Cuba and HIV

Preface for the Carnival of the Revolutions: Welcome! If your are interested in other posts about Cuba, you can go to Archives by Category and see what we have. Quid covers a wide range of subjects, as the spirit moves, so to speak.  If you are interested in humorous stuff, it's all filed under "Death of Communism," which always puts a smile on our faces.

“The food here is good. The medicine is very good. But I prefer to be free, even if it means no medical care.” —Resident of Los Cocos sanitarium during a period of forced confinement

One of the trendier aspects of Cuban news coverage is that county's remarkable record of containing the spread of HIV infections.  While looking at the reportage available on a simple Google search, one is struck by the admiring tone of the authors.  Reporters and researchers of a more scientific bent are alike in their laudatory approach to telling the story of how Cuba has beaten the scourge of the late 20th century.  While other countries struggle with ever-increasing infection rates, ineffective health initiatives, ignorance, and superstition, Cuba has kept its infection rate at astonishingly low 0.05%.  The first cases of HIV were detected in 1986 and the Cuban Government moved quickly to address the problem with a comprehensive approach that has come to include education, free treatment with anti-retrovirals, stays at sanatorium facilities for those infected and tracking and testing of the partners of those found to be HIV positive.  Pregnant women are tested for HIV as a part of their prenatal care and, if positive, their babies are delivered by caesarean section to prevent transmission of the infection to their babies.  In "Cuba: Is it a model in HIV-AIDS Battle," author Tom Fawthrop of the Global Policy Forum, says

Some aspects of Cuba’s broad development model, such as its emphasis on health and education, are held up by UN experts to other developing countries, including those in the Caribbean region, whose infection rate of 2.3% is the second highest in the world after sub-Saharan Africa (9%). Cuba’s neighbour Haiti has an infection rate of 6.1%. Dr Rigoberto Torres, director of the Health Ministry’s HIV/AIDS programme told Panos Features: “Cuba was one of the first countries to establish control and educational programmes. Our good educational system makes it easy. TV information ads teach people about AIDS and promote safe sex. We also have a sex education programme in schools.”

Yes, Cuba's development model, 45 years in the making, does emphasize health and education, so the UN holds it up as an example to other developing countries.  But another aspect of its "broad development model" has had an even greater effect on containment of the HIV infection: utter control of individuals by the State.  Or as it is delicately put by Dr. Byron Barksdale, director of the Cuban AIDS Project (an American charity):

...cultural differences between the two countries that would make it difficult to implement the Cuban model. “In the US, the rights of the individual are foremost, but in Cuba the individual is expected to do what is necessary to protect the collective society.” That is why people in high risk categories are willing to roll up their sleeves and not protest HIV tests, he adds.

Cultural differences, eh?  Well, the penalty for not upholding the collectivist ideal may have something to do with their willingness "to roll up their sleeves."

The food is good...and free.

So what does Cuba do that is so effective?  Let's take a look:

Forced indefinite quarantines:  When the first cases of HIV were detected, those infected were forced to go to sanitariums indefinitely.  Since 1993, quarantine beyond the mandatory 8 weeks is no longer compulsory, but life in the sanatorium has its advantages so nearly 50 percent of those quarantined residents choose to stay, as in this testimonial:

Manuel Acosta and his wife Mayalin, both HIV positive, choose to stay in Les Cocos rather than go home. Acosta told Panos Features: “I’m comfortable here. Since I became HIV positive, I have received training and now work as an x-ray technician. Food is free; it is much better than going home.” Since contracting HIV Mayalin has retrained as a nurse.

Ah, yes, free food.  Another cultural difference: in a society where food is scarce, the offer of free food is a powerful incentive to adhere to the "collective ideal."
Forced caesarean sections for HIV-positive mothers:  There is almost no mother-to-baby transmission of the disease.  We were somewhat confused by the fact that HIV testing isn't compulsory (though strongly recommended, and we know what that means) so how would anyone know if the mother is HIV-positive? and the answer is:
Surveillance: Early on, the Cuban Government had compulsory testing of "high risk groups: the sexual partners of those found to have HIV, Cubans who had visited Africa (all those "advisors" in Angola), and pregnant women. The BBC In Depth reports:

In addition, a national surveillance system tracks all infected people and their partners. As a result, the government has an extensive database on all HIV/Aids infections, including their source, whether from overseas or within the country.

