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----
bbmoe