After Columbus arrived, the native population of Cuba endured
decimating epidemics introduced from Europe. Yellow Fever, due to a Flavivirus,
caused epidemics devastating troops in the Spanish American War. Dengue fever
epidemics still occur in Cuba. The National Commission on AIDS was established
in Cuba in 1983 before Cuba had identified any Cuban nationals with HIV or
AIDS. In 1981, the first case of HIV/AIDS was diagnosed in the USA. Cuba first
diagnosed HIV/AIDS in a soldier returning from Mozambique in 1985...four years
after HIV/AIDS was first diagnosed in the USA. Large scale testing of the
Cuban population commenced in 1985. In 1986, Cuba, like many nations, was
concerned that HIV may be a highly contagious virus (Ebola or Marburg virus)
derived from Africa. Jorge Perez, M.D., an infectious disease expert who trained
at McGill University was very suspicious, despite international agency assurances,
that blood product transmission of HIV was possible. Dr. Perez ordered the
destruction of all foreign derived blood products in Cuba in 1983 which was
two years before a HIV positive patient was diagnosed in Cuba. This preemptive
destruction of foreign derived blood products strained the Cuban healthcare
system because blood products had to be rapidly replenished solely from the
healthy people of Cuba. Dr. Perez’s “educated hunch” to
destroy foreign derived blood products allowed Cuba to escape the ravages
of HIV transmitted to hemophiliacs and other blood transfusion recipients.
During 1985 and early 1986, a nationwide HIV screening program was initiated at a cost of US $3.0 million dollars. HIV screening in Cuba is required for all expectant females, sexual contacts of HIV patients and people with sexually transmitted diseases. Voluntary HIV screening is also encouraged. In 1985, condoms as a preventive measure for HIV/AIDS were introduced in Cuba. Routine condom use in Cuba has been hindered due to a “machismo” attitude of many Cuban men. Over 20 million HIV tests have been performed on the Cuban population since 1986. About 75% of HIV/AIDS patients in Cuba are male. The prevalence of HIV in Cuban females is increasing. HIV/AIDS in Cuba is essentially a sexually transmitted disease. Mother to child, blood product and IV drug abuse related HIV transmission in Cuba are very uncommon. Since 1983, there have been 12 children with AIDS. AZT (500mg b.i.d.) is given to all HIV positive expectant females from 14 weeks gestation until delivery by Caesarean section at 38-40 weeks. Vaginal delivery is not allowed.
Due to the chronic recession of the Cuban economy, the USA Embargo restricting availability of modern clinical laboratory testing and the simultaneous lack of antibiotics and prescription medications, Cuba, as it had done with other epidemics since 1900, instituted classic public health measures against HIV/AIDS in the late 1980s and early 1990s, including a vigilant quarantine of HIV positive patients. The HIV quarantine facilitated the education of patients and their families about HIV, allowed for directly observed patient treatments and safeguarded the general population of Cuba. (All HIV positive inmates at penal institutions were transferred to either the Habana AIDS Sanitorium or the IPK Tropical Medicine Institute. There are no HIV/AIDS patients in prisons in Cuba. While hospitalized, prisoners are watched by a policeman or security officer. Prisoners are not handcuffed to their beds or otherwise restrained.) Meticulous identification of every HIV positive individual in Cuba allowed the tracking back to the “source” of the patient’s HIV infection, whether from overseas or in Cuba. Cuba has an extensive confidential database of HIV positive individuals along with all their intimate contacts who have contracted HIV or remained HIV negative.
The first HIV/AIDS sanitorium in Cuba was located in rural Habana at Santiago de las Vegas. Because many HIV positive patients housed at the 24 hectare (59 acre) “Los Cocos” sanitorium were originally domiciled in other geographic areas of Cuba, Dr. Perez noticed family members moving to Havana to be close to their HIV positive kin. This migration of families to Santiago de las Vegas placed strains on this small rural town. Many of these family members were jobless, lacked local housing or food and wanted to enroll their children in local schools. The Los Cocos facility was administered to give HIV positive patients mobility, friendship among fellow patients and to produce food for local consumption at the sanitorium. Los Cocos originally had 150 small apartments to house HIV positive patients and their families. The capacity of the Los Cocos facility was quickly exceeded. High level Cuban government officials decided to open sanitoriums throughout Cuba. Although it was not his decision to authorize the sanitorium system, Dr. Perez was enlisted to implement the sanitorium system for HIV/AIDS in 1986. Between 1986-1989, Dr. Perez urged the Cuban government to relax the absolute quarantine policy for HIV/AIDS patients in Cuba. Dr. Perez successfully lobbied for the quarantine policy of Cuba to be discontinued in 1994. Long term residence at HIV/AIDS sanitoriums in Cuba is voluntary. New housing units are being constructed at Los Cocos.
The goal of the Cuban sanitorium system was to have HIV positive patients live in the regions of Cuba of their original residences close to their families. Sanitoriums were designed to provide proper nutrition, shelter, and medication dispensation. There was to be no charge to the patients for their care at the sanitoriums. These sanitoriums further evolved into being patient, local public and international education resources. The sanitoriums in Cuba have been visited by many international healthcare givers. Dr. Perez personally traveled throughout Cuba and carefully selected the locations for these sanitoriums and annually personally visits all the sanitoriums in Cuba.
