Background

The first AIDS cases were identified in the United States in 1981, and by 1983, Cuba had begun to take action to protect its population form the HIV virus.  The National AIDS Prevention and Management Commission was founded the same year by the Public Health Ministry, which then set up an epidemiological surveillance system and prohibited importation of hemoderivatives.  From that point on, these blood derivatives were produced only in Cuban laboratories.

In 1985, $2 million was invested by the public health system to develop the National HIV/AIDS Prevention and Control Program, and in particular to furnish the first 750,000 Elisa-system diagnostic kits and related equipment for the provincial blood banks and 42 diagnostic centers in the country. 

The first cases of HIV were diagnosed in Cuba in 1986, the same year the country began massive screenings.  These included all blood donations; persons returned from service in Africa (every six months); and workers in tourism, the merchant marine, fishing and airlines industries (once a year).  Later, testing would be extended to pregnant women in their first trimester, hospitalized patients, prisoners and patients suffering from sexually transmitted infections.  In 1987, Cuban laboratories began producing their own diagnostic kits; and a year later, a domestically designed kit was introduced, using SUMA technology.  According to the Ministry of Public Health, the Cuban AIDS strategy was based on four main programs:

Serological screenings of large population groups.

Epidemiological study of each HIV-positive case, with an attempt to identify partners at risk.

Hospitalization of seropositive patients in 13 sanatoriums, to offer specialized care, education and follow-up, and to reduce the dissemination of HIV in the Cuban population.

Development of an effective policy in health education and promotion concerning AIDS.

Perhaps the most controversial of these programs has been the sanatorial care for HIV-positive patients, which originally obligated seropositive Cubans to live the rest of their lives in these institutions.  Organized like small communities, the sanatoriums are made up of apartment complexes and small houses, plus infirmary, offices and other patient facilities. 

In 1993, the sanatorium policy underwent changes.  Until then, patients were permitted daily visits, but only allowed to return to their families and communities on the weekends.  That year, an out-patient program was begun.  Under this variant—after an initial six months in the provincial sanatorium for extended diagnosis and treatment recommendations, psychological counseling and education—patients are evaluated by an interdisciplinary team to determine their eligibility for the ambulatory program, based on their “understanding of their condition and commitment to safe sex”.  If they are approved and choose to do so, they return to their homes and receive regular care from the local family doctor, in addition to periodic visits to specialists.  Persons enrolled in the program receive special dietary supplements, in addition to this comprehensive medical attention.  By the end of 1995, 192 patients or one fourth of the 760 HIV patients who had not developed full-blown AIDS, were enrolled in this ambulatory care program. 

In 1999, the Santiago de las Vegas AIDS Sanatorium began an eight-week course for all seropositive persons in Havana—designed for later extension to the remaining 13 sanatoriums in the country—called “Learning to Live with HIV”.

Early treatment of AIDS consisted of AZT, interferons and other drugs commonly used in international protocols—but often more difficult for Cuba to purchase because many were patented by U.S. pharmaceutical companies and therefore not freely available to Cuban importers under the restrictions imposed by the U.S. embargo.

Earlier this year, Cuban began to manufacture its own anti-retrovirals and make them available to AIDS patients free of charge (See Health News from Cuba).

Cuba has maintained a strong research component in the fight against AIDS, primarily through studies of the application of interferons to AIDS patients and the continued research to develop and HIV/AIDS vaccine.

The Current AIDS Program: Prevention the Key

Cuba’s current rate of HIV infection is 17 times lower than the average for the rest of Latin America, at 0.03% for persons between 15 and 49 years of age.  However, public health authorities are bent on further reductions.

The Cuban Program has most recently given greater emphasis to prevention strategies:  in 1996, the National Center for Prevention of STDs, HIV-AIDS was established in Havana (See MR Interview).  Its responsibilities include training of both health personnel and activists who promote safe sexual practices in their communities; research in communities, bringing a socio-cultural focus to an epidemiological analysis of various population groups (such as young people, women, men who have sex with men, etc.); counseling services through the helpline, face-to-face sessions for walk-ins to the center, and psychological counseling pre- and post-HIV testing. 

By the end of 2001, Cuba will have approved its most ambitious offensive yet against HIV/AIDS:  setting up a National Task Force Against AIDS (GOPELS), headed by the Minister of Public Health, Dr. Carlos Dotres, and the Secretary of the Council of Ministers, Dr. Carlos Lage (Dr. Lage represented Cuba at the UNAIDS Summit in June, see From the Editors this issue).  Their job will be to integrate prevention strategies among the various national players, including the Public Health and Education Ministries, the Federation of Cuban Women, and other government agencies and NGOs.  They will be guided by the “Strategic Plan for Controling HIV/AIDS”, outlining national strategies against the virus for the next five years.