Originally created 08/12/01

West Africa's Senegal boasts rare achievements fighting AIDS



DAKAR, Senegal -- With a twinkle in her eye, a mother of 10 slips a condom over a Coke bottle before a room of attentive Muslim women in veils and long dresses.

"This is how I protect my partner," Aminata Niang explains, then cracks a few risque jokes before launching into a frank discussion about how to safely use and dispose of condoms.

The gathering in an impoverished neighborhood on the outskirts of Dakar is part of a far-reaching campaign - drawing in politicians, aid workers, religious leaders and prostitutes - that has helped Senegal avoid the worst of the AIDS epidemic gripping Africa.

On a continent that accounts for more than 70 percent of the world's 36 million people living with the AIDS virus, and where the infection rate in many nations runs in double digits, Senegal's HIV rate is less than 2 percent.

Health officials believe the West African country has been shielded in part by widely held cultural and religious values that limit sex to marriage.

But Senegal, which is predominantly Muslim, also took up the AIDS challenge long before the disease started ravaging the continent. When most African countries still denied the scope - and in some cases the existence - of the virus, Senegal had a government-sponsored prevention program going in 1987, within a year of the diagnosis of its first three HIV cases.

Muslim clerics preached about AIDS in crowded mosques with a frankness rare in the Islamic world. Teachers spoke about the virus in schools. The government required prostitutes to submit to annual HIV tests.

When expensive drug cocktails transformed the disease from a virtual death sentence to a manageable condition in the West, Senegal's elected government was one of the first in Africa to negotiate cut-rate treatment for its people.

But as the paint starts to peel off old murals explaining HIV, and posters promoting condoms are covered over with soap ads, Senegal's health officials have started warning against complacency.

"Today, the big challenge is to preserve what has been achieved," says Dr. Isseu Toure, a reproductive health specialist for the World Health Organization.

Senegal's AIDS campaign has benefited from decades of relative stability on a continent known for coups and civil wars. But bitter poverty remains. Nearly two-thirds of the country's 10 million people are illiterate, roads and hospitals are in disrepair and unemployment is on the rise.

One of Senegal's first priorities was to secure the national blood supply, says Dr. Karim Seck, deputy coordinator of the national AIDS program. While transfusions remain risky in some African countries, Senegal has been systematically testing all blood donations for HIV since within a year of the first known infections.

Prevention information was spread through television, radio, newspapers and posters. A class on AIDS and other sexually transmitted diseases was introduced in school, and major companies set up programs for their employees.

Aid groups mobilized, organizing marches and workshops in the farthest corners of the country to raise awareness of the danger. These organizations worked with local associations of women, youths and others to educate about HIV.

"There is a great tradition of community organizations in Senegal, more than in many other African countries," says Dr. Abdel Bacha, an official with Third World Environment and Development, one of the first groups to take up the cause. "That is one of the biggest factors in Senegal's success in the struggle against HIV."

Niang and her women's group have been staging their condom demonstrations in Dakar's impoverished suburbs since 1989. Feet stomping and hips gyrating, they entertain the crowds at neighborhood festivals with wild dancing, bawdy jokes - and a few lessons about HIV.

"In the beginning, we had all kinds of problems talking openly about sex and condoms," Niang says. "People said we were just a group of prostitutes ... But if we make them laugh, we dance, we sing, we can get the message across."

The government and aid groups also persuaded religious leaders to help.

While Muslim protesters ripped down posters promoting condoms elsewhere in West Africa, religious leaders in Senegal started talking about AIDS in mosques and churches, at conferences, on television and on the radio.

Like many imams, Ahmadou Kante initially believed AIDS was a disease that affected only homosexuals.

"Based on the book I believe in, a behavior like that must inevitably lead to divine retribution," he says. "Later, I found out the disease could infect anyone."

While most clerics still refuse to promote condoms, Kante and others preach abstinence before marriage and fidelity to spouses.

Kante even invited a doctor to address his congregation after a Friday sermon and contributed to a guide on AIDS for imams in French and Arabic - with a cartoon-like cover showing a bearded Muslim cleric counseling a couple in traditional robes.

Senegal's AIDS campaign was helped by a long tradition of fighting sexually transmitted diseases. By the time the country's first HIV cases were diagnosed, there were already structures in place to contain the disease.

Prostitution, for example, has been allowed since 1966, provided the women register with special clinics and submit to regular exams.

At the main clinic in a Dakar hospital, a dozen women dressed in flowing African robes or Western jeans and T-shirts, wait patiently on benches for their monthly checkups.

Using a back door to avoid being seen by other patients, each woman carries a green booklet that identifies her as a prostitute and that records her clinic visits. Police can demand to see the book at any time, and will arrest prostitutes who have missed an appointment.

Staffers say the system works well, providing a regular opportunity to discuss safe sex with the women, conduct tests and hand out free condoms.

But while most prostitutes seem informed about the risks of HIV, some admit they don't always protect themselves.

"There are times when you get a client who doesn't want to use a condom," says a gaunt, middle-aged woman with discolored teeth, who turned to prostitution when her husband abandoned her with three children. "If you have nothing to feed your family, you have to agree."

The woman, who spoke on condition of anonymity, has watched other prostitutes die of AIDS-related diseases.

"Not one, not two, but many," she says. "I'm afraid, but what can I do?"

The government says between 9 percent and 35 percent of registered prostitutes are infected with HIV, depending on the region.

But there are chinks in the system. About 90 percent of prostitutes work clandestinely, with no access to government centers. Many are under 21, the minimum age for registering. Others want to avoid the stigma of being identified as prostitutes.

"If we don't take care of this population, the disease can spread," says Marie Thioye, a clinic social worker. "It is these prostitutes who are frequenting our husbands."

Authorities also worry some traditional practices in Senegal could be spreading HIV, including polygamous marriages and men's custom of marrying their brothers' widows.

While AIDS awareness appears higher than in many African countries, campaigners question whether people always apply what they know.

Some fear Senegal's initial success at keeping the infection rate down could actually be spreading a false - and dangerous - sense of security.

"People talk a lot about AIDS, but in my family we didn't believe it because we had never met someone with HIV," says a cleaner, who learned four years ago that her husband had given her the virus.

"We thought it was just something people invented to discourage lovers."