How Cuba has kept AIDS at bay

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    May 08, 2012 10:15 PM GMT
    Quite an interesting read, click on the link cause the posted story did not fit

    http://www.thehindu.com/opinion/op-ed/article3398119.ece
    Yudelsy García O'Connor, the first baby known to have been born with HIV in Cuba, is not merely still alive. She is vibrant, funny and, at age 25, recently divorced but hoping to remarry and have children.

    Her father died of AIDS when she was 10, her mother when she was 23. She was near death herself in her youth.

    “I'm not afraid of death,” she said. “I know it could knock on my door. It comes for everyone. But I take my medicine.”

    Ms García is alive thanks partly to lucky genes, and partly to the intensity with which Cuba has attacked its AIDS epidemic. Whatever debate may linger about the government's harsh early tactics — until 1993, everyone who tested positive for HIV was forced into quarantine — there is no question that they succeeded.

    Cuba now has one of the world's smallest epidemics, a mere 14,038 cases. Its infection rate is 0.1 per cent, on par with Finland, Singapore and Kazakhstan. That is one-sixth the rate of the United States, one-twentieth of nearby Haiti.

    The population of Cuba is only slightly larger than that of New York City. In the three decades of the global AIDS epidemic, 78,763 New Yorkers have died of AIDS. Only 2,364 Cubans have.

    Other factors

    Other elements have contributed to Cuba's success: It has free universal basic health care; it has stunningly high rates of HIV testing; it saturates its population with free condoms, concentrating on high-risk groups like prostitutes; it gives its teenagers graphic safe-sex education; it rigorously traces the sexual contacts of each person who tests positive.

    By contrast, the response in the United States — which records 50,000 new infections every year — seems feeble. Millions of poor people never see a doctor.

    Testing is voluntary, and many patients do not return for their results. Sex education is so politicised that many schools teach nothing about protected sex; condoms are expensive, and distribution of free ones is haphazard.

    Cuba has succeeded even though it has the most genetically diverse epidemic outside Africa. Almost all American cases are of one strain, subtype B. Cuba has 21 different strains.

    The genetic diversity is a legacy of its foreign aid. Since the 1960s, Cuba has sent abroad thousands of “internationalists” — soldiers, doctors, teachers and engineers. Stationed all over Africa, they brought back a wide array of strains. According to a study in 2002, 11 of Cuba's 21 strains are unknown elsewhere, formed when two others mixed.

    And Cuba's success has come despite its being a sex tourism destination for Europeans and Canadians.

    While the police enforce laws against overt streetwalking, bars and hotel lobbies in downtown Havana are filled with young women known as jineteras — slang for “jockeys” — who approach foreigners, asking if they would like to go for a drink, or perhaps dancing, with the unspoken assumption that it will lead to more. Even so, of the roughly 1,000 new infections diagnosed each year, 81 per cent are among men and very few among young unmarried women.

    In a survey in 2009, 77 per cent of all sex workers said they regularly used condoms.

    Heroin use, which drives epidemics in many countries, is virtually non-existent in Cuba, officials insist.

    And since 1986, only 38 babies have been born with the virus. In Cuba's cradle-to-grave health care system, pregnant women get up to 12 free prenatal check-ups, during which they are tested for HIV at least twice.

    Before antiretroviral drugs were available, HIV-infected women were offered abortions or, if they chose to deliver, Caesareans and free infant formula to discourage breast-feeding and reduce the risk of transmission. Now they get the drugs free.

    Universal coverage

    As broken as it is economically, Cuba still points proudly to one legacy of its 1959 revolution: Basic health care is universal and free. Cuba has 535,000 health care workers (“We're all either doctors or baseball players,” one hospital microbiologist joked) and each citizen is officially registered with a family doctor nearby; if a patient skips a check-up, the doctor is expected to find out why.

    “I was trained to expect my patients to come to me,” said Dr. Rafael Mazín, senior AIDS adviser for the Pan American Health Organization in Washington, who is Mexican. “In Cuba, the doctor comes to you.”

    Cuba is tied with the United States in both life expectancy and infant mortality. Dr. Jorge Pérez Ávila is Cuba's Tony Fauci, its best-known AIDS doctor. He is grandfatherly now, and clearly much loved by former patients like Ms García, but he has memories of helping his bus driver father make gasoline bombs to throw at the police during the Batista government. As a teenager he dropped out of school to live in the mountains, teaching villagers to read under a literacy programme after Castro came to power.

    He treated Ms García's parents on their deathbeds and heard her father beg, “Do whatever it takes to help my daughter live.” (Her father, who had been a soldier in Angola, was a truck driver. He had nine girlfriends in different towns, five of whom he infected.)

