It's a tiny island 90 miles off the coast of Florida, easily dismissed by many as a communist country with a depressed economy. Like many other places in the world, HIV remains a serious concern. But what some people don't know is that Cuba has achieved a milestone in HIV prevention that has made the world stand up and take note.
Early in the AIDS epidemic, Cuba was notorious for its mandatory HIV quarantine program. Seventeen facilities dotted the island, housing anyone who tested HIV-positive. The largest facility was the sanatorium at Santiago de las Vegas, located just outside of Havana.
From 1986 to 1993, Santiago de las Vegas segregated people living with HIV from the general population, an action that was highly politicized by the rest of the world in a time when HIV and AIDS fear was most rampant. Forced quarantine ended in 1993, but for years afterward, the government continued to maintain strict control over anyone living with HIV. Those that were permitted to live outside of the camps had to disclose their sexual partners and encounters had to be reported to the government. On the world stage, Cuba's approach towards those living with HIV only served to further tarnish its already diminished reputation throughout the world.
Fast forward more than 20 years later and Cuba is suddenly leading in breakthrough studies and most recently was the first country to receive what can be considered as a global seal of approval -- the World Health Organization (WHO) validation -- for essentially eliminating transmission of HIV from a mother to her baby. By 2014, more than 40 countries, including the United States, Canada, Anguilla, and Barbados, were testing and treating pregnant women in programs and studies to achieve the same, but Cuba was the first to go through the WHO monitoring program. The program requires data on transmission for a period of at least two years as well as onsite visits by WHO members who examine care in all parts of the country, including even the most remote and underserved parts of a country.
Cuba was able to achieve this accomplishment mainly because its health care system is so highly regulated. HIV tests are commonplace during routine doctor visits and patients who are HIV-positive are put on a treatment regimen and monitored. When a Cuban national goes to see their doctor, they will eventually, at some point, have an HIV test, regardless if they ask for one or not. Women who become pregnant and are HIV-positive are referred to a clinic with a higher level of expertise in HIV, where they will be monitored closely and started on oral antiretroviral treatment, which has shown to reduce transmission to newborns to less than 2%.
At approximately 38 weeks into pregnancy, at the discretion of the doctor and the woman, the mother gives birth via cesarean section, another method proven to reduce transmission of HIV, instead of through the birth canal.* Women are also instructed not to breastfeed their newborns. Additionally, the infant receives antiretroviral treatment for up to six weeks after birth.
The United States has achieved the elimination target at a national level as the rate of transmission of HIV through pregnancy and childbirth is below the two percent mark, which meets the standards of WHO. The problem is that criteria for validation must be met in an equal manner, even in subgroups of the lowest performing areas, and in the United States, the rates of HIV transmission to infants are higher in poor and underserved areas, and communities of color.
Things have dramatically changed for those living with HIV in Cuba since the days of the quarantine. Over the past four years, according to research documented on the government's official websites, new infections of HIV have been maintained at the same level, and have neither declined nor risen. With regards to the number of new infections, when compared to the small population of the island, the numbers are low. Of every 10 new infections, eight are men, and of those, 88.6% are men who have sex with men, which is the group most at risk.
Beyond the free medical treatment and resources provided by the government, various organizations offer assistance and support. Linea de Apoyo ("helpline" in English) is an organization made up of volunteers, which is funded by Fondo Mundial (known in English as The Global Fund to Fight AIDS, Tuberculosis, and Malaria) and ON USIDA (UNAIDS). Those organizations all come under the umbrella of the government's Plan Estratégico Nacional (PEN, "national strategy plan" in English), which is now the law, created in response to the HIV epidemic. PEN has been approved through 2018. It was developed in cooperation with the public and Cuba's Ministry of Public Health. Through PEN, the government pays 100% of all HIV services, including medications and lab work.
Beyond medical care and services, those living with HIV in Cuba are given supplementary rations of food. Cuban nationals receive rations of food each month as mandated by the government. It typically is very little, and includes rice, beans, and a very small amount of meat. Those living with HIV are put on a special diet plan that includes three bags of powdered milk, six pounds of fish, thirty eggs, and two pounds of beef. The additional food is considered to be needed by someone on antiretroviral medications.
Cuba still faces stigma because of its form of government and its history since its revolution, but the country has drastically changed in the past decade since Raúl Castro took power. More rights have been granted to its citizens, including the right to travel outside of Cuba. LGBT advancements have also taken place within the island nation, and now with improved relations with the United States, there may be better days to come for the Cuban people. The country is still under a dictatorship and although treatment and care for those living with HIV is more civilized than it was in the past, people there are still being controlled. But under that control, fortunately, those living with the virus are generally living a normal life and receiving proper medical care. The country as a whole is working towards lowering and perhaps one day ending HIV transmission in Cuba.
* Editor's note: U.S. guidelines do not recommend cesarean section, because there is no significant risk reduction over the use of antiviral therapy.
David Durán is a Cuban American freelance journalist writing about LGBT, HIV, and travel news for such publications as The Advocate, Positively Aware_,_ The Huffington Post_, and_ Fodor's Travel_._