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Health Certificates for Commercial Sex Workers in Senegal 

Student Researcher: Shanthi Manian
Location: Senegal

Commercial sex workers constitute a critical core population in the epidemiology of HIV and other sexually transmitted infections (STIs). Therefore, regulation of the commercial sex industry has important implications for STI control. Recognizing this, many countries have adopted a policy of legalization with regulation of sex work. This policy, typically implemented through a registration program, allows sex workers to operate legally, conditional on fulfilling certain health requirements. However, the causal effect of this regulatory framework on health outcomes has not been documented.

This study examines the health certification effects of a sex worker registration program in Dakar, Senegal, in place since 1969.

Adapting a standard information disclosure model, we would expect that when sex workers’ health status is unobservable, certified providers should earn higher prices, and as long as certification costs are low, all suppliers should obtain certification. These predictions were tested using a novel randomized experiment among uncertified female sex workers. A randomly selected treatment group was offered a one-time incentive that reduced monetary certification costs to zero.


Contrary to the theoretical prediction, take-up of this incentive was very low: only 7 percent of the treatment group obtained certification, relative to 2 percent in control. Moreover, there was no evidence for a large price premium to certified sex workers.
New evidence indicates that sex workers’ health status is partially observable and already priced into the sex market: sex workers earn 19 percent lower prices when they have visible STI symptoms. As a result, the value of certification is limited for both clients and sex workers. These results, combined with evidence for high non-monetary costs related to stigma, suggest that complementary services for uncertified sex workers are needed to achieve sexually transmitted infection control.

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