So, stringent measures early on have been relaxed somewhat because there is now a comprehensive database of people who have HIV/AIDS and their partners, and anyway, half of those are in sanatoriums which makes the job of keeping track even easier.
Anti-retroviral therapy: Cuba does not have the foreign exchange capacity to purchase drugs on the international market, so they set about copying various anti-retroviral drugs, which they now manufacture and administer to those infected.  This, and the free food, has led to better long-term health and lower mortality rates for those infected.

In our previous post, we touched on one aspect of the Cuban economy that is growing by leaps and bounds, sexual tourism.  It occurred to us that visitors to Cuba have it pretty good: a very low infection rate in the native population, bargain basement prices, and women who are doing it for noble reasons, like out of necessity (as opposed to doing it to feed a drug habit or a pimp).  The American Foundation for AIDS Research (AmFAR)  points out that this is indeed the weak link in the AIDS prevention chain

The burgeoning tourist industry has opened up new avenues for the spread of HIV, including drug use and prostitution. Although prostitution is officially banned, many Cubans have been turning to commercial sex work as the only means of obtaining foreign currency. And as commercial sex workers (CSW) remain highly marginalized, AIDS educators have had difficulty in reaching them with prevention information. In addition, condoms are not widely available in Cuba, although some efforts are being made to increase their distribution, especially in tourist and recreational areas.

We wonder: is the UN touting THIS part of Cuba's development model to other developing countries?

Sources used in this post:
AmFAR
Global Policy Forum
BBC News

(Photo from AmFAR, courtesy Bill Stephenson)

Thanks to:
John Ray at Socialized Medicine: the downward spiral observed
No Pasaran!
Val Prieto at Babalu Blog----

Update on Wednesday, April 27, 2005 at 08:27PM by bbmoe

We have already discussed AIDS in developing countries here.  Check it out if you want a peak at how a country, Uganda, under a leader, Museveni,  dramatically lowered infection rates while AFFIRMING the humanity of individuals.

Comments

[Murel Bailey]

I'm surprised our opinion shapers aren't lauding the mainland Chinese efforts to eradicate venereal diseases. From what I hear, they did it by euthanizing the infected, and that there are still Chinese people who fear to go to the doctor lest something be found that they treat with extermination.

The short version being "a low infection rate is not a good thing in all contexts." Eliminating disease by eliminating the diseased is not a medical achievement.

[The Redhunter]

A most excellent post. You expose the fellow-traveler apologists beautifully. Actually, of course it is enough to make you cry. Cuba is a double tragedy; one because the people suffer under such a dictatorship when the island holds such promise, and second because so many refuse to see the dictatorship for what it is.

Your discussion of the hospitals reminds of of a book I read recently; "Commies: A Journey through the Old Left, the New Left, and the Leftover Left" by Ronald Radosh. One of his "Molotov-Ribbentrop Pact" moments came during a visit he took to a Cuban hospital. He'd made the trip to Cuba with some other commies in the 70s, and was aghast at what he saw. He talked about homosexuals imprisoned in psythiatritric hospitals for no other reason than being Gay. All this pre-AIDS, of course.

Your post also reminds me of the description of fellow-travelers by Paul Hollander in his excellent book "Political Pilgrims". When visiting the Soviet Union in the 1930s, at the height of Stalin's terror, these folks would praise the Soviet system to no end. Malcome Muggeridge called them "among the wonders of our age" Alas, they are with us still.

[Howard E. Morseburg]

You do as straightforward a job of exposing and explaining the idiosyncracies of Cuba and its' medical system as I have ever read. Too bad it cannot be required reading at San Jose State and Berkeley, eh?

Imagine, I remember Cuba from my visits there in 1941, as a 16 year old seaman in the Merchant Marine. I've followed the history of the island ever since, and published and sold the first anti-Castro posters in the early 1960s. (They were banned in Berkeley, believe it or not, after the Free Speech Committee protested them!)

Keep up the good work. What we have to do now is to recapture our colleges and universities from the extreme Left. How do we go about that?

[matthew glesne]

So let me get this straight. In the 1980s, when no one knew much about AIDS, you think that the Cubans made a bad choice in mandating treatment and education, despite the fact that hundreds of thousands of lives were saved. So the "rights" of those hundreds to be free from medical care trumps the rights of hundreds of thousands to live? Just like the "rights" of pharmacutecal companies to make billions trumps that of humanity to live? And that Haiti and other Carribean and Latin and African countries actually, in hindsight, acted correctly in confronting the AIDS epidemic, while Cuba... overreacted. Well thank you for highlighting the morally bankruptcy and hypocrisy of the ocnservative "culture of life" position.

