Institute for Global Health, University College London, London, United Kingdom.
CNRS, INRAE, Grenoble INP, GAEL, Univ. Grenoble Alpes, Grenoble, France.
PLoS One. 2024 Aug 15;19(8):e0306803. doi: 10.1371/journal.pone.0306803. eCollection 2024.
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.
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.
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.
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.
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.
有确凿的证据表明，消除性工作者（FSW）中的性传播感染（STI）是减少艾滋病毒/艾滋病传播的一种具有成本效益的方法。尽管许多国家都将性工作视为公共卫生问题，但很少有国家实施专门针对控制 FSW 中艾滋病毒/艾滋病传播的公共卫生政策。特别是，塞内加尔是唯一通过要求 FSW 在卫生中心注册的特定公共卫生政策来规范性工作的非洲国家。尽管注册与潜在的健康和法律利益相关，但塞内加尔仍有令人震惊的 80%的 FSW 未注册。这种低注册率阻碍了该政策在实现公共卫生效益方面的全部潜力。FSW 不愿意注册是由于政策设计中的固有缺陷，即注册对 FSW 的弊端大于收益。
确定对当前注册政策进行哪些修改有可能提高 FSW 的注册率，并评估其在塞内加尔的可行性。
我们采用定性政策研究方法，对参与该政策的 22 名国家利益相关者进行了半结构化深入访谈，包括塞内加尔达喀尔的警察、政府和非政府组织（NGO）的代表以及 FSW 领袖。使用访谈主题指南和其他反复出现的主题对访谈数据进行主题编码，并在 Nvivo 12 上进行主题分析。
共选择了 20 个相关主题，主要侧重于评估潜在干预措施的可行性以及确定潜在障碍和相关风险。我们发现，在不改变现行立法的情况下，改善 FSW 与警察之间的关系、提供有关政策规则和收益的准确和可及的信息以及提供心理社会支持，有可能提高 FSW 的注册率和福祉。还讨论了旨在通过提高 FSW 的保密性（从而提高他们对所提供服务的信心）来增加注册率的政策特征。
该研究强调，在不推翻宪法的情况下，可以对几项国家公共卫生政策进行修改，以提高 FSW 的注册率并改善其福祉。
