishment make people seek her out. The garage mechanics and drivers who frequent the street come to her for advice and condoms and, occasionally, she even persuades one of them to come to the clinic for testing.
There are now about 300 sex workers enrolled in AWA in five towns in Senegal. Organized through the government-run STI clinics that treat legal sex workers, AWA has a 10-member board composed of sex workers, midwives, social workers, and AIDS experts. "The prostitutes have the decision-making power," explained Soumaré. "But most are not literate, so we help organize activities and apply for funding."
AWA's funding has never been steady, but since 1993, international organizations have provided intermittent financial support. Start-up money from the Canadian International Development Agency (CIDA) helped launch their activities, followed by funding from AIDSCAP of Family Health International (FHI), the UN Development Programme, Handicap International, and additional funding from CIDA. According to Soumaré, from January 1997 to July 2000, AWA received 48 million CFA francs (US$68,000) and assistance in the form of training, consultants, and medicine. She says the organization is now planning to ask for a three-year contract of 235 million CFA francs, or an annual budget of US$110,000 for three years to permit them to expand their activities.
Senegalese Legislation "Tolerates" Sex Workers
Since its founding, AWA has been closely tied to the National AIDS Program, which provides some technical assistance. AWA's links to this program and state-run clinics can be traced to Senegal's legislation that "tolerates" prostitution. Based mainly on a series of decrees and laws made since the 1960s, legislation on sex workers focuses on three main points. It aims to prevent soliciting in public, control STIs through regular mandatory medical tests, and prevent sex work by minors who are under the age of 21.
The legislation requires sex workers to register with their local STI clinic and obtain a special ID card. To maintain their legal status, sex workers must report every month to a special sex workers' section of their local STI clinic where they are regularly tested for STIs and HIV. Though the law calls for two visits per month, clinic staff say overcrowding has forced them to reduce the visits to one a month. A woman who has an STI must relinquish her card until treatment is completed, a precaution that aims to keep her from working, since the police can arrest her for working without her card. Sex workers are asked to pay the clinic 500 CFA francs (about 80 cents) a month for tests and treatment, but many do not.
Official sex workers are eligible to join AWA and take advantage of its activities as well as become part of its informal family, a bonus for women who are frequently rejected by their own. Members receive information on AIDS and STIs, including training in AWA's peer-education program. The organization also provides help in emergencies, including medical care and psychological counseling.
Finding Other Occupations Is Difficult
Job training — another focus of AWA's activities — is high on the list of reasons sex workers give for joining the organization. Most are illiterate, have no financial resources, and generally, are the sole source of support for their children. The sex workers are well aware of the dangers they face. As the midwives point out, even among AWA members, STIs, including HIV, are still too common. "We need to find other occupations for them so they don't have to say 'yes' to men who won't wear condoms," said Marie-Jeanne Ndoye, a midwife at the clinic.
Many sex workers are clear about their desire to change. "I'm looking for a way to stop," said a woman in her mid-30s, who was interviewed at the beach resort at Mbour. "There are too many diseases, and besides, I'm too old … They take one look at me and, 'Whump, it's out you go, Mama," she said, making a forceful sweeping gesture with her hand. She would like to work as a peer educator, organizing AIDS prevention sessions in bars every night, a goal of other AWA members. Yet, their funding barely pays the small staff.
Leaving sex work is difficult for AWA members. Training courses to prepare women for other occupations have not met with much success, nor has it been easy to establish a "tontine," a common savings plan in West Africa. Ramatoulaye Dioume, formerly of FHI, suggested that the organization needs a full-time financial specialist because, as the social workers are the first to admit, they do not have the time or financial skills.
AWA also aims to protect sex workers' legal rights, but social workers complain about the lack of resources to protect women when the police arrest them on trumped-up charges. Sometimes the women have to choose between going to jail or meeting police demands for money or sex, or both.