If Cuba's model would have been applied in this country, I might not have lost a close friend... not to mention the millions and entire countries that lay devastated to this disease. But instead I imagine you side with Reagan and the other "leaders" who 1) denied the disease's impact and 2) sided with anti-government ideology rather than realizing government needed to play a strong role. Amazing.

[bbmoe]

I'm sorry about your friend.

So those are my only two choices? I'm sorry, I can't think like an agendized automoton so I'm having trouble with your comment. If Cuba's model had been applied in this country, you most assuredly would not have had a close friend to lose, at least not in that way. He would have been locked up for degeneracy. Oh, but that's ok because then he can't infect anyone. Outside of prison, that is. I do so love it when the phrase "moral bankruptcy" comes up in this context. It's almost never applied to the correct party.

But with you and the vast majority of the AIDS activist/interested parties, this is all about controlling people through the government. So if you are really interested in "getting this straight," you have a ways to go. Did you march in the ACTUP parades with a banner that said "MANDATORY QUARANTINES NOW!"?

Thought not.

[matt glesne]

So it is clear, the Cubans ended mandatory quarantines for HIV Positive persons in 1993, when the situation was deemed under control.

Not sure what you are referring to with my friend being"locked up for degeneracy"... that Cuba suposedly arrests gays?? This is a seperate topic, and any research whatsoever will show you that was a holdover from the previous regime and mindset and that Cuba is long gone. Gays are very prominent in Havana, enjoying the freedom to congregate all night in public - on the Malecon.

And yes, if I knew then what I know now, I would have certainly hoped for this policy in AIDS' early years here... as would anyone else who has been afected by the disease. At the time, we were all told this was proof # 1 of Castro's inhumanity. You can still pedlle that line but history is proving you wrong every day... who is taking care of 90% of Haiti's sick and AIDS-ridden, who has sent 20,000 doctors to treat the most marginal in Africa and Latin America? Who focuses their country's drugs effort on helping those who can least afford and most need it (and thereby not profitable)? Who beleives in limiting drugs to those who can afford it?

But I am told this "is all about controlling people through the government." Sorry, I guess I see it about saving humanity from a plague that has set parts of the world back decades... and wrought immeasurable havoc on families. Your readers might also be interested in knowing your model Uganda suffers with a 6% rate and that most AIDS groups, along with Human Rightrs Watch, heavily criticize the effort there because it focuses on abstinence and rarely mentions safe sex or condoms. I think we need education that is based on the best science not religion... but this approach does seem to be bringing Uganda the bucks from Washington (hundreds of millions a year versus 0 to Cuba.

[bbmoe]

Tell the truth: you can't look back 20 years and say "Yeah, I would have." You didn't. And a whole lot of people whom you condemn today would have gladly locked people up to curb this disease if they could have.

Quarantines are a legitimate tool to fight contagious disease. But I think that you would tire very quickly of living in a state that had the power to put you away for infecting your fellow man with...ideas.

Or perhaps you wouldn't.

BTW, Human Rights Watch doesn't impress me. And "any research whatsoever" has led me to conclude that much of your rhetoric is straight out of Fidel's "Talking Points for Promoting Tourism By Wealthy (and horny) Gay and Lesbian Tourists" memorandum that was issued about 10 years ago. When everyone starts saying "That's a thing of the past" in unison, we get suspicious.

.

[Matthew Glesne]

Another misconception is that you can get locked up for ideas in Cuba. The 50-60 so-called "prisinors od conscience" you are referring to were each found with either 1) US taxpayer cash, 2) US taxpayer funded materials or 3) were at the service of a foreign Government - the US or Spain. Some may still argue Cuba overreacted. But you have to put yourselves in the mindset of a nation that has been attacked with every form of state terrorism and blockade, had over 200 plots against its leader, that is on the US regime change hit list because it's a supposed state sponsor of terror (a relic) and its bio-WMD production (a lie that became famous by an over-zealous John Bolton).

Can you expect a nation to sit and watch as everything it fought for (equality, justice, humanity) is undermined by the lure of easy foreign money.. so "independent journalists" can work aginst the country or write one-sided drivel (that gets cited in human rights reports by backers of Helms-Burton and regime change)? Was the US supposed to allow Baathist agents to operate here?? No, the one we found is in jail.. for allegedly riting a letter to a cousin no less. The only innocents in jail in Cuba are at Guantanamo (of course there are terrorists there too). And I wonder what you think of the 500-1000 Cubans in the US who a Court silently freed last month after they were in indefinate detention for the last 10-15 years on minor immigration violations??

[Chemist]

Twenty years of struggle against AIDS. Grassroots campaign against AIDS. The struggle to find a cure for AIDS has contributed to other areas... WBR LeoP