Cuba!

Terry C Wuerz

The Cuban AIDS Response

Terry C Wuerz

HIV/AIDS Early History

1981: Health community is baffled by a ‘new’ disease causing opportunistic infections and Karposi’s sarcoma emerging in the USA

1982: Disease is termed Acquired Immunodeficiency Syndrome

1985: FDA approves HIV seroantibody test 1987: FDA approves AZT, the first disease-

modifying drug effective against HIV/AIDS

Disease of the Century

A Brief Look at the Cuban Response to AIDS

1983: National Commission on AIDS established before any Cuban is known to be infected.

1985: Newly implemented AIDS policy mandatory testing and contact tracing programs.

1986: Patients diagnosed with AIDS quarantined for life in a sanatorium

1994: Mandatory long-term confinement ends New policy favours intense education, treatment with

ARVs, and close follow up of infected as outpatients

Dr. Jorge Perez Avila Cuban Infectious Disease

specialist, trained in Pharmacology at McGill

Ordered the destruction of all foreign-derived blood productsin 1986 on a hunch

Placed huge strain on Cuba’s already poor health care system

In 2002, blood product transmission of HIV in Cuba is extremely rare Provincialized sanitoriums & destigmatized AIDS in Cuba

Helped to prove lifetime quarantine of HIV+ individuals ultimately unnecessary using improved treatment and education pilot programs

Why Cuban HIV/AIDS Policy Was Possible Cuba is geographically and to some extent

politically isolated from surrounding nations Greater protection from international

transmission Local government does not view protection

of autonomy impediment to public health policy

Well-developed health infrastructure with a primary care doctor for every person allowed for comprehensive HIV testing

Cuban sanitoriums: thinly veiled prisons, or humane isolation?

Number of known HIV-infected individuals in Cuba

0

500

1000

1500

2000

2500

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

End of Year

HIV

+ I

nd

ivid

ual

s

Ying-Hen Hsieh, Hector de Arazoza, Shen-Ming Lee and Cathy WS Chen . 2002. Estimating the number of Cubans infected sexually by human immunodeficiency virus using contact tracing dataInternational Journal of Epidemiology. 31:679-683

Was Cuba’s AIDS Response Effective??? In 2002, the Cuban government reported

HIV prevalence of 0.03%, 11 times lower than that in the US.Between 10 and 60 times lower than any of

Cuba’s Caribbean neighbours HIV/AIDS in Cuba today is essentially a

sexually transmitted disease.Blood product, maternal to child, and IV drug

related transmission are very uncommon

Confounding Factors

1. Geographical, social, and political isolation

2. Guaranteed minimum levels of income, education, and housing

AIDS & the Western Response In the early 1980s, AIDS was quickly adopted as a

human rights protection of autonomy issue Historically…

HIV testing required express consent A positive test result was not reportable Contact tracing programs optional

Change is being implemented, slowly and with much resistance

Such value placed on autonomy over public protection exceptional to AIDS among other STIs and IDs in the US, as opposed to Cuba.

Ronald Bayer . 2004. Ethical Challenges of the Global AIDS Epicdemic. In AIDS and Other Manifestations of HIV Infection Fourth Edition, edited by Gary P. Wormser. 1045-1054 (Chapter 43).

Individual Rights vs. Rights of the Community

Individuality Communalism

------------------------------------------------------

•HIV testing required

•Mandatory contact tracing and quarantining

• Consent for testing

• Voluntary contact tracing

Lessons From Cuba

Focus on disease education

Mandatory HIV testing

Extensive contact tracing programs

Quarantine?

References Helena Hansen, Nora Groce. 2003. Human Immunodeficiency Virus and

Quarantine in Cuba. JAMA. 2003;290:2875.

Ronald Bayer. 2004. Ethical Challenges of the Global AIDS Epicdemic. In AIDS and Other Manifestations of HIV Infection Fourth Edition, edited by Gary P. Wormser. 1045-1054 (Chapter 43).

Ying-Hen Hsieh, Hector de Arazoza, Shen-Ming Lee and Cathy WS Chen . 2002. Estimating the number of Cubans infected sexually by human immunodeficiency virus using contact tracing dataInternational. Journal of Epidemiology. 31:679-683

Anne-Christine d'Adesky. 2003. Cuba Fights AIDS Its Own Way. The Body: The Complete HIV/AIDS Resource

Ed Susman. US could learn from Cuban AIDS policy. AIDS: Volume 17(13) 5 September 2003 pp N7-N8