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RESEARCH SUMMARY
Im p l e m e n t I n g StI/HIV pr e V e n t I o n a n d
Ca r e I n t e r V e n t I o n S f o r m e n w H o
Ha V e S e x w I t H m e n I n d a k a r , S e n e g a l
To read more about this study, go to
www.popcouncil.org/horizons/projects/Senegal_MSMHealthNeeds.htm
Peer education to improve HIV prevention knowl-•
edge and increase prevention and health-seeking
behaviors.
Diagnosis and treatment of STIs, and HIV coun-•
seling and testing, through accessible and “friend-
ly” health services.
Education and sensitization of the media about •
issues facing men who have sex with men.
e AIDS/STI Division within the Ministry of
Health coordinated the intervention with several
partner institutions, including Africa Consultants
International, the National AIDS Alliance (ANCS),
Exploratory research conducted by the Ho-
rizons Program in 2002 revealed that men
who have sex with men in Dakar, Senegal,
are particularly vulnerable to sexually transmitted
infections (STIs) and HIV because of high rates of
unprotected anal sex, a history of STI symptoms,
and poor knowledge of STIs. Further, the stigma and
discrimination suffered by many men who have sex
with men result in the concealment of sexual behav-
iors from health care providers, making it difficult
for this population to receive appropriate services.
Finally, there is a lack of HIV prevention campaigns
geared to this group, as key messages disseminated
in the country have largely focused on heterosexual
transmission (Niang et al. 2002).
In response to these findings, key stakeholders in
Dakar worked together to develop and implement
an intervention to meet the STI/HIV prevention
needs of men who have sex with men, and to address
prevailing stigma that effectively serves as a barrier to
care. e intervention had three components:
PHOTO: MELISSA MAY/©POPULATION COUNCIL
Many men who have sex with men in Dakar,
Senegal are at risk of STIs and HIV.
2
the Institute of Social Hygiene (IHS),
ENDA Santé, and Family Health
International. e Horizons Program, in
collaboration with the Institute of Envi-
ronmental Sciences/Cheikh Anta Diop
University in Dakar assessed the feasibil-
ity and acceptability of the intervention,
and its outcomes on the target group.
is paper summarizes the key findings
from the research, and the challenges and
lessons learned from implementing an
intervention to meet the needs of men
who have sex with men.
Description of the Intervention
Components
Peer education
ANCS, an affiliate of the International HIV/AIDS
Alliance, was the lead partner in implementing the peer
education component. ANCS coordinated the recruit-
ment and training of 40 men to serve as leaders and peer
educators to improve knowledge about HIV prevention,
and increase preventive and health-seeking behaviors
among men who have sex with men. Selection criteria
for the peer educators included an ability to mobilize
other men, leadership and communication skills, and
an understanding of and agreement with the aims of the
project. e peer educators received a small stipend for
their work.
Working with peers in their network one-on-one and in
groups, the peer educators encouraged regular condom
use and the avoidance of unprotected penetrative sex,
distributed condoms and shared information about
where to get them, and provided referrals to specially
designated health providers, including those from IHS,
who were trained to provide destigmatizing STI/HIV
services to men who have sex with men.
In addition, the peer educators informed the men in
their networks about the existence of two support
groups, And ligeey and ADAMA, which were either
started or strengthened with the help of ANCS during
the project period. e project team also intended for
the peer educators to distribute water-based lubricants,
but encountered problems in securing a steady supply
throughout the intervention period (see Challenges and
Lessons Learned).
STI and HIV services
is component aimed to improve
access to health services by men who
have sex with men in order to reduce
the spread of STIs, including HIV. e
AIDS/STI Division of the Ministry
of Health, with support from Fam-
ily Health International, created and
trained a network of health providers
who were sensitized to the special needs
of men who have sex with men, and
who were available to provide confiden-
tial, non-judgmental medical and psychosocial care. is
included HIV voluntary counseling and testing (VCT),
diagnosis and treatment of STIs, and referrals for antiret-
roviral therapy (ART).
In Dakar, the network included providers from IHS as
well as five other physicians from the public sector who
offered to see and treat men who have sex with men.
Another seven physicians from outside of Dakar also
joined the network during the study period. Men who
have sex with men learned about these providers from
the peer educators and the data collection facilitators
(see Research Methods), who sometimes accompanied
them when seeking services.
