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This report comprehensively summarizes the FHI/AIDSCAP program in Senegal (1993-1997). The report includes a discussion of accomplishments, outcomes, implementation and management issues, as well as a series of lessons learned and recommendations.
Table of Contents I. Country Program Description A. Introduction (See Below) B. Country Context (See Below) C. Accomplishments and Outcomes D. Implementation and Management Issues II. Lessons Learned and Recommendations III. Subproject Highlights I. Country Program Description A. Introduction Senegal has a population of 8.3 million people, primarily Muslim and primarily of the Wolof ethnic group. The population is expected to double by the year 2025. At present 45 percent of the population is urban, the majority of which live in the cities of Dakar, Thies and Kaolack. Senegal ranks 152 on the UNDP Human Development Index -- only 21 countries in the world rank lower than Senegal on this scale. In 1992, 26 percent of the women and 55 percent of the men were literate. Factors contributing to the risk of HIV transmission in Africa include a history of multiple sexual partners, an above average income, a history of sexually transmitted diseases (STIs) and engaging in unprotected sexual intercourse in exchange for money. One study in Africa showed that most infections found among pregnant women were more strongly related to the high-risk behaviors of their husbands than to their own behaviors. Wives of men who reported outside partners and especially men from higher socioeconomic groups who drank alcohol, were at much higher risk than women whose husbands did not drink or did not have higher incomes. Although AIDS in Africa has been documented to be largely an urban phenomenon in the early stages, the epidemic's reach into periurban areas is increasing due to high levels of commercial activity and migration of workers. Rates of infection in young people are rapidly increasing requiring urgent efforts to encourage safer sexual behaviors. The AIDS Control and Prevention (AIDSCAP) Projectin Senegal supported a number of components of Senegal's Programme National de Lutte Contre le SIDA (PNLS). It's strategic design allowed it to address areas of need not being met by other donors in regions of Senegal where the need was greatest. The activities supported under this project assisted the PNLS in meeting the objectives of its Medium Term Plan (MTP), as well as complementing ongoing efforts by other donor agencies. By linking resources with the expertise of community level nongovernmental organizations (NGOs), the project contributed to building the capacity of local agencies to manage intervention activities. The purpose of the AIDSCAP/Senegal program was to strengthen the capacity of Senegalese institutions to increase HIV risk reduction behaviors (e.g. condom use, decreasing the number of sexual partners and seeking early and effective treatment of STIs) within specific target groups with the goal of reducing the rate of sexually transmitted HIV infection in Senegal. The project was initially designed for five years (1993-1997) and budgeted at US$ 10.9 million (including US$ 500,000 in central funds for condoms). Activities were concentrated in four geographic regions with the greatest potential for spread of the epidemic: Dakar, Thies, Kaolack and Ziguinchor. The project focused primarily on urban populations, however extended during the life of the project to include activities in the regions of Fatick and Louga. The main groups targeted for intervention in the four main regions include:
The major components of the Senegal program were:
There were five additional support components to the program:
The HIV epidemic in Senegal is characterized by relatively low seroprevalence of HIV-1 and HIV-2 compared to other African nations where the epidemic is considerably more advanced. Since the first identified AIDS case in 1986, the Government of Senegal (GOS) in collaboration with the World Health Organization (WHO) and other donors such as the Canadian International Development Agency (CIDA), French Cooperation and the United States Agency for International Development (USAID), has developed a blood screening program, a surveillance system, the beginnings of a public information program and two Medium Term Plans. Since 1985, USAID/Dakar has provided funds for AIDS prevention and control primarily through its Family Health and Population Project, but also through the centrally-funded AIDSTECH and AIDSCAP projects. Numerous other donors, including the European Union (EU), CIDA, French Cooperation, and the United Nations Development Program (UNDP), have become involved in the effort to slow the transmission rate of HIV in Senegal. Their collective experience and the results of research in other parts of Africa have contributed to the development of a comprehensive strategic approach to HIV/AIDS control in Senegal that could prevent the epidemic from exploding as it has elsewhere in Africa. Statistics from the Programme National de Lutte Contre le SIDA (PNLS) of Senegal show that in 1993 there were 911 cumulative documented AIDS cases in Senegal. By May 1995 that number had risen to 1,573, a 73 percent increase in two years. As of June 1997 there were 80,000 reported HIV infections. The prevalence of HIV among hospital patients in 1993 was 15.9 percent. The most recent data from the PNLS show that proportions of HIV infection among pregnant women seen at maternity clinics range from 0.5 to 1.5 percent in major cities. The highest levels of HIV infection are among registered commercial sex workers. In Kaolack, for example, the prevalence is 30.3 percent. The overall national prevalence rate is 1 percent, with the ratio of men to women approximately 3:1. Senegal is characterized by a high prevalence of HIV-2 whose carriers have a slower rate of evolution from infection to AIDS (relative to those infected with HIV-1) and who may therefore continue to infect others while remaining in good health. |
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