Senegal fights to stay ahead of HIV, AIDS


Africa: Unlike many of its neighbors, the impoverished country faces the epidemic publicly and head-on.

May 23, 2004|By John Murphy | John Murphy,SUN FOREIGN STAFF

MALIKA, Senegal - The 55 students enrolled in Marie Therese Gomis' life skills center in this shabby city on the Atlantic Ocean face many of the risks that have allowed HIV/ AIDS to ravage the African continent, infecting one in five adults.

They are young, poor and illiterate; they live in a culture where polygamy is widely practiced. They are also female, making them 2.5 times as likely to become infected than men their age, according to the World Health Organization.

But in Senegal, odds are that these students, ages 12 to 18, will be spared the scourge of AIDS.

The disease that has killed millions of Africans in the prime of their lives, created legions of orphans and pushed the continent to deeper levels of poverty and hunger is still comparatively rare in Senegal, a West African nation of 10 million people.

While some African nations such as Botswana and Swaziland grapple with adult infection rates of nearly 39 percent, Senegal's rate has remained stable at just above 1 percent.

Like Africa's other success story, Uganda, where HIV infections declined from about 18.5 percent in 1992 to 6 percent in 2002, Senegal demonstrates how swift government action and an openness about the epidemic can curb its growth.

Senegal's achievement is all the more remarkable because the aggressive involvement of all segments of society, including the nation's Islamic leaders, helped contain the spread of AIDS from early on.

While other African governments denied that there was a crisis or dithered over their response, Senegal's leaders created national awareness campaigns, screened the nation's blood supply, promoted use of condoms and regularly tested Senegal's commercial sex workers for AIDS and sexually transmitted diseases. Senegal was also one of the first African nations to offer free anti-AIDS drugs to anyone who needed them.

But the torrent of AIDS billboards and advertisements that once overwhelmed residents with warnings about the virus has subsided. Many residents no longer consider AIDS a threat and refuse to take precautions against it, health workers say.

When Gomis invited counselors to speak to her students about the epidemic this month, she was surprised by how many of the students lacked basic knowledge of the virus.

"They didn't know anyone who is HIV-positive. Some didn't know AIDS existed," said Gomis, director of the center, where poor young women learn sewing, cooking and gardening. "I realized I didn't know much about AIDS either."

Such ignorance is evidence of Senegal's success in curbing infections as well as an alarming harbinger of how easily those gains might erode.

"It's hard to maintain what we have achieved," said Dr. Abdoulaye Ly, director of the AIDS and Sexually Transmitted Infections Division of Senegal's Ministry of Health.

A poster in Ly's office warns health workers to keep the infection rate below 3 percent, a threshold, Ly says, above which the government's annual health budget of $63 a person would be strained. So far, Senegal's infection rate has remained stable at about 1.4 percent of the population.

But the risk factors remain. The country ranks among the poorest in the world, with high illiteracy rates and rising unemployment. Bad roads and infrastructure make it difficult for the government to spread AIDS awareness in the most rural areas.

Prostitution continues to be a popular way for young women to earn money. According to the government's latest statistics, about 15 percent of the prostitutes are infected in Dakar, the capital; in some rural areas, the rates reach 30 percent.

Most worrying, Ly says, are the signs that the strict morals of the Senegalese family are weakening, increasing freer sexual behavior.

"Once, if your son or daughter was misbehaving, a neighbor would correct them. Now, no one pays much attention to them," Ly said.

Government officials and health workers say that Senegal's strong sense of family and morality was one of the crucial factors in shielding the country from AIDS. Although Senegal is a mix of more than half a dozen ethnic groups speaking different languages, about 90 percent of the population is Sunni Muslim, whose brotherhoods and religious leaders have been at the forefront of AIDS awareness campaigns.

"Without the involvement of religious leaders in sensitizing of AIDS, the rate of infection would be higher," said Ahmadou Kante, a professor of environmental science and an imam at the University of Dakar's mosque.

Alarmed at the danger Senegal faced, in the mid-1990s Kante became one of the first religious leaders to speak to his congregation about AIDS. He later produced a radio show on Islam and AIDS.

At first other Islamic leaders were shocked at the introduction of sexual discussion into the mosque, but eventually other imams followed suit. Like other Islamic leaders, Kante refuses to promote the use of condoms, instead encouraging sexual abstinence before marriage - a message that many Senegalese have followed.

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