{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:52:44Z","timestamp":1784335964461,"version":"3.55.0"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T00:00:00Z","timestamp":1723680000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["156535"],"award-info":[{"award-number":["156535"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Context<\/jats:title>\n<jats:p>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\u2019s 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Method<\/jats:title>\n<jats:p>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\u2019 leaders. The interview data were thematically coded using the interview topic guide and other recurring themes and analysed using thematic analysis on Nvivo 12.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>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\u2019 confidentiality, and thus their confidence in the services offered, were also discussed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0306803","type":"journal-article","created":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T17:43:48Z","timestamp":1723743828000},"page":"e0306803","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimising the public health benefits of sex work regulation in Senegal: Results from qualitative interviews with policy stakeholders"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9237-2914","authenticated-orcid":true,"given":"Aur\u00e9lia","family":"L\u00e9pine","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5399-3091","authenticated-orcid":true,"given":"Fanny","family":"Procureur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandie","family":"Szawlowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Treibich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"El Hadj","family":"Mbaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khady","family":"Gueye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheikh Tidiane","family":"Ndour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,15]]},"reference":[{"issue":"6","key":"pone.0306803.ref001","doi-asserted-by":"crossref","first-page":"e1001808","DOI":"10.1371\/journal.pmed.1001808","article-title":"HIV programs for sex workers: lessons and challenges for developing and delivering programs","volume":"12","author":"D. Wilson","year":"2015","journal-title":"PLoS medicine."},{"issue":"9","key":"pone.0306803.ref002","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1097\/QAD.0b013e32835fd7bd","article-title":"Scale-up of combination prevention and antiretroviral therapy for female sex workers in West Africa: time for action","volume":"27","author":"M Alary","year":"2013","journal-title":"Aids"},{"key":"pone.0306803.ref003","author":"A. IRESSE","year":"2015","journal-title":"Enqu\u00eate nationale de surveillance combin\u00e9e des ist et du vih\/sida"},{"key":"pone.0306803.ref004","first-page":"65","article-title":"A history of sexually transmitted diseases and AIDS in Senegal: difficulties in accounting for social logics in health policy","volume":"44","author":"C Becker","year":"1999","journal-title":"CONTRIBUTIONS IN MEDICAL STUDIES"},{"issue":"39\/B","key":"pone.0306803.ref005","first-page":"40","article-title":"Les prises en charge des pathologies v\u00e9n\u00e9riennes par le pouvoir colonial au S\u00e9n\u00e9gal, 1850\u20131960. Eclairages et enseignements pour le sida","author":"M. Ndao","year":"2009","journal-title":"Annales de la Facult\u00e9 des Lettres et Science Humaines"},{"key":"pone.0306803.ref006","first-page":"5","article-title":"L\u2019administration s\u00e9n\u00e9galaise et la gestion des\" fl\u00e9aux sociaux\".","author":"MC Diop","year":"1990","journal-title":"Africa Development\/Afrique et D\u00e9veloppement"},{"issue":"11","key":"pone.0306803.ref007","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1002\/hec.3791","article-title":"The effect of sex work regulation on health and well\u2010being of sex workers: Evidence from Senegal.","volume":"27","author":"S Ito","year":"2018","journal-title":"Health economics"},{"issue":"4","key":"pone.0306803.ref008","doi-asserted-by":"crossref","first-page":"325","DOI":"10.2989\/16085906.2010.545628","article-title":"Courting success in HIV\/AIDS prevention: the challenges of addressing aconcentrated epidemic in Senegal.","volume":"9","author":"EE Foley","year":"2010","journal-title":"Afr J AIDS Res"},{"key":"pone.0306803.ref009","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s10611-005-1735-6","article-title":"New directions in research on prostitution","volume":"43","author":"R. Weitzer","year":"2005","journal-title":"Crime, Law and Social Change."},{"issue":"1","key":"pone.0306803.ref010","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1093\/qje\/qjaa032","article-title":"Crimes against morality: unintended consequences of criminalizing sex work","volume":"136","author":"L Cameron","year":"2021","journal-title":"The Quarterly Journal of Economics"},{"issue":"3","key":"pone.0306803.ref011","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1093\/restud\/rdx065","article-title":"Decriminalizing indoor prostitution: Implications for sexual violence and public health","volume":"85","author":"S Cunningham","year":"2018","journal-title":"The Review of Economic Studies"},{"issue":"3","key":"pone.0306803.ref012","first-page":"142","article-title":"\u2019I wouldn\u2019t call the cops if I was being bashed to death\u2019: Sex work, whore stigma and the criminal legal system.","volume":"10","author":"C Treloar","year":"2021","journal-title":"International Journal for Crime, Justice and Social Democracy."},{"issue":"12","key":"pone.0306803.ref013","doi-asserted-by":"crossref","first-page":"e1002680","DOI":"10.1371\/journal.pmed.1002680","article-title":"Associations between sex work laws and sex workers\u2019 health: A systematic review and meta-analysis of quantitative and qualitative studies.","volume":"15","author":"L Platt","year":"2018","journal-title":"PLoS medicine."},{"issue":"4","key":"pone.0306803.ref014","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1086\/661634","article-title":"Sex work and infection: what\u2019s law enforcement got to do with it?","volume":"54","author":"PJ Gertler","year":"2011","journal-title":"The Journal of Law and Economics"},{"issue":"8","key":"pone.0306803.ref015","doi-asserted-by":"crossref","first-page":"e0289882","DOI":"10.1371\/journal.pone.0289882","article-title":"Reforming the registration policy of female sex workers in Senegal? Evidence from a discrete choice experiment.","volume":"18","author":"S Szawlowski","year":"2023","journal-title":"Plos one."},{"issue":"7","key":"pone.0306803.ref016","doi-asserted-by":"crossref","first-page":"e0196759","DOI":"10.1371\/journal.pone.0196759","article-title":"Depression and Post Traumatic Stress amongst female sex workers in Soweto, South Africa: A cross sectional, respondent driven sample.","volume":"13","author":"J Coetzee","year":"2018","journal-title":"PloS one."},{"issue":"6","key":"pone.0306803.ref017","doi-asserted-by":"crossref","first-page":"e002763","DOI":"10.1136\/bmjopen-2013-002763","article-title":"Violence, HIV risk behaviour and depression among female sex workers of eastern Nepal","volume":"3","author":"RA Sagtani","year":"2013","journal-title":"BMJ open"},{"issue":"1","key":"pone.0306803.ref018","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-021-11207-8","article-title":"Prevalence and factors associated with major depression among female sex workers in post-conflict Gulu district: a cross-sectional study.","volume":"21","author":"S Ouma","year":"2021","journal-title":"BMC public health."},{"key":"pone.0306803.ref019","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/BF00993439","article-title":"Justifying controversial political decisions: Home style in the laboratory","volume":"15","author":"KM McGraw","year":"1993","journal-title":"Political Behavior"},{"key":"pone.0306803.ref020","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/978-3-030-64171-9_7","volume-title":"Sex Work, Health, and Human Rights: Global Inequities, Challenges, and Opportunities for Action.","author":"A Kr\u00fcsi","year":"2021"},{"issue":"3","key":"pone.0306803.ref021","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1111\/acps.13559","article-title":"Invisible and stigmatized: A systematic review of mental health and risk factors among sex workers.","volume":"148","author":"L 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