TUNIS — During a routine check-up, Khawla discovered she was living with HIV along with other sexually transmitted infections. She confided, “I didn’t understand what was happening around me. I didn’t have the luxury to process it emotionally. I simply asked, ‘Alright, what do we do now?’” This diagnosis turned her life upside down and highlighted the challenges faced by 8,000 people living with HIV in Tunisia.
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“HIV is not just a medical issue but also a socio-economic, equality and human rights issue,” says Lassad Soua, director of the UNAIDS program in Tunisia. Since 2010, new HIV infections in the country have increased by 59%, a troubling statistic obscured by taboos and stigma. Structural barriers further hinder prevention efforts and necessary interventions to curb the virus’s spread.
Health system under pressure
Antiretroviral therapies (ART) have revolutionized global HIV management, enabling those infected to live healthy lives and prevent viral transmission. Yet, access to these treatments remains a significant challenge in Tunisia. The healthcare system struggles to meet demands, with only four specialized centers in Tunis, Sousse, Sfax and Monastir.
Testing services are limited, treatment coverage is inadequate, medication shortages persist and facilities are ill-equipped for affected populations.
Daily ART can reduce the viral load to undetectable levels, making the virus non-transmissible. But in Tunisia, despite the steady increase in new infections, accessing these therapies remains difficult. Only 26% of people with HIV are aware of their status, and just 25% receive ART — a stark shortfall from global targets aiming for 95% treatment coverage.
We are progressing, but not quickly enough to address high-risk behaviors.
“Since 2010, the epidemic has remained concentrated within certain populations, without reversing the trend. Access to services, geographic coverage, and outreach to affected groups remain major gaps,” Soua says.
Financial constraints have led to the closure of accessible centers in neighborhoods of Tunis like Mellassine and Nabeul, which provided essential services such as distributing sterile needles to injection drug users. Remaining centers struggle to meet rising demands with limited resources.
Meanwhile, the slow adoption of medical innovations — such as combination prevention strategies and methadone therapy for injection drug users — exposes systemic inadequacies. Soua explains, “We are progressing, but not quickly enough to address high-risk behaviors like chemsex or needle-sharing,” practices that significantly contribute to the virus’s spread.
Taboos behind the numbers
While healthcare gaps complicate the care of those living with HIV, the stigma and taboos surrounding the virus exacerbate the situation. Amira Derbali, coordinator at Lawyers Without Borders, explains, “Conservative social norms complicate discussions about sexual and reproductive health. Because HIV and STIs are associated with behaviors deemed immoral, fear of exclusion leads people to self-censor, limiting prevention and treatment.”
The impact of this stigma is measurable. A 2018 study showed that 53% of Tunisians refused to buy vegetables from someone living with HIV, and 47% believed HIV-positive children should not attend the same schools as others.
Stories like those of Khawla and Zeina* illustrate these challenges. In 2021, Khawla discovered her HIV status during a routine check-up, leaving her emotionally scarred: “I lost my ability to process what was happening.” Zeina, diagnosed 25 years ago, contracted the virus during her last encounter with a former partner. “That was the beginning of the hardships,” she recalls.
Some go as far as disguising their treatment as if hiding something illegal.
Despite Zeina’s efforts to educate her subsequent partner about safe practices, he betrayed her by disclosing her status without consent. “I realized I was better off alone,” she says with a mix of resolve and bitterness.
Khawla, on the other hand, turned her experience into advocacy, sharing her journey on social media to raise awareness. “I express my anger and confusion to promote understanding and humanize this reality,” she says. Despite her efforts, the stigma persists in her daily life.
“When I disclose my status, people’s tone and attitude change instantly. HIV primarily affects human relationships — with others and oneself,” she explains.
Dr. Rajeh Rezgui, an infectious disease resident at Rabta Hospital, witnesses the effects of this stigma daily. “Many patients live in constant fear that their families or communities will discover their status. Some go as far as disguising their treatment as if hiding something illegal,” he says.
Discrimination infiltrates healthcare institutions. Patients are sometimes placed at the end of clinic queues, forced to wear masks or denied care outright. “The worst discrimination happens within hospitals,” Dr. Rezgui says.
Between law and practice
Addressing HIV transcends public health, raising deeper human rights issues. Despite progress from advocacy groups and UNAIDS, Tunisia’s legal framework remains ill-suited to address the specific needs of HIV-positive individuals and vulnerable populations.
While the 1992 law prohibits discrimination in treating infectious diseases, amendments like Article 11 bis, introduced in 2007, allow for coercive measures such as mandatory testing or isolation for diseases classified as epidemics. Amira Derbali warns that these provisions risk stigmatizing individuals living with HIV rather than ensuring equitable care.
On the ground, legal barriers intersect with social and practical challenges. Peer educator Osama* recounts instances of police harassment despite carrying official permits. “Carrying condoms or HIV testing kits can lead to accusations of public indecency,” he says.
Tunisia’s 2021-2025 National Strategic Plan focuses on psychological and social support, tailored prevention and treatment, and integrating human rights into every stage of the response. Yet gaps in implementation hinder progress.
Despite the obstacles, Khawla remains resolute: “I share my story to break taboos and promote empathy. It’s not the virus that destroys us — it’s others’ rejection.”
*Some names have been changed to protect confidentiality.
