Dr Khoudia Sow, CRCF, UMI 233 Dakar Sénégal

1. “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

2. 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

3. Objectives • To present and discuss the strategies implemented by Senegalese officials to reduce exposure to the HIV epidemic, particularly for women.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.”

14. 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

15. Philipe MselattiKhoudia Sow ALICE DESCLAUX