Optimising the public health benefits of sex work regulation in Senegal: Results from qualitative interviews with policy stakeholders

Aurélia Lépine, Fanny Procureur, Sandie Szawlowski, Carole Treibich (), El Mbaye, Khady Gueye and Cheikh Ndour
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Aurélia Lépine: UCL - University College of London [London]
Fanny Procureur: UCL - University College of London [London]
Sandie Szawlowski: UCL - University College of London [London]
Carole Treibich: GAEL - Laboratoire d'Economie Appliquée de Grenoble - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - UGA - Université Grenoble Alpes - Grenoble INP - Institut polytechnique de Grenoble - Grenoble Institute of Technology - UGA - Université Grenoble Alpes
El Mbaye: Ministry of Health and Social Action, Dakar
Khady Gueye: Ministry of Health and Social Action, Dakar
Cheikh Ndour: Ministry of Health and Social Action, Dakar

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Abstract: Context: There is compelling evidence that eliminating sexually transmitted infections (STIs) among female sex workers (FSWs) is a cost-effective approach to reducing the spread of HIV/ AIDS. Although many countries recognise sex work as a public health issue, few have implemented public health policies specifically aimed at controlling the transmission of HIV/ AIDS among FSWs. In particular, Senegal stands out as the only African country to regulate sex work through a specific public health policy that requires FSWs to register with a health centre. Despite the potential health and legal benefits associated with registration, a staggering 80% of FSWs in Senegal remain unregistered. This low registration rate hinders the realisation of the policy's full potential for public health benefits. The reluctance of FSWs to register is due to inherent flaws in the policy design, where the disadvantages of registration outweigh the benefits for FSWs. Objective: To identify which modifications to the current registration policy have the potential to increase uptake of registration by FSWs and to assess their feasibility in the context of Senegal. Method: We conducted a qualitative policy research study using semi-structured in-depth interviews with 22 national stakeholders in this policy, including representatives from the police, government and non-governmental organisations (NGOs) in Dakar, Senegal, as well as FSWs' leaders. The interview data were thematically coded using the interview topic guide and other recurring themes and analysed using thematic analysis on Nvivo 12. Results: A total of 20 relevant themes were selected, focusing primarily on assessing the feasibility of potential interventions and identifying potential barriers and associated risks. We found that, without changing current legislation, improving relationships between FSWs and police officers, providing accurate and accessible information about the rules and benefits of the policy, and offering psychosocial support have the potential to improve both the registration rate of FSWs and their wellbeing. Policy features designed to increase registration by improving FSWs' confidentiality, and thus their confidence in the services offered, were also discussed. Conclusions: The study highlighted that several national public health policies could be changed to increase the registration rate of FSWs and improve their wellbeing without overturning constitutional law.

Date: 2024
New Economics Papers: this item is included in nep-hea
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Published in PLoS ONE, 2024, 19 (8), pp.e0306803. ⟨10.1371/journal.pone.0306803⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-04750353

DOI: 10.1371/journal.pone.0306803

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