In Tunisia, an alarming increase in cases of HIV infection

One summer evening, Farooq*, looking to meet new people, finds Ahmed’s profile on a dedicated app. Although the latter does not exactly fit his criteria, one detail attracts his attention: mention “Prep Negative” In his description. This means that Ahmed is not infected with HIV and is taking prevention treatment against the AIDS virus, known as pre-exposure prophylaxis (PrEP).

PrEP is an HIV prevention strategy that involves taking antiretroviral medication by individuals who are not infected but are at high risk of transmission. This method is known to reduce According to a published French study, the risk of transmission of the virus in the event of contact with an infected person is significantly (93%). The Lancet Public Health in 2022). At age 37, Farouk, an architect living in the northern suburbs of Tunis, takes a cautious approach during his casual sexual encounters with other men. However, he admits that condom use is not always systematic, with his partners often reluctant.

Well-acquainted with PrEP, which he himself has been taking without a prescription for contacts in Europe for years, Farouk had never seen this mentioned before in Tunisia. Interesting, he Ahmed spoke to, revealing the existence of a PrEP pilot program at the University Hospital Center (CHU) in the east coast city of Monastir. After making an appointment via email, Farouk travels two hours from Tunis to receive treatment a few days later.

A “very active” epidemic

When he arrived, he saw the presence of other men who had come for the same reason. “I wanted to start a conversation but they looked scared”He says, describing people who are anxious and try to hide their faces to avoid the gaze of others.

Corroborating these concerns, the doctor who welcomed Farooq told him that participants in the program rarely fear being stigmatized or prosecuted by the authorities due to the criminalization of same-sex sex, which can carry up to three years in prison. .

Despite this, the PrEP program specifically targets men who have sex with men, as part of the national HIV strategy. An initiative that is little known. Between December 2022 and January 2024, only 58 people were able to benefit from this program, of which 43 are still ongoing. Obstacles associated with traveling to Monastir forced Farouk to favor a solution outside of official channels, obtaining his drugs abroad.

Originally from the governorate of Medenine, located in the south of the country, Malek, 30, has not benefited from the same opportunities. This worker weirdwho had discovered her HIV status a year earlier, had no access to PrEP, even though the pilot program had just begun. “I only found out about this program after I was diagnosed”That explains.

Despite the relatively low prevalence of infection, less than 0.1% of the general population, according to the UN and the Ministry of Health, HIV is considered epidemic. “very active” The number of infections has steadily increased over the past ten years, according to authorities. According to the latest data from the United Nations Program on HIV/AIDS (UNAIDS), the number of people living with HIV in Tunisia is estimated to be 7,100 in 2022, up from 4,700 in 2010. Although antiretroviral treatment is free, only 26% benefit from it due to difficulties associated with screening and follow-up.

“Stopping communication with authorities”

As part of its screening strategy for the years 2022 and 2023, the Ministry of Health has noted a gradual increase in seroprevalence among populations most exposed to the virus. Specifically, men who have sex with men, whose HIV rate reaches 8.2%, while for injection drug users, it is 8.8%. “The worrying thing is that we have gone from a stable epidemic to a concentrated epidemic. Unlike other regions of the world where the epidemic is declining, ours is seeing a steady increase”Remi Khouli, director of Lawyers Without Borders (ASF) in Tunisia and an activist in the fight against AIDS for more than twenty years, worries.

Supported by the Tunisian Association for the Fight Against Sexually Transmitted Diseases and AIDS (ATL MST Sida), Malek was able to seek treatment at the Sfax care center, one of four in the country, located hundreds of kilometers from his residence. Despite the difficulties of transportation, accommodation, and stigmatizing comments during his treatment, Malek adhered to his treatment and is one of the 24% of patients whose viral load is no longer detectable, a percentage that is still far from average. Global target 95%. “In addition to low screening rates, many people give up their right to access health to avoid stigma”Remy Khouli says.

Behind her office in the Tunis section of ATL MST Sida, Sonia Torkhani, responsible for the association, regrets that the existing 23 screening centers are not all active. “Many prefer to come to association centers with the principle of community screening to avoid discrimination and stigmatization of medical personnel”, she testifies. with its mobile units and centres A “low threshold” that provides support and harm reduction services to drug users without requiring abstinence, the organization seeks to reach the most marginalized populations, including women, in remote regions.

“As long as they are criminalized it will be very difficult to access these populations”, for his part believes the director of the ASF in Tunisia, who calls for the criminalization of homosexuality, drug use and sex work. Reforms that have been put on the back burner since the coup of President Qais Said on July 25, 2021, synonymous, according to Remi Khouli, with “Complete cessation of communication with public authorities”.