Education and sensitization of the media
Findings from the exploratory research pointed to the
need to educate and sensitize different societal groups
to the HIV prevention and care needs of men who have
sex with men, and the deleterious effects of stigma,
discrimination, and violence on this population. e
project team focused on representatives of the media as
a conduit for reaching other key stakeholders, such as
the police and community leaders. In August 2003, the
project held a two-day, residential workshop for media
representatives in Saly, outside of Dakar. e workshop
brought together 29 participants from 20 media groups,
including 15 print journalists and reporters from four
radio and two television stations. Also in attendance
were a sociologist, a sexologist, two men who have sex
with men to share their personal experiences, the Head
of the AIDS/STI Division of the Ministry of Health,
and the organizers. e workshop included presentations
on the results from the exploratory study and findings
from a five-year review of news articles from Senegal on
men who have sex with men. Participants discussed the
Horizons conducts global operations
research to improve HIV/AIDS
prevention, care, and support
programs. Horizons is implemented by
the Population Council in partnership
with the International Center for
Research on Women (ICRW), PATH,
the International HIV/AIDS Alliance,
Tulane University, Family Health
International, and Johns Hopkins
University.
3
the perceptions of the intervention activities among
different groups. A total of 71 individual interviews
were conducted with men who have sex with men; 50
interviewees responded to questions about STI/HIV ser-
vices, and 18 gave their views about the peer education
activities. ree doctors were also interviewed in order
to better understand the limitations and constraints that
impeded the provision of STI/HIV services to men who
have sex with men. In addition, six focus group discus-
sions (FGDs) were held with a total of 56 men who took
part in peer education activities and/or used the health
services set up by the project. All respondents provided
oral informed consent prior to participation in the
surveys, interviews, and FGDs.
e research team collected process data on the men
who accessed services at IHS during the study period
(May 2003 to April 2006) and the results of their exami-
nations. A total of 1,206 physical examinations of men
who have sex with men were conducted at IHS. ese
were men who had been referred or accompanied by the
data collection facilitators and peer educators.
e study was approved by the Senegal National AIDS
Council and the Population Council’s Institutional
Review Board.
Characteristics of the Survey Samples
At baseline, the mean age of respondents was 26 years
(range: 17–57). e vast majority had never been
married (92 percent), yet 14 percent had at least one
child. Almost all identified as Muslim. Nearly half of
the sample had not gone beyond the primary level of
education. Nearly one in five was a laborer or unskilled
worker, 20 percent were unemployed, 16 percent were
traders, and 11 percent were students. Overall, the
sociodemographic characteristics of the men interviewed
at baseline and follow up were similar.
Key Findings
STI/HIV knowledge increased between the
beginning and end of the study, but important
gaps remained.
Awareness of the existence of STIs and HIV/AIDS was
high at baseline (91 percent), and increased further by
the end of the study (99 percent; p <. 001). Among
risk of HIV infection among men who have sex with
men compared to the general population, the contribu-
tion the media can make in supporting HIV and STI
prevention and care programs, the quality and ethics of
media information gathering in Senegal, and the need
for fair, unbiased, and accurate reporting.
Research Methods
e study used a pre-test/post-test research design to
assess the outcomes of the intervention on men who
have sex with men. e research team first conducted
mapping activities in the Dakar area to determine where
men who have sex with men could be found. ey
then selected 12 men from various networks identified
through the mapping activities to serve as data collec-
tion facilitators. Specifically, their role was to recruit two
separate cross-sectional samples of men using snowball
sampling to participate in a structured interview at
baseline (May – October 2003) and again at follow up
(January – March 2005). ese men also helped the
research team find suitable places for the interviews so
they would be private and confidential.
e men were chosen based on their capacity to mobilize
other men and for their ability to adhere to ethical prin-
cipals when carrying out their responsibilities, including
maintaining confidentiality. e facilitators participated
in training sessions on quality control and ethics related
to data collection, and received a small stipend for their
work in recruiting men to be interviewed. In addition
to helping with data collection, the facilitators identified
men to be trained as peer educators, and some became
peer educators themselves.
e baseline sample consisted of 258 men, and the
follow-up sample included 290 men. Men were eligible
to be interviewed if they were 18 years or older and had
ever had sexual relations with another male. Men were
first approached by a study facilitator who explained the
purpose of the study. If a man agreed to be interviewed,
he was given a small amount of money to cover his
transportation costs to and from a private location for
the interview, which was conducted by a trained mem-
ber of the research team. e facilitators also referred
men whom they approached about the study to IHS if
they were concerned about possible STI symptoms.
e research team also conducted qualitative assessments
midway through the evaluation process to determine
4
respondents, the number who knew at least three STI
symptoms more than doubled from 26 percent to 61
percent (p < 0.001). ere was also significant improve-
ment in knowing that one can avoid HIV infection by
using condoms (87 percent to 93 percent; p < 0.05).
