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（FSW）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，艾滋病毒流行病集中在性工作者中，因为75%的男子艾滋病毒感染可归因于与性工作者性交。在塞内加尔，FSW的感染率是普通人群的9倍。1969年，为了限制性传播感染的传播，塞内加尔政府将卖淫合法化，并对性工作活动进行监管。这项政策在非洲大陆是独一无二的，作为这项政策的一部分，21岁以上的性服务工作者必须在保健中心登记，并每月接受健康检查，以检测和治疗性传播感染。为了记录到指定的保健中心就诊的情况，将发放一张印有FSW照片的正式登记卡。最新的身份证赋予FSW招揽客户的权利，未注册的FSW或未遵守每月健康检查的注册FSW可能会被判处最高六个月的监禁。尽管性工作具有法律的地位，但在塞内加尔，性工作在道德上受到社会成员的谴责，保持性工作的秘密是塞内加尔FSW的主要关注。携带登记卡会使性工作者面临社会排斥的风险，如果他们的性工作活动被其亲属发现，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。登记的性工作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，并解释了为什么性工作者仍然是这一集中的艾滋病毒流行病的主要贡献者。此外，由于目前的登记政策设计带有污名，已登记的女性性工作者的福利水平很低。由于附加到这一政策的耻辱是适得其反的艾滋病毒预防工作，干预措施是必要的，以更好地满足FSWs的偏好，以实现更高的登记率和改善FSWs的福祉的方式重新架构登记。早期阶段的研究将旨在确定一个政策的变化，这将允许解决登记的主要障碍，并将增加登记的好处。早期研究亦会提供证据，证明在日后的研究中，评估这项政策改变的成效和成本效益是否可行。

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.