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“A V ision of Hope” Experience of Senegal in the Fight against AIDS and Reducing Women’s Vulnerability. Dr Khoudia Sow, CRCF, UMI 233 Dakar Sénégal. Context. Senegal, a West African country with a population over 98 % Muslim Low overall HIV-prevalence rate (0.7%)
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“A Vision of Hope” Experience of Senegal in the Fight against AIDS and Reducing Women’s Vulnerability Dr Khoudia Sow, CRCF, UMI 233 Dakar Sénégal
Context • Senegal, a West African country with a population over 98% Muslim • Low overall HIV-prevalence rate (0.7%) • Stabilized for over 20 years with peak concentrations in specific populations that are particularly exposed, such as sex workers (20%) • More women (with a 0.9%, prevalence rate) are infected than men (0.4%); three women are infected for every two infected men
Objectives • To present and discuss the strategies implemented by Senegalese officials to reduce exposure to the HIV epidemic, particularly for women.
Presentation overview • Political, economic and programming strategies • Preventive interventions in the general population • Preventive interventions for populations with the highest risk of exposure • Medical and psychosocial care of PLHIV • Specific measures targeting women • Achievements • Challenges • Conclusion
Political, economic and programming strategies (vision) • Clear recognition of the reality of risk factors. • Adopting a spirit of tolerance all risk practices, whether morally condemned or not by society, in a public health approach
Political, economic and programming strategies • Continuous commitment of the State and political leadership • National funding for HIV/AIDS : budget in the six largest ministries • Multisectoral approaches between the Ministry of Health, Ministries responsible for women’s issues, civil society organizations and the health and private sectors • Decentralization program in all regions in Senegal • Search for financial and technical partners (World Bank, Global Fund, United Nations System, bilateral agencies, etc.) • In 20 years, the budget for combating AIDS has been multiplied by 50
Preventive interventions for the general population • Intensified IEC/BCC, promotion of female and male condoms and HIV testing ( Abstinence Be faithful Condom) • Condom availability in health facilities • Community distribution of condoms • Free testing HIV
Prevention in risk populations • Supervision of prostitution, which is legal in Senegal • Strengthening prevention measures and care for vulnerable groups (mobile populations, men who have sex with men, sex workers and mobiles workers…) • Raising awareness about and providing male and female condoms free to sex workers
Care for PLHIV • Increase in the number of HIV-treatment centers and free access to ARVs since 2001(first country in Africa) • Over 75% of PLHIV have access to treatment • Psychosocial support and counseling • Combat stigmatization and discrimination • Support community-based organizations and PLHIV associations providing various financial, nutritional and psychological support; conducting family and community mediation; and defending their right to not be subjected to rejection or stigmatization
Specific measures targeting women • Leadership from the Ministry of the Family in association with women’s organizations and civil society • Organization of “Women & AIDS” week • Promotion of PMTCT, routine HIV testing for pregnant women • Advocacy from religious leaders to combat stigmatization of PLHIV and any sociocultural practice at risk • Development HIV law that guides practices health professionals and ensures protection of PLHIV, specifically women
Specific measures targeting women • Free access to care for HIV-positive women and support for orphans and vulnerable children (OVCs): financial aid, scholarships, etc. • Counseling support, particularly women • Special support for associations of women living with HIV
Achievements • Increased understanding about the HIV/AIDS epidemic • Reduction in risk behaviors: increasing age of sexuality, improving condom use during at-risk sexual relations, etc. • Decrease prevalence among populations in risk: HIV prevalence among the youngest sex workers dropped from 19% to 9% • Stability of HIV prevalence in the general population • Improved quality of life for PLHIV, particularly among women, who can now have children with close to zero risk on ARVs
Challenges • Ongoing social stigma related to HIV especially for widows of husbands who died of HIV infection, who have lost social status and could be stigmatized. • The heavy burden placed on women to care for themselves and their children • The lack of protection for young women against contamination within a marriage (pre-nuptial testing rarely conducted). • Better understanding of men’s vulnerability to HIV infection; “Support men to improve protection of women and families.”
Conclusion • The fight against AIDS has led us to explore “cracks in our society” and see “women’s vulnerability” but also enormous capacity to respond • “Sometimes I forget that the virus is living in me because I can live like everyone else thanks to ARVs.” • The hope to reduce risks is possible through • the personal commitment of all eaders who understand and accept the factors affecting vulnerability and confront taboos in the complex reality of vulnerability • Support for partners with leadership of UNAIDS
Philipe MselattiKhoudia Sow ALICE DESCLAUX