HIVexing: Stigmas about HIV & AIDS in Tunisia

AIDS is the common name given to the disease, which is considered the scourge of the 20th century and for which scientists have not found a vaccine yet. However, the word AIDS is often misused. The acronym HIV is less used and yet it remains the most accurate term when the disease is discovered.

HIV and AIDS are two different things, but they have a causal link. HIV is the human immunodeficiency virus, a species of retrovirus that infects humans and is responsible for acquired immunodeficiency syndrome (AIDS), which corresponds to a weakening of the immune system making it vulnerable to multiple opportunistic infections.

AIDS is the acronym for acquired immunodeficiency syndrome, which is the set of symptoms following the destruction of cells in the immune system by the human immunodeficiency virus, HIV. AIDS is the last stage of HIV infection when immunosuppression is severe. It leads to death through opportunistic diseases to which this immunosuppression gives rise.

According to the World Health Organization, in 2022 almost 39 million people are living with HIV, two third of whom (25,6M) are in Africa.?

In Tunisia, the first case was discovered in 1985, and since then until 2009, a total number of 1568 HIV+ cases and 497 deceases were reported. In 2019, according to ATL MST SIDA TUNISIE - one of the very few NGOs that work on HIV and AIDS- 6500 person are living with HIV. This number had increased by 328% between 2010 and 2019.?

Among the main reasons behind these numbers are the social barriers and stigmas that made HIV and AIDS referred to as “The shame disease” in the Tunisian urban language.?

Tunisians as part of the Arab and Muslim world have been screening everything based on religious criteria, and since HIV and AIDS are mainly transmitted through sex – among other ways- some people are convinced that it’s god punishment to MSM (Men having sex with Men). These statements and illiterate and ignorant judgements lead to the denial of the existence of HIV and AIDS and causes more ignorance and a resistance against learning more about the disease. In fact, sexually uneducated generations are being raised, lacking the knowledge of the minimum means of protection against contracting HIV, which leads to the increase of HIV+ numbers in the country.?

Based on the above, it is important to clarify:

1-?????How is HIV transmitted?

2-??????Basics of HIV prevention.

1-?????How is HIV transmitted?

The human to human transmitting of HIV?may be through certain bodily fluids that might contain high concentrations of the virus. These fluids include:

• Blood (including sharing injection drug equipment)
• Semen
• Vaginal secretions
• Rectal secretions
• Breast milk

Since the disease first spread in the 1980s, all sorts of crazy ideas - about how the AIDS virus spreads and what it’s like to live with HIV - have fueled prejudice and stigma.

Despite all awareness campaigns, in 2016, 20% of people living in the UK still believed that HIV could be transmitted through contact with a patient’s skin or saliva.

It is also important to note that it is time to break the myth and stop believing that HIV can be transmitted through:

• Saliva (closed and non-deep kissing is safe)
• Tears
• Sweat
• Holding hands
• Hugging
• Shaking hands
• Sharing a toilet
• Sharing dishes
• Through air and water
• Sitting next to someone with HIV
• Closed-mouth kissing
• Scratching surface skin
• A bite that doesn’t break the skin
• Insects that bite, like ticks and mosquitoes
• Other casual contact that does not involve transmission of bodily fluids

?As mentioned above in this article, HIV is transmitted through close and unprotected contact with an infected person’s body fluids, when the HIV+ person’s viral load is high:

The risk of transmission exists at an early stage of infection and persists throughout the life of a person with HIV, even if the risk becomes very low when the viral load is undetectable.

Prevention is therefore essential.

PREVENTING THE OCCURRENCE OF HIV DURING SEX

The fact of having one unprotected sexual relation with an infected person is enough to transmit the HIV virus. Having unprotected sex with someone you don’t really know is though like a Russian roulette.

The risk of sexual contamination is increased:

·????????When mucous membranes have lesions;

·????????During the first sexual intercourse;

·????????During the woman’s period;

·????????If one of the partners has a sexually transmitted infection (STI);

·????????If sexual intercourse is accompanied by violence, which can cause damage to the mucous membranes, even if they are invisible.

Only two contraceptive methods, male and female condoms, protect against HIV, but also from other sexually transmitted infections (STIs) during sex.

PREVENTING HIV TRANSMISSION WHEN USING SYRINGES AND NEEDLES

Even though we do not encourage the idea of drug use, it is important to mention that any intravenous drug user should only use his personal equipment. Do not share needles, syringes, spoons, water, products or filters. Remember the following:

• A syringe should only be used once.
• HIV can survive in a used syringe for?up to 42 days, depending on temperature and other factors.?
• Syringes and needles are sold over the counter in pharmacies

PREEXPOSURE TO HIV BY TRUVADA? OR DESCOVY OR ITS GENERICS

What is PrEP?

PrEP or pre-exposure prophylaxis is a prevention method that provides a drug against human immunodeficiency virus (HIV) infection to a person not infected with HIV. It is used intermittently or continuously.

PrEP is made for men and women who are at high risk of contracting HIV through their practices. This prevention is intended to reduce the risk of becoming infected.

PrEP reduces the risk of HIV infection but does not eliminate it and, unlike condoms, does not prevent other sexually transmitted infections (STIs), such as syphilis, chlamydia infections, genital herpes. Furthermore, PrEP does not prevent other blood-borne infections such as hepatitis C.

?

PrEP: for whom?

PrEP is currently recommended for all adults at high risk of HIV.

Populations at high risk of HIV infection include:

• Men who have sex with men (MSM) or transgender people who meet one or more of the following criteria:

1.??????anal sex without condom with at least 2 different sexual partners in the last 6 months;

2.??????STI episodes in the last 12 months;

3.??????at least one use of post-exposure HIV treatment in the past 12 months;

4.??????Drug use during sexual intercourse.

• ??On a case-by-case basis, persons in the following situations:

1.??????Injection drug use with needle exchanges;

2.??????Sex workers with unprotected sex;

3.??????Vulnerability to unprotected sex at high risk of HIV transmission.

In Tunisia, other than condoms (men) no other means of protection are used. As for PrEP, the population of high risk does not even know that such a prevention exists because of the mindset that link HIV to homosexuality. This means that if anyone brings the HIV subject or PrEP will be judged, not for trying to enlighten minds but for "Encouraging homosexuality".