With a lackluster complexion and struggling to articulate, Salwa is in need of a coffee. Exhaustion and the cumulative effects of injecting drug use have taken their toll on 37-year-old Salwa, who looks to be closer to 50. She has spent the night in a cafe. Yesterday, it was pouring rain. “I was freezing cold. The server who works in this cafe was nice, he said I could stay until morning.” In the evening, she had gotten off work at a popular restaurant-bar where she is employed as a cleaning lady.
She was told that if she shared tips with the waiters, she would have enough for a hotel room for the night—one of those seedy motels in downtown Tunis where the cost of a room is 20 dinars. In the end, her co-workers only gave her five dinars.
It was not the first time she spent the rest of the evening wandering the streets of downtown Tunis. Salwa was introduced to this kind of lifestyle upon her arrival in the capital. It was her boyfriend who initiated her into an existence of sleepless nights in the street and under bridges. Originally from southern Tunisia, Salwa met her boyfriend over the phone and was wooed by his promises of a better life. “I loved him without ever having seen him,” she recalls, bemused by her own “naivité.”
Turning point
In the midst of the country’s revolution in 2011, Salwa and her boyfriend planned to meet in Tunis. He was from Sidi Hassine, and kept Salwa separate from his family. She became his sexual partner. But that wasn’t all.
I started out with a few drugs, then moved on to ecstasy which we would sniff together. Then, he would dissolve it in water and inject it into my veins. I followed him blindly.
While there are no official statistics quantifying the number of persons who inject drugs (PWID) in Tunisia, the associations that serve them indicate that they are in the thousands. According to a recent study by the NGO Lawyers Without Borders (LWOB), there are more than 4,000 PWID in Tunis alone.
Like Salwa, most of them come from poor neighborhoods and regions outside the capital. They start using at a young age, around 25 years old. These women, often mothers, almost all know one another, according to Kods Brahmi, sociology researcher and advocacy officer with the association ATL/MST Sida, during an interview with Nawaat.
“There are more and more of them, and they are starting to use at a younger age,” Brahmi informs us. Their vulnerability reflects a combination of different factors such as low education level, rejection by their families, lack of financial resources, difficulty finding work and exposure to sexual violence. Salwa, who dropped out during her first year of high school, is a case in point.
Where does she get so many drugs? The question surprises her. “They’re within easy reach,” she answers.
Subutex is the most common drug used by PWID, followed by ketamine and heroin. However, cocaine is also becoming more popular due to its decreased price as well as its availability on the market, where it can be obtained in little quantities. According to the LWOB, the cost of cocaine is about 40 dinars a day (between 20 to 150 dinars) for daily use.
In 2011, finding herself homeless, Salwa met another girl who said she could stay with her.
She left the house, pretending she was heading out to run errands. Some men showed up and took me to an isolated spot in El Mourouj. They took turns raping me. One man came to get me out, pretending it was his turn to have me. Years later, I bumped into him downtown. He reproached me for not having returned home.
But she had become pregnant by her boyfriend. Going home had become dangerous, especially because his family was against them getting married.
“Every time I tried to return to my family, I faced the same criticism and attacks. My mother was softened by the birth of my daughter, but not my brothers, and she remained torn between us,” Salwa explains in a tone of resignation.
So she went back to the streets and turned to sex work.
Sex work and drug use: a vicious cycle
Salwa meets her clients in downtown Tunis. Over time, she became well known. One client would lead to another. Some were regulars and even brought her home with them.
“It was often young men, sometimes younger than me. We would stay together for a month or two. We would live as a couple: he would take care of me, and his friends didn’t touch me. During this period of time, I was treated with respect,” she recalls. But it was only temporary respite before returning to the street.
Sex work often goes hand-in-hand with drug use. In order to subsidize their habit, these women turn to prostitution, says a member of ATL/MST Sida.
“Drugs help them to endure this work and to be more productive,” she explains. They are generally paid between 10 and 20 dinars, and sometimes remunerated with food.
Salwa fell into this vicious cycle. At one point, she spent nights with her daughter sleeping on a mattress in an abandoned house. One day, neighbors notified the police. Her daughter was placed in an SOS Children’s Village. Later, Salwa became pregnant with a boy who was placed with his half-sister. Ultimately, their grandmother recovered them.
During the Covid epidemic, Salwa left the capital. “There was no more work. I returned to my family, even though that meant becoming a scapegoat for my brothers,” she says. But soon enough, she fled home again.
I could tolerate being hit—I had become used to it—but not humiliated in front of my children; I couldn’t bear to hear them called bastards.