However, knowledge about other ways of avoiding HIV
remained low (e.g., limiting oneself to a single partner;
29 percent vs. 23 percent, NS) or decreased further (e.g.,
having a sexual partner who is not infected; 17 percent
vs. 10 percent; p < 0.05)
HIV testing among men who have sex with men
increased substantially.
As shown in Table 1, awareness of a test to detect HIV
significantly increased among respondents (52 percent
to 83 percent; p < 0.001). is increased knowledge co-
incided with an increase in the proportion who reported
having received an HIV test (16 percent to 64 percent;
p < 0.001). Importantly, 80 percent of the men who
were tested at follow up returned to get their test results.
Reasons cited by those who had not been tested included
not getting the chance to test, fear of knowing their HIV
status, and feeling healthy. Surprisingly, the proportion
of respondents who reported not knowing where to find
a testing center more than doubled from 16 percent to
34 percent.
e results were mixed for condom use post-
intervention.
At baseline, 73 percent of the men interviewed reported
using a condom during their last anal intercourse with
another man. is proportion increased to 82 percent at
follow up (p = 0.01). However, when asked about con-
sistent condom use during anal sex for the previous 12
months, there was little change from baseline to follow
up (52 percent to 58 percent, NS).
As shown in Table 2, respondents cited many reasons
for not using condoms at last anal sex at baseline and
follow up, including difficulty finding them, trusting
their sexual partners, and the refusal of some partners
to use them. But the most common reason at follow up
(38 percent) was that sex was unexpected, suggesting
that such liaisons were not conducive to having pro-
tected anal intercourse. Although the proportion of men
reporting difficulties in obtaining a condom decreased
from 14 percent at baseline to 7 percent at follow up,
increased access to condoms might make it more likely
that men would have condoms available for such unex-
pected liaisons.
e vast majority of men in both surveys reported
ever having had sexual intercourse with a woman (88
percent and 91 percent, respectively). When asked about
condom use during the previous 12 months, less than
half of these respondents at both baseline and follow
up reported using a condom with a woman during anal
intercourse (41 percent and 42 percent) and during
vaginal intercourse (45 percent and 49 percent).
Consistent use of water-based lubricants was
low.
ere was a significant increase in the number of
respondents who reported using water-based lubricants,
from 51 percent at baseline to 70 percent at follow up
(p < 0.0001). When users of water-based lubricants were
asked about consistent use, only 22 percent at baseline
Table 1 HIV testing: Awareness and experience
Baseline
n = 258
n (%)
Follow up
n = 290
n (%)
Heard about HIV testing 133 (52) 242 ( 83**)
Had an HIV test 21 (16) 186 ( 64**)
Returned to get test
results
— 149 (80)
Reasons why did not
get tested for HIV
n = 112§n = 104§
Did not get the chance — 44 (42)
Fears knowing his HIV
status
39 (35) 14 (13**)
Does not see the need
for testing
24 (21) 9 ( 9*)
Feels healthy 16 (14) 14 (13)
Does not know a
testing center
18 (16) 35 (34*)
Other 12 (11) 5 (5)
*p < 0.05; **p < 0.001
§In the baseline survey the number of men who were asked why
they did not get tested (112) consisted of the men who had heard of
HIV testing (133) minus those who had an HIV test (21). At follow
up, those asked to provide reasons for not getting tested (104) was
calculated by subtracting the number who tested (186) from the
total number of survey respondents (290).
5
which 88 tested positive for HIV (33 percent). Among
these men, 81 were referred to a government outpatient
center that offers treatment, care, and support to HIV-
positive individuals, and seven others did not return for
their results.
Men appreciated the availability of STI services
that were high quality and non-stigmatizing.
e provision of services would not have been possible
without the determination of qualified and committed
medical personnel who provided men with high quality
services that were not stigmatizing or discriminatory.
