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Doing More With Less: Cuba's Lessons on HIV Treatment and Prevention

July 9, 2015

Standing in the Rose Garden earlier this month, President Obama announced to the assembled press, the American people and the world that the U.S. would be opening its embassy in Havana for the first time in more than half a century. "The progress that we mark today is yet another demonstration that we don't have to be imprisoned by the past. When something isn't working, we can and will change," the President remarked. By and large, the American public agrees with President Obama's assessment of the situation, with 63% of the country openly in favor of re-establishing diplomatic relations with our Southern neighbor. For many of the 51% of Cuban Americans who are in favor of the normalization of relations with Cuba, support for opening the pathways of diplomacy and trade are rooted in their desire to reunify with family and rekindle relationships that have lain dormant for decades. For non-Cuban Americans, the opening of the U.S. embassy in Havana not only means the end of 54 years of failed isolationist policy, but also signals resurrected economic and travel opportunities in what was once the premier American tourist destination in the Caribbean. However, potential resource exchanges between the two nations extend to ideas as well as goods and services, and in the realm of intellectual capital there are few Cuban imports as valuable as public health policy.

At the same time that President Obama was announcing Washington's diplomatic rapprochement with Havana, news outlets were reporting that Cuba had become the first country in the world to end mother-to-child transmission of HIV. In point of fact, the Cubans didn't eradicate mother-to-child HIV transmission as there were two babies born with the virus in 2013, but since the current preventative measures available for perinatal infection aren't foolproof, two is tantamount to zero from a public health standpoint.

This is a huge breakthrough for preventative HIV practices across the globe, as it provides other nations with hope that they too can eliminate mother-to-child transmission of HIV. On the other hand, Cuban success in HIV prevention is old news. With an adult HIV prevalence rate of just 0.2%, Cuba has the lowest rate of HIV infection among Caribbean nations and has historically had one of the most comprehensive -- if controversial -- HIV/AIDS prevention programs in the world.

In the early 1980s, at a time when President Ronald Reagan was refusing to publicly acknowledge the existence of AIDS and his press secretary was addressing the epidemic with derision and laughter, Cuba had already begun preparations for stopping the spread of the virus. In 1983, after seeing the virus explode in nations around it -- more than two years before the country's first documented case of the virus -- the Cuban government destroyed all foreign-derived blood products and set up a national AIDS commission. Such proactive actions have been characteristic of the Cuban response to the AIDS epidemic, especially in its early years. But Cuba's determined approach also opened up the nation to allegations that it was abusing the human rights of its citizens, and garnered rebuke from the international community.

Beginning in 1986, Cuba set up a network of sanatoria across the country for a state-mandated quarantine of HIV-positive citizens. For seven years, the HIV-positive population of Cuba was held at these 14 sanatoria, where they received medical care and were kept apart from the general population. Hearing this might conjure up images of oppressive, poorly maintained hospitals, but the sanatoria have been described by the World Health Organization (WHO) as "like suburban communities on several acres of land with modern one- and two-story apartment duplexes ... surrounded by lush vegetation and a small garden." While housed in these sanatoria, patients were treated by family physicians and monitored by public health officials seeking to learn more about the natural history of the epidemic.

The medical monitoring of patients was paired with other measures, such as following up with and testing the sexual partners of HIV-positive persons; and the mandatory testing of certain groups, including blood donors, pregnant women and adults with sexually transmitted infections. Cuba has also placed a large emphasis on education, implementing a compulsory six-week "Living With HIV" program for all newly diagnosed Cubans, and providing children with sex education beginning in the fifth grade. Since the end of 1993, when residency at sanatoria became optional, the Cuban government has worked to integrate HIV-positive citizens back into the community through a host of measures ranging from inpatient job training programs to anti-discrimination laws that not only prohibit employers from firing people for being HIV positive, but also require them to pay salaries to HIV-positive employees taking part in educational programs or living in a sanatorium.

It is easy for Americans who place the rights of the individual above those of the collective to look at the Cuban response to HIV and criticize the lack of autonomy Cuba has allowed its HIV-positive citizens. But to focus on this policy limitation and disregard Cuban successes would be to throw the baby out with the bathwater. The fact that the U.S. has nearly the same life expectancy and WHO health system ranking as Cuba when it has nearly an 8-to-1 advantage in GDP per capita should tell us that there are aspects of Cuba's approach to HIV and public health that we should be adopting. In 2011 in the U.S., only 37% of people living with HIV had been prescribed antiretroviral medications, while Cuba was one of only 12 nations to achieve universal access to antiretroviral treatment (defined by WHO as at least 80% of people eligible). I don't know about you, but I'm having a pretty hard time seeing the human rights violation in that.

Drew Gibson is a social worker and freelance writer based out of Cincinnati, Ohio. He does his best to split his time and efforts between his work as a case manager for people living with HIV/AIDS in Northern Kentucky and the maintenance of his blog, "Virally Suppressed," which covers a multitude of issues related to inequity and social justice. You can follow him on Twitter at @SuppressThis.

Copyright © 2015 Remedy Health Media, LLC. All rights reserved.

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