Perspectives: Cuba's success with HIV/AIDS

With all the hubbub in the United States and the hemisphere right now about the Washington-Havana relationship, let’s let it rest for today. The debate is hot as President Obama makes his first visit to Latin America, and John McAuliff’s note of the day provides very good grist for that mill.

Instead let’s take up a different and important topic, HIV/AIDS, because just last week, Cuba opened a center in Santiago de Cuba to assist more than 2,000 HIV/AIDS patients in the six eastern provinces on the island. Previously, most patients had to make a trek to Havana for treatment. This will make their lives much easier, and represents yet another step in the fight against HIV/AIDS on the island that other countries would do well to emulate. After all, Cuba has the lowest adult AIDS prevalence rate in the Americas and one of the lowest in the world, at 0.03%. Its HIV infection rate is 0.05%, again one of the world’s lowest, and especially impressive relative to the region—the Caribbean has a rate around 2.3%, the second highest of any region in the world.

The approach to treatment and prevention in Cuba has been a comprehensive model from the beginning, although its initial steps were correctly considered harsh and discriminatory. As Tom Fawthrop reports:

When the first cases emerged, the government treated HIV/AIDS as a public health emergency: HIV patients were quarantined indefinitely and their sexual partners traced and tested; Cubans who had visited Africa were tested, as were pregnant women; HIV positive women were given drugs to prevent transmission to their unborn children, their babies were delivered by caesarian section.

Indefinite quarantine and mandatory testing were heavy-handed responses to the problem. But the approach has become more humane, and seems to work. Cuban laboratories developed generic versions of retroviral drugs and today provide a full supply to all HIV/AIDS patients. Education of HIV/AIDS is prevalent in schools and through media and TV, testing is voluntary, and those who test positive are required to take an eight-week education course, but patients continue to receive their salaries (modest as these state salaries are) even if they decide to live in one of the treatment sanatoriums, which 47% of HIV-positive Cubans choose to do. And with these policies in place, Cuba has succeeded in halting transmissions of the virus through intravenous drug use, blood transfusions and mother-to-infant transfer during childbirth.

Certainly there are differences from country to country that prevent a direct transplant of the Cuban model. For instance, the Cuban government compiles a database of those infected with HIV and their sexual partners. This sort of information is an issue of doctor-patient confidentiality in many countries, whereas in Cuba, under a Socialist model, personal privacy loses out to a different value: the individual is expected to do what is necessary to protect the collective society, including and especially with respect to health.

But with some of the lowest HIV/AIDS numbers in the world, even the United States could stand to learn from such comprehensive care and education. Medical and educational travel would facilitate exchanges on these topics. And this brings us back to the current issue of the day: Hillary Clinton suggested that the measures announced Monday to allow Cuban Americans to travel and send money freely to the island were a first step in what will be a full review of policy toward Cuba, leaving open the possibility of lifting more travel restrictions.