From quarantine to condoms: Shifting policies and problems of HIV control in Cuba

Abstract

This study reviews HIV prevention in Cuba in light of (1) the liberalization of HIV quarantine, (2) the growth in tourism, and (3) the aggressive system of public health promotion. Sixty-two key informants, including Cubans who are HIV-positive, at risk, or working as health professionals, were interviewed during June and July of 1996. Findings include: (1) there is a common public perception that the government's national HIV screening and contact tracing system obviates the need for individual precaution; and (2) both commercial sex workers and men who have sex with men believe that legal and social forces hinder their indigenous HIV prevention efforts. A well developed system of preventive health care offers the potential for effective HIV prevention. The fact that Cuban officials use the success of their HIV/AIDS control program to promote national pride may retard appropriate changes in their response to currently rising levels of infection.

Phylodynamics of the HIV-1 Epidemic in Cuba

“…It has been proposed that Cuba's low rate of HIV infection is due to several factors that served to prevent sexual transmission of the virus, including: wide-scale HIV screening and subsequent contact tracing of HIV-positive individuals, mandatory quarantine of the first HIV-infected individuals at sanatoria, free access to a well structured public health system, comprehensive HIV education campaigns, coordinated work of Cuban government agencies and community, and restricted tourism between Cuba and western countries up to the early 1990s [43], [44], [45], [46]. The estimated initial growth rates of the major HIV-1 Cuban clades (∼0.4–1.6 year −1 ), however, were comparable to those obtained for different HIV-1 epidemics in the Americas (∼0.5–1.3 year −1 ) [38], [47], [48], [49], [50], [51], [52], Europe (∼0.4–1.5 year −1 ) [52], [53], [54], [55], Africa (∼0.2–0.8 year −1 ) [47], [52], [56], [57], [58] and Asia (∼0.8 year −1 ) [59].…”

AIDS stigma in health services in the Eastern Caribbean

“…Such views may prompt governments to enact discriminatory and coercive policies ( e.g. quarantine, mandatory testing, tattooing/branding, employment restrictions, denial of immigration) (Herek et al 1998, Malcom et al 1998, Hansen and Broce 2001. In turn, these structural influences reinforce cultural responses (Goldin 1994).…”

“…1998, Malcom et al. 1998, Hansen and Broce 2001). In turn, these structural influences reinforce cultural responses (Goldin 1994).…”

Public health achievements III: Control of infectious disease

“…The incarceration of people with HIV infection in Cuba regrettably has been quietly ignored by the rest of the world; the Cuban national screening program appears to have obviated the need for individuals to take personal responsibility for protective behaviours and HIV rates seem to be rising. 7 However, plenty of other measures have helped reduce chronic as well as acute infectious disease rates. Students of public health are familiar with declining numbers of cases of cases of TB and polio, well before the development of vaccines, attributable to improved housing and less crowding, clean water, sewerage, better food and so on.…”