Despite a comprehensive approach to combating HIV-Aids, ignorance about the disease pervades Tunisian society

This article originally appeared on the Guardian’s website. View the original here.

Hamdi Sfaxi, who sells prayer rugs outside his local mosque in Tunis, has heard it all before. “If you’re going to treat AIDS,” he says “you need to know where it came from. It didn’t exist in the past. The first person to get AIDS was a gay man who had sex with a monkey.”

Sfaxi is not alone in his opinions. As the international AIDS conference begins in Melbourne this week, Tunisia, a country with one of the most far-reaching and comprehensive approaches to combating HIV-AIDS in the Middle East and north Africa, is in a war of attrition with the pervasive influences of ignorance and stigma that cut through to the marrow of Tunisian society.

While infection rates among its 10.8 million people remain relatively low – UNAIDS estimated the figure at 2,300 in 2012 – the numbers have reached much higher levels among certain groups. According to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the rate increases to 13% among men who have sex with men, 2.7% among intravenous drug users and 0.61% among female sex workers – all groups that are far outside the limits of traditional Tunisian society.

In comparison with much of the region, the response to the spread of HIV-AIDS from Tunisia’s government and civil society has been impressive. As Dr Zied Mhirsi, chair of the Global Network of Researchers on HIV-AIDS in the Middle East and North Africa, points out, much has been done: condoms, lubricants and single-use syringes have been distributed; free treatment of people with HIV, and awareness projects among sex workers, drug users, prisoners and men who have sex with men. But despite such efforts, he says stigma remains. “Stigma exists in Tunisia and it is due mostly to ignorance and the lack of awareness around the issue,” he said.

The anonymous testimony given to the Tunisian Association to Combat Sexually Transmitted Diseases and AIDS makes for chilling reading. One woman told the association: “I got HIV-AIDS when a delinquent locked me up and then raped me over the course of a month. I suffered a lot … he was torturing me.” Among the other “terrible things” she experienced was the stubbing out of cigarettes on her arms.

After she escaped and contacted the authorities, she was referred for psychiatric care. “[But] instead of recovery I suffered more and more because I was again raped by other patients in the hospital. Then I discovered my infection.”

Another woman told researchers that she and her children were thrown out of their house by her husband’s family after he died as a result of the virus. “We are now living on the streets, dependent on people’s kindness and charity,” she said. “Sometimes we are out in the open without food or clothing.”

Such stories are familiar to those who deal with the virus. But, they say, ignorance is widespread. “The lack of education of our leaders and influential people is a huge barrier that hinders the adoption of better prevention and treatment strategies,” said Mhirsi. “Educating the decision-makers will help [in] pushing for reforms – especially legislative ones that have been so far the biggest hurdles facing the HIV response.”

While equal access to healthcare is enshrined in Tunisian law, other, less progressive, legal measures exist that stigmatise those most at risk and often prevent them from coming forward.

It’s a problem acknowledged by Mohamed Lassaad Soua, Tunisia director for UNAIDS, who said: “Punitive laws hinder access of key populations to prevention and treatment.”

Article 230 of the Tunisian penal code says same-sex relations are punishable by three years’ imprisonment, while drug users – including those taking drugs for the first time and irrespective of the drug in question – face five years in jail. Although it carries a two-year prison term, sex work remains largely ignored.

In February 2012, Samir Dilou, Tunisia’s human rights minister and a member of the majority Ennahda party’s executive committee, joked with a television host that homosexuality was not a human rights issue, but a medical condition requiring treatment. Such attitudes indicate that, although civil society and healthcare professionals are pushing for a change in government attitudes, progress has not been encouraging.