Optimising the public health benefits of sex work regulation in Senegal: A formative study

优化塞内加尔性工作监管对公众健康的益处：一项形成性研究

基本信息

批准号：
MR/T00262X/1
负责人：
Aurelia Lepine
金额：
$ 19.21万
依托单位：
University College London
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2020
资助国家：
英国
起止时间：
2020 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FT00262X%2F1
关键词：
Optimising public health benefits sex

项目摘要

Globally, there is strong evidence that reducing the transmission of STIs among female sex workers (FSWs) is a cost-effective strategy to reduce the spread of HIV/AIDS. In West Africa, the HIV epidemic is concentrated among FSWs since 75% of HIV infections among men are attributable to sexual intercourse with FSWs. In Senegal, FSWs are up to 9 times more likely to be infected than the general population.In 1969, in order to limit the spread of STIs, the Senegalese government legalised prostitution and regulated sex work activities. As part of this policy, which is unique on the African continent, FSWs over 21 years old are compelled to register with a health centre and to attend monthly health visits to test for and treat STIs. An official registration card is issued with the FSW's photograph in order to keep a record of the visits made to the appointed health centre. An up-to-date card gives FSWs the right to solicit clients and non-registered FSWs or registered FSWs who did not comply to their monthly health checks may incur a prison sentence of up to six months.Despite its legal status, sex work is morally condemned by society members in Senegal and keeping sex work secret is a central preoccupation of Senegalese FSWs. Carrying the registration card puts FSWs at risk of social exclusion if their sex work activity is discovered by their relatives and as a result, 80% of FSWs in Senegal and 57% in the capital city, Dakar, are not registered. The low proportion of registered FSWs limits the impact of this public health policy on HIV transmission and explains why FSWs are still a main contributor in this concentrated HIV epidemic. In addition, registered FSWs have very low level of well-being because of the stigma attached to the current design of the registration policy. Because the stigma attached to this policy is counterproductive to HIV prevention efforts, an intervention is needed to reframe registration in ways that better meet preferences of FSWs in order to achieve higher rates of registration and improved well-being of FSWs.The early phase study will aim to define a policy change that will allow to address the main barriers to registration and that will increase benefits of registration. The early phase study will also provide evidence on the feasibility to evaluate the effectiveness and cost-effectiveness of this policy change in a future study.

在全球范围内，有强有力的证据表明，减少女性性工作者 (FSW) 中性传播感染的传播是减少艾滋病毒/艾滋病传播的一项具有成本效益的战略。在西非，艾滋病毒流行集中在女性性工作者中，因为男性中 75% 的艾滋病毒感染是与女性性工作者发生性交所致。在塞内加尔，性工作者被感染的可能性比一般人群高出9倍。1969年，为了限制性传播感染的传播，塞内加尔政府将卖淫合法化，并对性工作活动进行规范。这项在非洲大陆独一无二的政策的一部分是，21 岁以上的 FSW 必须在健康中心登记，并每月进行健康检查，以检测和治疗性传播感染。官方登记卡上会附有 FSW 的照片，以便记录前往指定健康中心的访问记录。最新的卡赋予 FSW 招揽客户的权利，未注册的 FSW 或不遵守每月健康检查的注册 FSW 可能会被判处最高六个月的监禁。尽管具有法律地位，但性工作是塞内加尔社会成员在道义上谴责性行为，而保守性工作秘密是塞内加尔 FSW 的主要关注点。如果携带登记卡，女性调工的性工作活动被亲属发现，她们将面临被社会排斥的风险，因此，塞内加尔 80% 的女性调工和首都达喀尔 57% 的女性调工没有登记。注册的 FSW 比例较低，限制了这一公共卫生政策对艾滋病毒传播的影响，这也解释了为什么 FSW 仍然是艾滋病毒集中流行的主要推动者。此外，由于当前注册政策的设计带有污名，注册的外劳的福利水平非常低。由于这项政策带来的耻辱对艾滋病毒预防工作适得其反，因此需要采取干预措施，以更好地满足外劳的偏好的方式重新设计登记，以实现更高的登记率并改善外劳的福祉。早期研究将旨在确定一项政策变革，以解决注册的主要障碍并增加注册的好处。早期研究还将为未来研究中评估这一政策变化的有效性和成本效益的可行性提供证据。