Despite some weaknesses, AWA offers real benefits to sex workers. As their conversations illustrate, the more incentives AWA has to offer, such as legal protection, training, microcredit projects, even free condoms, the greater the numbers who will join.
But becoming a member of AWA requires registering at the local clinic and, for various reasons, significant numbers of sex workers do not take this first step. In fact, some experts claim that only a fraction of the women involved in sex work are registered. Their reasons vary: many are too embarrassed; some work only occasionally; and many do not consider themselves prostitutes, though their activities meet the criteria set out in Senegal's legislation of soliciting, having sex, and accepting money.
Number of Young, Clandestine Sex Workers Increasing
One of the major reasons sex workers do not join AWA is the law that states sex workers have to be at least 21 years old. At the same time, the number of young sex workers is increasing sharply, and the young women face heightened risks of HIV infection for physiological and social reasons. As Marième Soumaré pointed out, the law was made before economic conditions forced so many young girls into prostitution and also before AIDS added to the dangers facing them.
A Saturday afternoon in the beach town of Mbour, which has a thriving sex market for European tourists, illustrates the situation. Girls, some as young as 15, lean on bar stools and giggle like the schoolgirls they would be elsewhere. Dressed in short skirts and skin-tight trousers, with rows of tiny gold hoops glittering in their ears, they are the belles of the bars in this raunchy seaside town.
Prevalence rates among sex workers of Mbour are among the highest in Senegal — around 29 percent, according to Mary Cissé Thioye, a social worker at the Polyclinic. These figures do not take into account the young girls whose age makes it illegal for them to be treated at the local STI center and makes them ineligible for AWA membership.
Young Sex Workers Not Tested
The absence of clandestine sex workers from the official clinic lists is a reason for concern among public health and AIDS experts. First, these women are not being treated for STIs or tested for HIV. Second, the test results from official sex workers' monthly check-ups provide data for calculating Senegal's AIDS prevalence rates among high-risk groups. Not including the HIV rates of clandestine sex workers means the prevalence rates could well be considerably higher than the rates now reported.
Despite the clear-cut need to lower the age for legal prostitution, experts in the field, physicians, social workers, and officials at the National AIDS Program agree that it would be impossible to take this step because of the country's powerful religious leaders.
"The legal age of prostitution will never be changed in Senegal," said Dr. Charlotte Faty Ndiaye, president of the Society of Women Against AIDS in Africa (SWAA). "Even to point out that prostitution is legal for those over 21 will raise a furor from the public. The religious leaders would start a campaign to make all prostitution illegal."
Dr. Karim Seck, an adjunct to the director of the National AIDS Program, agreed. "The religious leaders would lobby. Already they say we have authorized prostitution. If we try to lower the age, we will only have more problems."
In the meantime, the clinic has an informal strategy to work around the laws. Mary Cissé Thioye, who works at the STI clinic in Dakar, said that a woman under 21 could probably receive free treatment for an STI at the clinic, but she would have to pay for testing. The HIV test costs 5000 CFA francs (about US$7.50), while the testing for STIs is 3000 CFA francs (US$4.50) — high enough to prevent a woman who earns her living from sex work to avoid regular testing. Equally important, social workers and medical staff would not follow up on her case with house calls and re-testing as they would for a registered sex worker.
Expanding the AIDS Awareness Campaign
Social workers, medical personnel, and sex workers agree that changes need to be made. They point to the need to protect sex workers, especially the growing numbers of young ones, and to facilitate the gathering of accurate information on AIDS prevalence among high-risk groups. In the meantime, AWA is filling a place in the lives of its members.
"AWA lets us take our place among the women of our society. At International AIDS day, all the women are there, and I am, too. Before, we didn't dare participate … We were only in the waiting room of the clinic. Now, we have something to share with other women," said Bambera, the former sex worker and AWA board member.
Victoria Ebin is a freelance journalist and consultant to the Population Reference Bureau, based in New York City.
For More Information
Latest UN data on HIV/AIDS: www.unaids.org.