Cannabis and psychotropic drugs are the most common drugs used in Tunisia. Heroin and Cocaine are also available and used (WHO Website). The country estimates that there are 9,000 PWIDs in Tunisia (Tunisia MoH, 2012). Drug treatment services are not well developed.

HIV prevalence is low in the general population. There are reports of concentrated epidemics in MSMs. PWIDs and FSWs are other most at risk groups in Tunisia (Tunisia MoH, 2012). Injecting drug use accounts for 23.9% of HIV infections. Transmission through injecting drug use was relatively high at the beginning of the epidemic. In recent years, a few cases of infection have been reported among PWIDs (Tunisia MoH, 2012). In the years 2009 and 2011, two studies were carried out among PWIDs in Tunis and Bizert which provided the primary information about HIV prevalence and the extent of risk behaviors. HIV prevalence was 3.1% and 2.4% in 2009 and 2011, respectively. Sharing injection equipment and unsafe sex was not rare (Mathers, et al., 2011; Tunisia MoH, 2012).

The seventh National AIDS Strategy (2006-2010) was extended to 2011 due to the political crisis in the country. The new National Strategy has been developed for 2012-2016 (Tunisia MoH, 2012). The strategy includes PWIDs as an important target group and envisages outreach services for education and condom distribution (Tunisia MoH, 2012). The implemented GFATM Round 6 program included similar strategies (Tunisia MoH, 2006). NSP, although, not included in the National Strategy, is provided through three sites. In 2011, more than 100,000 syringes were distributed. VCTs are widely available in the country, and around 20% of PWIDs had been tested in the past 12 months and knew their results (Tunisia MoH, 2012). Only four centers are providing ART, which is also available for PWIDs (Tunisia MoH, 2012; WHO, et al., 2011). OST is not available in the country.

A few NGOs are providing HIV prevention for PWIDs (Tunisia MoH, 2012) and the coverage is very low (Tunisia MoH, 2012; UNAIDS, 2011a). Their capacity is limited and the services are highly dependent on external financial sources. The political change has slowed down the process of decision making and expansion of the facilities. HIV programs need political support and should be considered as a priority for the country.

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