In addition to the establishment of the provincial sanitorium system, Dr. Perez destigmatized HIV/AIDS in Cuba. Worries about HIV/AIDS being highly contagious and a imminent threat to the public health of the general population of Cuba lessened as Dr. Perez demonstrated the overwhelming majority of HIV positive individuals in Cuba acted responsibly and were able to return to work, school, live with their families and be treated as outpatients in an ambulatory setting. Today, many HIV positive patients elect to voluntarily continue to live and work in the sanitoriums to help Cuba prevent and control HIV nationwide. Sanitoriums also assisted Cuba in determining local sources of HIV who had not been diagnosed, treated or educated about their HIV status and the impact it had on HIV/AIDS spread in Cuba.
In addition to government programs regarding HIV/AIDS in Cuba, Alberto Montano, a USA citizen living in Miami, after discussing his plans with Dr. Perez and Father Fernando de la Vega, founded the Cuba AIDS Project in 1995. In 1997, Alberto sought the help of Byron L. Barksdale, M.D., a Nebraska pathologist who had a lifetime interest in Cuba and HIV/AIDS in Cuba. Alberto lacked healthcare credentials and needed a physician in the USA to add credibility to his efforts through Cuba AIDS Project. Alberto remained the director of the Cuba AIDS Project until his death in 1999. Sor Fara, an influential dedicated nun in Habana, also has greatly assisted Cuba’s efforts to control HIV/AIDS.
Cuba now produces sufficient quantities of seven anti-viral medications (AZT, D4T, DDI, DDC, 3TC, nevirapine, and indinavir) domestically for use in its patients. Cuba also intends to produce nalfinavir, abacavir, efavirenz, and novatec in 2003. Since 1986, Cuba has realized the importance of nationwide supportive infrastructure for HIV patients and their families. Support facilities for proper nutrition, patient education, prevention and caring partnered with preventive or interventional therapeutics are the best way to offer hope to people with HIV/AIDS and to control HIV/AIDS prevalence, morbidity and mortality in any country. Cuba has understood and implemented these concepts for many years. Preventive therapeutics includes prevention of opportunistic infections. Interventional therapeutics includes treatment of opportunistic infections (Mycobacteria, Pneumocystis), malignancies, sexually transmitted diseases (syphilis, herpes, gonorrhea) as well as the HIV infection itself with anti-HIV medications. Cuban produced anti-HIV medications already have resulted in a significant decrease in morbidity and mortality among HIV/AIDS patients in Cuba. The prevalence of HIV in Cuba is 0.03%. Surplus HIV medicines produced by Cuba are sold at cost to Caribbean and Latin American nations.
Behavioral changes (monogamous relationships, abstinence, etc.), increased counseling and voluntary testing for HIV, the delivery of medications, food and nutritional supplements, including vitamins (hunger is a potent driving force for people to enter the sex business fueling HIV spread), condoms, and informational materials to the people of Cuba must be increased to assure adequate control of HIV/AIDS in the population as well as optimal management of any patient’s disease. Educational materials in Spanish regarding HIV/AIDS should be provided extensively to Non-Governmental Organizations (NGOs) including the HIV/AIDS support group at the Monseratte Church (Galiano at Concordia Streets) in Central Habana. Many members of the Monseratte Church support group are in a desperate situation because the majority of them are: (1) gay or bisexual, (2) AfroCuban, (3) HIV positive or have AIDS, (4) unemployed, (5) homeless, (6) marginalized by their families, (7) disenfranchised by the government, and (8) have no Miami USA dollar support connection.
The efforts of Father Fernando de la Vega at Monseratte Church and Sister Sor Fara should not be underestimated as an effective mechanism to restore a sense of hope and community among homeless, hungry, despairing, sick HIV/AIDS patients in Havana. Local community Non-Governmental Organizations (NGOs) for HIV/AIDS patients should be established in all major cities in Cuba (Cuba AIDS Project is planning to help start these support groups in Santiago de Cuba and Cienfuegos). The Church offers a renewal in faith, love, patience, and hope for the future while simultaneously the Church ameliorates the persecution, suffering and the disenfranchisement HIV/AIDS patients and their families often experience in many countries, including Cuba. The people of the USA, through Cuba AIDS Project, have an opportunity to present, through their care, donations, and support, the “greatness and compassion of the people of the USA” directly to the people of Cuba.
Public campaigns for prevention of HIV need high priority because any funds spent are cost-effective. Preventive and interventional therapeutics must be partnered with overall prevention programs. Treatment offers hope for the future to HIV patients and their families of transforming HIV into a chronic disease (such as diabetes) which can be managed permitting people to return to school, work or enjoy a wholesome life.
The enormous increase in tourism to Cuba from many countries (Europe, Canada, USA, etc.) mandates Cuba maintain and continuously improve its HIV/AIDS program. Currently, it is estimated 180,000 USA citizens travel to Cuba annually. After the USA Embargo against Cuba is lifted, there may be millions of USA citizens visiting Cuba each year. The USA does not need to have HIV/AIDS endemic and highly prevalent in its neighbor country, Cuba, with millions of USA citizens visiting in the post-Embargo era, contracting the virus, and then returning to the USA infected with new genetic strains of HIV-1 to be further disseminated within the USA.
The Cuba AIDS Project continues its efforts to bring USA awareness to the uniqueness of HIV/AIDS in Cuba. USA citizens are eligible to travel to Cuba and help in its humanitarian efforts under the Cuba AIDS Project USA Treasury Specific License as long as all travelers comply with all USA laws, rules, regulations and orders regarding OFAC licensed humanitarian travel to Cuba. More information about HIV/AIDS in Cuba and Cuba AIDS Project can be found at these websites: www.cubaaidsproject.com or by calling Byron L. Barksdale, M.D. at 308 532 4700. Email:CubaAIDS@aol.com