Senegal is a developing country model for tackling AIDS. This in-depth feature examines some of the fresh problems facing Senegal in its brave battle.
In contrast to most sub-Saharan African countries, Senegal's successful attempts to check the spread of HIV/AIDS has transformed the country into a model over the last two decades – a source of inspiration in the global fight against the epidemic.
Soon after the epidemic broke out, the then government – the country is now ruled by the Democratic Party of Senegal – speedily mounted a socialist-style public education strategy in 1984 that massively mobilised the society against the disease. The effort involved all levels of society, notably women's groups, faith-based organisations, government agencies, the private sector and the media.
According to UNAIDS, Senegal's decision early in its epidemic to invest massively in HIV prevention-and-awareness programmes when HIV infection rates were very low is "still paying off". At the end of 2001 the rate of infection among adults was 0.5 per cent, the UN agency says, (the government puts the current rate at 0.3 per cent). There were 24,000 adults living with HIV/AIDS in 2001, 14,000 of them women. Another 2,900 were children up to the age of 15.
This gives Senegal the lowest infection rate in sub-Saharan Africa – the world's worst-affected region. HIV prevalence rates in Botswana and Swaziland, for instance, are nearly 40 per cent. More than one in five pregnant women are HIV-infected in most countries of southern Africa, compared with one in 100 in Senegal – a figure that has held through 1990-2002, according to UNAIDS.
"When we launched the struggle in the early eighties, the situation was not very bad and since the phenomenon was new, we did everything to forestall the spread of the disease," says Dr Abdel Kader Bacha, one of Senegal's leading AIDS activists.
"Our struggle is still going on unabated… in educating the people about the disease and encouraging them to use condoms," he adds. "As a predominantly Muslim country, we have successfully involved religious communities and leaders in our struggle and their efforts are proving a success."
Twenty years on Senegal is still having to battle against some die-hard attitudes, including risky sex behaviour among the youth, whose reticence to test – because of societal stigma attached to HIV positive status – is raising tremendous concern.
"The problem is occurring throughout the country, but there is no reason for young people to be more afraid of being stigmatised than dying," says Kaltoum Kamara, a social worker with ENDA Santé, a leading AIDS NGO. "In fact if they are found to be HIV-positive, we are always available to assist them in every aspect of their lives."
There are also risks associated with continuing polygamous marriages and clandestine sex-work in both rural and urban areas. According to UNAIDS, HIV prevalence among sex workers has increased slowly over the past decade.
The situation is exacerbated by uncoordinated local research efforts, the inability of the National AIDS Council to reach all sectors of society, especially those living in the remote and rural areas and duplication in the work among the 25 odd NGOs that are working on AIDS. All of this has prompted the government of Senegal to get more directly involved in the battle against AIDS.
One move by the government has been to take direct control of the National AIDS Council, which hitherto was run almost exclusively by local medical practitioners, by placing it directly under the Prime Minister's supervision. Government officials are tight lipped about the exact reasons for the move, saying only that it is aimed at motivating "a multi-sectoral response to the epidemic by directly involving government ministries, grassroots communities and the civil society".
Katy Cisse Wone, programme officer at the National AIDS Council, explains that the move was taken within the framework of an international agreement between the Economic Commission of Africa, a regional arm of the United Nations, and the UN Special Session on HIV/AIDS in 2001. Among other things, it calls for the direct involvement of civil societies and grassroots communities in the struggle against AIDS.
According to Wone, the move is also aimed at enabling grassroots communities that are affected by the epidemic – people who are often left out of health development plans – including those living with HIV/AIDS in rural areas, so that they themselves can come up with project proposals that could be financed directly by the Council.
Projects could include income generation activities such as small-scale farming, arts and craft, and small scale trading. The expectation is that with these projects funded and operational, communities affected by HIV/AIDS could earn enough to buy the drugs and food needed to take care of themselves. The Council has already trained some community leaders in counselling and prevention strategies and, in some cases, provided drugs.
"The question we are faced with is how to strike a balance between the excellent management (of the available donor funds) and the need for an urgent intervention that is needed in the struggle against AIDS," Wone says.
But Tidiane Sy of ENDA Sante, who has been working on AIDS since its inception in Senegal, is cautious about the Senegal success story. He says the AIDS campaign has not been well coordinated between activists and the government and says the infection rate is probably more than the 0.3 per cent put out by government officials.
To back up his assertion, Sy points out that just one region – Mbour, a tourist resort about 150 km from Dakar – accounts for nearly one per cent of those who are infected with HIV/AIDS nation-wide. But Mbour also lacks testing and care centres. Coupled with the reluctance of many young Senegalese to test for HIV – only one centre, run by the Catholic Church in Dakar, is free – this may mean that the many more people are HIV-positive than is commonly acknowledged.
Sy says that poverty is one of the main causes for the spread HIV in Senegal. Large numbers of teenage girls from different parts of the country have settled in Mbour and other tourist havens in southern Senegal, offering sex for money – just to make ends meet.
This trend has also been noticed by UNAIDS. It says HIV prevalence among sex workers in Dakar increased rapidly from 0.1 per cent in 1994 to 19.1 per cent in 1997 before declining to 6.1 per cent in 1998. But the figure rose again to 18.5 per cent in 2001. HIV prevalence among sex workers in Mbour was 24.8 per cent in 2000.
Another area where many hope to see a revival of activity is HIV/AIDS research. Senegalese university-based researchers started work on AIDS as early as 1983 and in 1984-5, the leading researcher, Dr Souleymane Mboup, together with his team of academics and scientists, discovered a strand of HIV different from that in Europe.
The resultant international recognition of Dr Mboup played a major role when the doctor, accompanied by several senior academics and scientists, visited President Diouf to convince him that an HIV/AIDS campaign was needed. It was Senegal's lead role in research on HIV/AIDS that helped build political consensus behind the campaign and to solidify the broad coalition of support.
But now, academics such as Papa Salif Sow, professor of infectious diseases at Dakar University, say that although the expertise is available, there is no research undertaken in the key area of finding an AIDS vaccine due a lack of financial resources.
"There is a marked absence of a planning, coordination and collective mechanism which leads to the fact that the efforts made by some (local) researchers are often limited because they are individual moves rather a coherent team work," says Prof. Sow.
It still remains to be seen if the government's renewed effort to coordinate the activities of all of the AIDS organisations will bear fruit. In the meantime, the public's increasing concern is to see the return of a long list of medical doctors-turned-AIDS activists back to the hospitals.
Tamba Jean-Matthew III is a freelance journalist who was formerly with the Liberia News Agency (LINA).