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Editorials and Commentary

The Network Effect -- Why Senegal's Bold Anti-AIDS Program Is Working

January 8, 2003

"... Prostitution was legalized in this predominantly Muslim country [Senegal] in 1969, and today the government tolerates it as long as each prostitute registers with the state, is over 21 years old, and comes regularly to a center run by the Ministry of Health for checkups, education and medical treatment. And that's a big reason why [Senegal] has an HIV infection rate of about 2 percent while ... some Southern African countries, such as Botswana, report that a mind-boggling 39 percent or more of the adult population is infected.

"As University of Notre Dame physicist Albert-Lszl Barabsi sought to demonstrate in his recent book, 'Linked: The New Science of Networks,' an epidemic like AIDS spreads, to a large degree, from a very small number of individuals. ... And as in other networks, like the World Wide Web, these 'hubs' bear the lion's share of responsibility for connecting everyone else -- which in this case means spreading the disease. Educating one typical young man or woman about AIDS might save five additional people. But educating and protecting a single prostitute might save thousands, or even more. ...

"Senegal is desperately trying to stop infections from spreading among people who could serve as hubs by regularly checking prostitutes from AIDS and other [STDs]. If they are HIV-positive, they have the option of government-funded treatment. If a prostitute is discovered to have an STD, she will lose her little green license card until she's finished treatment, largely because infection with one STD dramatically increases one's risk of contracting HIV. This program is similar to one in ... Nevada, where prostitutes are tested and screened for AIDS and other STDs before they are licensed to work. But where Nevada bans HIV-positive prostitutes from working, Senegal allows most of them to go back on the streets after undergoing additional AIDS education. Banning HIV-positive prostitutes, the government's reasoning goes, would both stop these women from coming in for checkups and increase illegal, unregulated prostitution. ...

"And the program is working. Fewer than 15 percent of women who come to the center test positive for HIV. ... Educating even a few prostitutes about AIDS helps spread information throughout the profession. ...

"... Senegal has simply been smart and original in recognizing that prostitution exists, that it feeds the epidemic, and that it's better to deal with this problem instead of ignoring it. ..."

The author is a fellow at the New America Foundation.

Back to other CDC news for January 8, 2003

Previous Updates

Adapted from:
Boston Globe
01.05.03; Nicholas Thompson

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This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
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