Comments attesting to the skill with which the clini-
cians interacted with men who have sex with men were
frequent during the FGDs:
e polyclinic [IHS] is a discreet location and
the medical officers are very kind and available
to attend to us…if we had been mistreated, it is
obvious that we would not have returned. We are
very much welcomed and made to feel comfort-
able. We receive counseling which is very vital to
us because it is directly related to our activities.
We also obtain condoms and lubricants to better
protect ourselves from diseases. Honestly speaking,
all the medical officers there are exemplary.
25-year-old male
ey are doing a wonderful job because they are
available when we need them and they are not
judgmental.
23-year-old male
A collaborative approach to the media was well
received by journalists.
A component of the intervention involved working in
collaboration with the media to provide quality informa-
tion, to raise the general public awareness, and to reduce
discrimination toward men who have sex with men. As
mentioned above, a workshop for the exchange of in-
formation and discussion was organized, which brought
together journalists from various media in Senegal,
partners in the implementation of the intervention, and
stakeholders involved in HIV work in Senegal. Men who
have sex with men participated in the workshop in order
to bring a human face to the issues and allow journalists
to better understand the hidden realities of the men's
lives.
and 35 percent at follow up said that they used them
every time they engaged in anal sex with another man.
e men surveyed often resorted to products other than
commercial, water-based lubricants (see Table 3). Vase-
line, an oil-based lubricant which is not compatible with
condoms was most often used, and the use of this prod-
uct during anal sex increased considerably between the
two surveys, from 11 percent to 34 percent. Shea butter
and saliva were also used in many cases; 22 percent of
respondents at follow up said they used each one.
Low use of water-based lubricants may be partly ex-
plained by the challenge of accessing the product and
shortages in the market. At follow up, more than four
in ten men (43 percent) reported difficulties finding
them.
Respondents using water-based lubricants said that they
preferred buying them from drug stores. However, the
high cost of water-based lubricants sold in pharmacies
(approximately US$10.00/tube) and the low purchasing
power of many of the men interviewed likely made their
consistent use problematic.
HIV prevalence was high among men who sought
HIV testing as part of STI services.
During the study period, a total of 1,206 men who have
sex with men sought services at IHS. Among these men,
a total of 145 cases of STI symptoms were diagnosed
and treated. is included 89 cases of genital discharge,
49 cases of genital/anal sores, and seven cases of genital
ulcers. A total of 263 men requested HIV testing, of
Table 2 Reasons for non-use of condoms during
last anal sex with a man
Baseline
(n = 66)
Follow up
(n = 58)
% %
Condom is unobtainable 14 7
Partner does not want to use it 23 23
Does not like the condom 38 7*
Sexual relations were unexpected 12 38*
Have condence in their partners 9 17
Others 6 9
*p < 0.001
6
e participation of men who have sex with men in the
workshop was also designed to reduce their suspicion of
journalists, to improve their perception about the work
journalists do, and to establish an atmosphere of col-
laboration between them. Initially, these participants did
not reveal their identities. However, the discussions gave
them the confidence to speak up and they voluntarily
shared their experiences about stigma, discrimination,
and violence, and their powerful stories had an impact
on everyone present.
During the 18-month period after the workshop, the
project team found that there had not been any offensive
or stigmatizing articles written about men who have sex
with men, including in the tabloid press.
Challenges and Lessons Learned
Although the retention rate was high among peer
educators, limited supervision and monitoring
of their activities impeded progress.
At the beginning of the study, 40 men were recruited
and trained as peer educators. By the end of the study,
only two had dropped out. Despite a high level of reten-
tion, there were a number of challenges that affected the
peer educators’ performance. Some peer educators found
it difficult to gain the acceptance and trust of their peers.
Others feared possible disclosure of their sexual identity
to family members as a result of their involvement in
the project, and therefore were not as active as expected.
Many found managing the men in their group sessions
and staying on course challenging. Further, the peer edu-
cators were not well equipped to monitor the activities
they conducted and report accurately how many men
attended and what was discussed, which hindered the
overall assessment of this intervention component. Bet-
ter supervision of peer educators could have contributed
to taking necessary steps in a timely manner, such as
providing additional training or re-thinking job respon-
sibilities, to limit the inadequacies that occurred.
Another challenge concerned the capabilities of the
peer educators. e project team aimed to select peer
educators based on their capacity to mobilize other men
who have sex with men, and their leadership and com-
munication abilities. In reality, however, the candidates
were often selected by the facilitators based on cronyism.
