Senegal has one of Africa's lowest HIV/AIDS infection rates -- less than 1 percent -- but vulnerable groups such as sex workers and gay men have higher HIV prevalence. Currently, HIV infection among legal sex workers in Dakar has risen to 21 percent, compared to 1 percent 20 years ago, according to Enda Third World, an international nongovernmental organization based in the capital. The rate is as high as 30 percent in the southern city of Ziguinchor, where sufficient medical care is lacking.
Prostitution in Senegal has been regulated since 1969. Sex workers register at public health clinics, where they receive photo identity cards and make monthly visits for medical checkups. However, many operate outside the system. Enda estimates that more than 80 percent of Senegal's sex workers do not register.
Even among legal sex workers, many forego monthly checkups due to stigma, thus missing medical care and free condoms, said Fanta Diop, a program manager at Enda. Diop noted that buying condoms at a pharmacy can carry shame in a Muslim country where religious leaders preach abstinence and fidelity.
Although the HIV prevalence for clandestine sex workers is not available, Diop said it is thought to be much higher than the rate for registered sex workers. In a recent Enda survey of 613 illegal sex workers in Dakar, 177 (29 percent) said they did not use condoms.
The most recent UNAIDS report said a study in five Senegalese cities found a 22 percent HIV prevalence among men having sex with men, 94 percent of whom said they also have sex with women. Only half reported using condoms in the previous month.
Elhadj Ousmane Gueye, head of a Senegalese Islamic AIDS awareness group, said imams have become increasingly active preaching tolerance and acceptance of infected people in the 94-percent Muslim country.