CUBA:

Cuba has been a well-received exception to the AIDS epidemic. The disease has spread slowly with just over 1,500 HIV-positive individuals as of April 1997. As of yet 557 have developed full-blown AIDS with 339 of which have died. Sexual activity has remained the chief cause of infection with only nine AIDS sufferers having contracted HIV from blood contamination. The World Health Organization (WHO) says that sexual contact is the cause of transmission in 76 percent of AIDS cases occurring in Central America and the Caribbean. The latest WHO release reported that AIDS was growing at an accelerated rate in Latin America and the Caribbean where over 450,000 of the 6.7 million adults are suffering from AIDS throughout the world.

Cuba has one of the most successful AIDS programs in the world with death from AIDS 35 times less likely than in the United States. The Centers for Disease Control and Prevention estimate that HIV-positive Americans may outnumber HIV-positive Cubans by 31-to-one with statistics being adjusted for differences in population levels. Despite its comparatively low numbers of cases, there has been an increasing infection rate causing alarm in the health care community which Cuba prides itself. Jorge Perez, director of the Cuban Institute of Tropical Medicine said that 124 HIV-positive individuals were detected in 1995 which rose by 88.7 percent to 234 in 1996.

Assessing Cuba's approach to HIV/AIDS
General status on HIV/AIDS in Cuba

Cuba and Prostitution:

Outlawed after the 1959 Marxist revolution, prostitution has once again become common as Cubans look for new ways to earn dollars that they can use to buy valued goods that are not for sale in pesos. Prostitutes are among those now at highest risk for AIDS in Cuba. They also have been the most difficult group to reach with AIDS prevention information.
Crackdown on Prostitution
Prostitution and the law
Prostitutes for Dignity

Prevention, Education & Treatment:
The health sector continues to be one of Fidel Castro’s adornments in spite of the massive economic crisis facing Cuba. Still one of the top priorities of the Caribbean nation's social policy, public health will receive around seven percent of the annual budget this year, Health Minister Carlos Dotres reported. That allotment is nearly double the 66.9 million spent in 1993, considered the peak of the crisis that broke out in 1990. The government has maintained universal health care free of cost, as well as its immunization programmes, and basic indicators of health have not suffered.

Cuba had approached the AIDS epidemic in the 1980’s by requiring HIV-positive people to live in sanatoriums. The nation fell under world-wide dissapproval with critics comparing the sanatoriums to concentration camps and claiming they violated human rights. However, sanitorium treatment successfully controlled the spread of the disease during that period when there was great uncertainty over the characteristics of the virus and its transmission pathways.

Sanitorium treatment guaranteed that carriers - and people with full blown AIDS - received proper nourishment and care needed to improve their quality of life. At that time, AIDS patients received top medical care in the sanatoriums, including 3,500- calorie a day diets and information on how to prevent HIV from spreading. As a result, Cuba extended the period of asymptomatic survival to an average of 10 years.

But as the number of people infected has grown and the island's economic crisis has deepened, Cuba can no longer afford to keep patients in sanitariums until they die. Now, people with AIDS are brought to sanitariums for several months of intensive counseling, with an emphasis on their responsibility not to infect others. At the end of that period, patients, in consultation with psychologists, decide whether to remain in the sanitarium or to return to the community, health care workers said.

As prevention and education efforts are being explored a major theme has surfaced. There is little AIDS awareness with the belief that all of those infected are locked in sanitoriums. A general public belief is that there is no risk when all those infected have been contained or educated on transmission risks.

An international medical aid organization, Doctors Without Borders, is designing and implementing a public health campaign to prevent the increasing spread of AIDS. This Dutch-Cuban team began conducting seminars and distributing AIDS information brochures and condoms outside rock concerts and in homes.

Since the main means of transmission is heterosexual contact, organizations have been examining the use of safe-sex methods within relationships. Last year, a study was conducted in Cuba which showed that 31.9 percent of single and married people had non-committed sexual relationships in the 12 months prior to interviewing, and that only one-fifth of them used condoms. Another study by the Public Health Ministry, sponsored by the United Nations Population Fund, revealed that while 81.2 percent of the Cuban women admitted knowing what a condom is, only 9.2 percent had ever used one. For the moment, health officials have decided to focus attention on sexual education projects and on strengthening efforts to encourage "safe sex" practices.

Among Cuba's many AIDS-related challenges is the need to obtain sufficient financing to acquire a 120 million condoms annually. This is the number or condoms that will be needed to satisfy demand if the condom utilization campaign is successful. Doctors without Borders presently offers condoms for one cent a piece.

Rights and Responsibilities
 

Community Based Organizations:

Alberto Montano
Cuba AIDS Project
502 - 14th St., Suite 5
Miami Beach, FL 33139