Better monitoring and supervision by implementation
partners would have been beneficial for identifying
unproductive peer educators and recruiting men with
better skills and more interest in the aims of the project.
e intervention did not reach “invisible” men.
Informants noted that intervention activities failed to
reach “invisible” men. is term refers to older men,
often of a higher socioeconomic status, who are very
concerned about keeping their sexual activities confiden-
tial to protect jobs and family. One respondent explained
this self exclusion:
ere are older Ibbis [one group of men who
have sex with men] that my friends and I visit
and sometimes they ask us questions about the
project activities…and it happens that they would
like to take part in these activities but are afraid
to do so. ey are not as bold as that. It must also
be understood that we do not belong to the same
generation and the realities are not the same.
22-year-old peer educator
Another informant noted the importance of targeting
older men because they may have more money and
hence more power in a sexual relationship:
...the old ones...attract the young ones with money.
And where money is available, the young Ibbi can
forget everything about prevention. at is the
reason why it is necessary to involve the older Ibbis
as well in the awareness-raising program.
23-year-old male
Table 3 Types of lubricants used during anal sex
(excluding commercial, water-based
lubricants)
Baseline
(n = 165)
Follow up
(n = 202)
% %
Vaseline 1 34**
Shea butter 8 21**
Saliva — 22
Beauty lotion — 19
Gel/Shaving cream 5 9
Butter/Cooking oil 2 3
Other lubricating products 11 4*
*p < 0.05; ** p < 0.001
7
jobs or training. Others felt that future efforts should
include training and professional development for the
study population, given their low levels of education and
frequent reliance on trading sex for economic gain. As
one respondent stated:
…you should help us to quickly find jobs because
we are living in a dire situation and are rejected
by society. No one supports us. If that is not pos-
sible, you should at least provide us with funding
to undertake income-generating activities.
33-year-old male
Programs need to clearly communicate what is and what
is not offered as a result of participation. At the same
time, programs could identify economic and educational
resources and opportunities in the community and make
sure peer educators are aware of them in order to com-
municate their availability to others.
Conclusions
is was one of the first intervention studies to address
the HIV and sexual health needs of men who have sex
with men in Africa. e study highlights both gains and
limitations of the intervention strategies implemented.
On the one hand, the project was able to recruit and
retain men to serve as peer educators to disseminate
information and condoms to their peers. In addition, the
project was able to recruit health providers to offer high
quality, non-stigmatizing STI services to men who have
sex with men, and to engage the media in a discussion
about how they can play a more constructive and less
stigmatizing role in fostering HIV prevention among
men who have sex with men and their partners.
On the other hand, there were clear problems with re-
cruiting appropriate leaders to carry out peer education
activities, providing adequate training and supervision,
and ensuring adequate supplies of lubricants compatible
with condom use. In addition, the project had limited
success in reaching older men, including those of higher
socioeconomic status. Moreover, there was uneven sup-
port for the program by intervention partners as a result
of wavering donor commitment to address the needs of
men who have sex with men.
e quantitative data suggest some improvements over
time among the study population, such as in HIV/STI
knowledge, condom use at last sex, and uptake of HIV
testing, which may reflect accomplishments of the inter-
Future efforts should focus on recruiting older men as
peer educators as well as using other communication
channels, such as a telephone hotline or the internet, to
inform and mobilize this population.
Men had very limited access to free or moder-
ately priced water-based lubricants.
e baseline data highlighted the need to increase men’s
access to water-based lubricants. e project contacted
many potential donors to receive supplies but only
received a small amount from a private Belgian donor.
ese were distributed during the first peer educator
training sessions conducted by ANCS. No further dona-
tions were obtained; thus the only option was purchas-
ing the product from a pharmacy where it was very
expensive (about US$10.00 for a tube).
Changing donor priorities impeded the imple-
mentation of planned activities.
Because of the political sensitivities associated with
men who have sex with men, donors were not always
consistent in their support of the project. Consequently,
the implementing partners who counted on receiving
funds for project activities were subject to donor-
specific constraints, including funding interruptions. For
example, the project initially planned to conduct a series
of sensitization and training activities with the police
to decrease stigma and violence perpetrated by them
against men who have sex with men. However, funding
limitations resulted in the cancellation of these activities.
