In Senegal, sex work has been legally regulated since 1969 to curb the spread of sexually transmitted infections (STIs). Registered sex workers must be at least 21 years old, enroll with a health facility, and undergo regular health checkups. These workers are issued a carnet sanitaire, or medical report card, which they are required to carry as proof of compliance with health regulations if stopped by the police. Through this regulated system, sex workers also gain access to health services, free condoms, and educational initiatives aimed at reducing the spread of HIV and other STDs.

Despite these measures, challenges remain due to the social stigma surrounding sex work, which deters some workers from registering out of fear of discrimination. Additionally, law enforcement practices contribute to a hostile environment; there are frequent reports of police and security forces extorting money from sex workers in exchange for overlooking minor infractions. The legal framework itself also poses challenges for anonymity and discretion, as Senegal’s laws do not cover newer, unregulated forms of sex work, making registration undesirable for some.

Nonetheless, Senegal’s approach has contributed to its remarkably low HIV prevalence rate of less than 1%, one of the lowest in sub-Saharan Africa and significantly lower than in neighboring countries. Early intervention strategies, including the promotion of condom use, voluntary testing, a sentinel surveillance system, and Africa’s first antiretroviral treatment program in 1998, have been central to maintaining this low infection rate.

Experts suggest modernizing the system to better meet the needs of sex workers, such as offering psychosocial support during registration, replacing the carnet sanitaire with a QR code for privacy, and replacing routine health visits with maternal health services. This modernization could help increase registration rates, thereby strengthening the public health benefits of Senegal’s regulated approach to sex work.

According to the United Nations Programme on HIV/AIDS (UNAIDS), Senegal’s pragmatic approach has been remarkably effective compared to other African nations. The International AIDS Society and other health advocacy groups have acknowledged Senegal’s policy as exemplary, showing how preventive health interventions in high-risk populations can yield substantial public health benefits.

In contrast, many African countries face challenges with higher HIV prevalence among sex workers and lack similar regulatory systems. For example, South Africa—where sex work remains illegal—reports higher HIV rates among sex workers, with estimates reaching over 40% in this population, according to UNAIDS data. Likewise, countries like Kenya and Nigeria, which have less regulated or criminalized systems, face ongoing difficulties in reducing HIV rates among sex workers due to limited access to healthcare and preventive resources for those in the profession.

Senegal’s proactive strategy highlights the potential benefits of health-focused policies over criminalization, providing a framework that other nations are increasingly interested in exploring. While moral and legal debates around sex work persist, Senegal’s model demonstrates that, from a public health perspective, legal recognition coupled with supportive services can have a transformative impact on community health outcomes.