Until this point, Salwa has remained impassive, calmly sharing her story as if numbed by the pain. Now she bursts into tears. She then tells us about the next great disappointment of her journey.
HIV
Her first boyfriend reappeared with promises of a stable life and the possibility of starting a family. “I was prepared to do anything to stop this downward spiral,” she admitted. But to do so, she started using again, under his influence.
One day, they took a blood test. Her partner turned out to be HIV positive. He had never before thought to get tested. “He had been using since he was young. As he said, he was born into it.”
A fate that he decided to share with her—by trying to infect her with the virus.
“We started to get high, having injected Subutex in our veins, as usual. But one time, he drew a little blood and injected me with it. He said that our destinies would be forever tied. I let him do it, because I was high, numbed by the drug,” she recounts, chain-smoking an inexpensive brand of cigarettes. Her damaged teeth reveal years of suffering. A bitter smile appears on her face. “I can’t believe how gullible I was.”
PWID are particularly vulnerable to viral infections. “Women who inject drugs say that they often share needles, explaining this choice by their lack of awareness about the risks, or the impossibility of obtaining syringes at the pharmacy and fear of being intercepted by the police. Some women also mention that they shared needles with their partner as a sign of love or trust,” LWOB writes.
The HIV epidemic in Tunisia is concentrated, with a very high prevalence among key populations, especially people who inject drugs and sex workers. This trend is growing at a steady rate, according to the report.
Salwa has accepted her new life which is structured around a daily dose of pills to treat HIV. She follows her treatment assiduously, seeming to have come to terms with her destiny. “Very young people have died before my eyes, ravaged by drugs and HIV,” she says, horrified. “I don’t want to meet the same fate.”
Yet again, her search for comfort revolves around a man who she describes as a “lifebuoy.” She hopes to start a family with him, before her dreams are dashed anew. The man in question returned to his hometown in the middle of the country, where his family is firm in their decision to marry him—not to Salwa, but to a cousin. Several months ago, Salwa gave birth to his daughter, but the infant was placed in an SOS Children’s Village.
Ignored, forgotten
In spite of everything, Salwa’s resignation sometimes gives way to hope. She participated in a cooking program thanks to an NGO, and remains determined to get her children back. At one point, she stopped sex work and started working with downtown street vendors, until they too were driven away.
She is resolved to bring her children together and to rebuild her life. She is no longer sure whether she should set her hopes on the father of her first daughter or the father of her last. The important thing is to find some stability and gather the strength necessary to raise her children.
When her mental state deteriorates, she is sent to Al-Razi Psychiatric Hospital. “I would like to receive psychological support—I need it so badly. But I don’t want medication that makes me numb,” she affirms. She aspires to staying active and motivated to work. “I want to pull through, to not return to the street and its sordidness.” And yet she still doesn’t know where she will spend the night. When Salwa found out that she was HIV positive, her family rejected her. “They say I deserve it. They refuse to eat with me or come close to me. I have become an outcast.”
Her reception is hardly better in certain public institutions where she has stayed, especially the hospital where she gave birth to her last child, a healthy baby girl. “The nurses informed the patients with whom I shared my room that I am HIV positive. They avoided me, even though all I needed was to talk,” she says sadly.
Women who inject drugs face social and legal issues. Socially, they are ostracized, seen as deviants who do not fit with society’s image of a “virtuous” woman, wife and mother. Legally, they risk imprisonment under Law 52 which criminalizes drug use. Under the Penal Code, they can also wind up behind bars—and are prey to police violence—for soliciting.
“Reported police practices included harassment, extortion, arbitrary arrests and violence, including sexual violence,” the report highlights.
Marginalization does nothing to help women who use to stop their habit. In 2023, the Tanit outpatient unit at Al-Razi Psychiatric Hospital in La Manouba opened to provide care services for women addicts. “It is only one unit and is only open during the day. If a user truly wants to wean herself off drugs, there is only the detox center in Djebel Oust. But you must have the resources for treatment,” says Kods Brahmi. For years, associations have demanded the introduction of methadone, a molecule that doctors prescribe for recovering drug addicts.
Meanwhile, Brahmi mentions, these same associations are struggling to provide social assistance and sterile syringes to minimize the spread of HIV. Ultimately, many women are simply left to fend for themselves.
Thus isolated, Salwa falls apart. “I think I’ve never known happiness and never will. Disappointment and disaster have been recurring events in my life since I was young. Sometimes, I imagine putting an end to everything by ending my life. Then I think of my children.” Salwa has already attempted suicide.
Women like Salwa are ignored and forgotten by the government and feminists alike. As if, Brahmi notes, they did not exist; as if they did not have the same right to social-economic reintegration as other marginalized women.
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