Funding interruptions experienced by the partners also
created coordination problems, which interfered with
a streamlined effort to conduct activities. In the future,
as interventions for men who have sex with men are
implemented in other countries, donor concerns (and
concerns of host governments and other key players)
should be addressed early on, prior to study implemen-
tation, to ensure the uninterrupted implementation of
project activities.
e aims of the project were sometimes misun-
derstood by participants to include economic
benefits.
Some respondents thought that by participating in
the program they would receive financial gain, such as
vention as well as positive secular changes. However, the
survey data highlight other areas that remained problem-
atic, (e.g., such as limited condom use with women), or
that worsened from baseline to endline (e.g., the use of
Vaseline as a lubricant).
In order to move ahead in Senegal and in other regions
of Africa, it is clear that political and donor commit-
ment are key to effectively addressing the HIV-related
needs of men who have sex with men. While the extent
to which sexual activity among men contributes to the
HIV epidemic in Africa is unknown, it is clear that
certain behaviors increase this population’s risk and that
of their female sexual partners, and that there are few
resources committed to men who have sex with men in
many countries in the region. Political and donor com-
mitment therefore are critical, because each can facilitate
the smooth collaboration between implementing partner
organizations, ensure the continued availability of prod-
ucts and technologies such as condoms and appropriate
lubricants, support the creation and sustainability of
non-stigmatizing health services, and help curb stigma,
discrimination, and violence perpetuated by different
actors in the community through sensitization and
educational activities.
Another important area to address is that of capac-
ity building. For many implementing organizations,
working with men who have sex with men may be new,
or organizations made up of men who have sex with
men may be just getting off the ground. For both types
of groups, capacity building around community mo-
bilization, peer education, monitoring and evaluation,
supervision and support, and participatory approaches
needs to be considered.
Research Utilization
In response to this study, the Senegal National AIDS
Council is providing financial support to NGOs to work
with men who have sex with men, using both World
Bank and the Global Fund to Fight AIDS, Tuberculosis,
and Malaria resources. Findings from this project and
the earlier diagnostic study have informed the work
of other groups working to address the HIV-related
needs of men who have sex with men in countries such
as Ghana, Mali, Burkina Faso, the Gambia, and Côte
d’Ivoire, with funding provided by the Bristol Myers-
Squibb Foundation and the World Bank’s Multi-country
AIDS Program (MAP).
December 2007
References
Niang, Cheikh I. et al. 2002. "Meeting the sexual health
needs of men who have sex with men in Senegal," Hori-
zons Final Report. Washington, DC: Population Council.
is work was made possible through the efforts and contributions of
several institutions and the commitment of a number of people. Dr.
Abdoulaye Ly, in his capacity as Head of AIDS/STI Division Senegal
(Ministry of Health) provided invaluable insights, guidance, and sup-
port throughout the project. We also thank all the partner institutions
that contributed to the implementation of this study. We express our
gratitude to the individual men who voluntarily participated in the
surveys; without their contribution, this study will not have been pos-
sible.
We thank all members of the research team: Ndèye Fatou Ngom Guèye,
Moustapha Diagne, Alioune Fall, Abdoulaye Sidibé Wade, Ababacar
iam, omas Lax, Tidiane Kassé and Youssoupha Niang. Our spe-
cial appreciation goes to the facilitators who spared no effort to assist in
the gathering of information, often in difficult circumstances.
Finally, we would like to thank all those who contributed to the imple-
mentation of this project.
Study investigators include: Amadou Moreau and Placide Tapsoba, Ho-
rizons Program/Population Council; Abdoulaye Ly and Abdou Khoudia
Diop, AIDS/STI Division, Ministry of Health Senegal; Cheikh Ibra-
hima Niang, Institute of Environmental Sciences, Cheikh Anta Diop
University.
Suggested citation: Moreau, Amadou, Placide Tapsoba, Abdoulaye
Ly, Cheikh Ibrahima Niang, and Abdou Khoudia Diop. 2007.
“Implementing STI/HIV prevention and care interventions for
men who have sex with men in Senegal,” Horizons Research Sum-
mary. Washington, DC: Population Council.
4
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Tel: 202-237-9400
Fax: 202-237-8410
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This research summary is made possible by the gen-
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United States Agency for International Development
(USAID) and the President’s Emergency Plan for AIDS
Relief under the terms of HRN-A-00-97-00012-00.
The contents are the responsibility of the Horizons
Program and do not necessarily reflect the views of
USAID or the United States Government.
©2007 The Population Council Inc.
This document may be reproduced in whole or in part without
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