Optimising the public health benefits of sex work regulation in Senegal: A formative study

在全球范围内，有强有力的证据表明，减少性传播感染在女性性工作者（FSWs）中的传播是减少艾滋病毒/艾滋病传播的一项具有成本效益的战略。在西非，艾滋病毒的流行集中在女服务员中，因为75%的男性艾滋病毒感染可归因于与女服务员的性交。在塞内加尔，妇女受感染的可能性是一般人口的9倍。1969年，为了限制性传播疾病的传播，塞内加尔政府将卖淫合法化，并规范了性工作活动。这一政策在非洲大陆是独一无二的，作为该政策的一部分，21岁以上的女伴必须在保健中心登记，并每月参加健康检查，以检测和治疗性传播感染。签发带有妇女福利署照片的正式登记卡，以便记录到指定的保健中心就诊的情况。持有最新的登记证可让房护局有权招揽客户，而非注册房护局或未遵守每月健康检查的注册房护局可被判处最多六个月的监禁。尽管性工作具有法律地位，但在塞内加尔，性工作在道德上受到社会成员的谴责，保守性工作的秘密是塞内加尔女服务员的核心关注点。如果携带登记卡的性工作者的性工作活动被其亲属发现，她们将面临被社会排斥的风险。因此，塞内加尔80%的性工作者和首都达喀尔57%的性工作者没有登记。登记的家庭服务提供者比例低限制了这一公共卫生政策对艾滋病毒传播的影响，并解释了为什么家庭服务提供者仍然是这种集中的艾滋病毒流行的主要贡献者。此外，由于注册政策的现行设计所附带的污名，注册的fsww的幸福水平非常低。由于这一政策带来的耻辱不利于艾滋病毒预防工作，因此需要采取干预措施，以更好地满足fsw的偏好的方式重新制定登记，以实现更高的登记率并改善fsw的福祉。早期阶段的研究将旨在确定一项政策变化，以解决注册的主要障碍，并增加注册的好处。早期阶段的研究还将提供证据，证明在未来的研究中评估这一政策变化的有效性和成本效益的可行性。

Globally, there is strong evidence that reducing the transmission of STIs among female sex workers (FSWs) is a cost-effective strategy to reduce the spread of HIV/AIDS. In West Africa, the HIV epidemic is concentrated among FSWs since 75% of HIV infections among men are attributable to sexual intercourse with FSWs. In Senegal, FSWs are up to 9 times more likely to be infected than the general population.In 1969, in order to limit the spread of STIs, the Senegalese government legalised prostitution and regulated sex work activities. As part of this policy, which is unique on the African continent, FSWs over 21 years old are compelled to register with a health centre and to attend monthly health visits to test for and treat STIs. An official registration card is issued with the FSW's photograph in order to keep a record of the visits made to the appointed health centre. An up-to-date card gives FSWs the right to solicit clients and non-registered FSWs or registered FSWs who did not comply to their monthly health checks may incur a prison sentence of up to six months.Despite its legal status, sex work is morally condemned by society members in Senegal and keeping sex work secret is a central preoccupation of Senegalese FSWs. Carrying the registration card puts FSWs at risk of social exclusion if their sex work activity is discovered by their relatives and as a result, 80% of FSWs in Senegal and 57% in the capital city, Dakar, are not registered. The low proportion of registered FSWs limits the impact of this public health policy on HIV transmission and explains why FSWs are still a main contributor in this concentrated HIV epidemic. In addition, registered FSWs have very low level of well-being because of the stigma attached to the current design of the registration policy. Because the stigma attached to this policy is counterproductive to HIV prevention efforts, an intervention is needed to reframe registration in ways that better meet preferences of FSWs in order to achieve higher rates of registration and improved well-being of FSWs.The early phase study will aim to define a policy change that will allow to address the main barriers to registration and that will increase benefits of registration. The early phase study will also provide evidence on the feasibility to evaluate the effectiveness and cost-effectiveness of this policy change in a future study.