    Many medical authorities agree that Cuba had an early and effective response to the epidemic. In his book, “AIDS: Confessions to a Doctor,” published only in Spanish, Dr. Pérez gave his account of the meeting that galvanised Cuba's response.

    In 1983, Fidel Castro visited the Pedro Kourí Institute, Cuba's top tropical disease hospital, to hear a presentation on malaria and dengue fever.

    As it ended, he suddenly asked the director, “Gustavo, what are you doing to keep AIDS from entering Cuba?”

    Dr. Gustavo Kourí, son of the institute's founder, was caught off guard, Dr. Pérez said, and stammered: “AIDS, comandante? AIDS? It is a new disease. We don't even know whether it's produced by a bacteria, a virus or a fungus. There isn't much data on it, just what's been reported in the United States and a few cases in Europe. It will take time to know how big it is.”

    Mr. Castro replied: “I think it will be the epidemic of this century. And it's your responsibility, Gustavo, to stop it becoming a major problem here.”

    This was two years before any American President publicly uttered the word “AIDS.” Asked how Mr. Castro could have been so prescient, Dr. Pérez struggled to find the right word, then said: “Castro has luz larga” — “big lights,” the Cuban slang for automobile high beams. “He reads a lot. He sees far ahead.”

    Dr. Pérez is simultaneously both a fan of the Castro government and a bit of a cynic; on December 1, he led a “Viva, Fidel!” cheer at his hospital's World AIDS Day. But he also mentioned that Mr. Castro once praised him by saying: “Jorge, I've been reading your mail. Your patients say very nice things about you.”

    The medical establishment reacted quickly. The first step was to throw out all imported blood — 20,000 units. That avoided the devastation that the haemophiliac populations in the United States and France suffered.

    Doctors were sent to Brazil and France to study cases.

    All of the country's family doctors were ordered to watch for infections that indicate AIDS like Kaposi's sarcoma or Pneumocystis carinii pneumonia.

    Because there was no HIV test yet, the first cases were found late in the disease, leading doctors to think most patients died within a year — an erroneous assumption that helped justify the quarantine policy.

    In 1986, blocked by the embargo from buying American test kits, Cuba bought 750,000 French ones.

    continue on this link

    http://www.thehindu.com/opinion/op-ed/article3398119.ece
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    May 09, 2012 12:42 AM GMT
    That is beyond impressive. If only the US was even close to the way Cuba handles these diseases.
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    May 09, 2012 1:05 AM GMT
    Hardly strange. Haiti is essentially a failed state, with little infrastructure, extraordinarily poor educational standards and rates of participation, and as far as I know little in the way of public health programs. People there struggle just to get clean water.

    Is it any wonder that an epidemic can really need roughshod over that sort of nation?
  • barriehomeboy

    Posts: 2475

    May 09, 2012 1:16 AM GMT
    Canadian men get to go to Cuba to hook up with hot cubans, where gay marriage is now legal. Canadian men also get to smoke up and get married on the continent if the Americas. Not so much for USA gay guys going to Haiti, or staying home.
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    May 09, 2012 1:37 AM GMT
    Thanks for posting the article. Great news.
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    May 09, 2012 1:45 AM GMT
    MuchMoreThanMuscle saidI'd be interested to learn of a comparison study as to why Haiti has so much HIV when it's basically a neighboring island. Isn't like thirty percent or more of the Haitian population infected with HIV?


    A good author to look up is Dr. Paul Farmer. He's a medical anthropologist whose work in Haiti and Latin America, Africa and Russia has made a major impact on how the world fights tuberculosis and HIV. His particular focus has been Haiti, where he first became interested in social justice and specifically, medical anthropology and epidemiology.

    AIDS and Accusation: Haiti and the Geography of Blame, Berkeley: University of California Press, 1992, 1993, 2006 edition: ISBN 978-0-520-08343-1

    Infections and Inequalities: The Modern Plagues, Berkeley: University of California Press, 1999, revised 2001 edition: ISBN 978-0-520-22913-6

    Pathologies of Power: Health, Human Rights, and the New War on the Poor, Berkeley: University of California Press, 2003, 2005 edition: ISBN 978-0-520-24326-2

    His nonprofit, Partners in Health, is a pretty amazing organization. After the earthquake, they were pretty much the most sophisticated healthcare organization with boots on the ground.

    http://www.pih.org/pages/who-we-are/

    http://en.wikipedia.org/wiki/Paul_Farmer
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    May 09, 2012 1:45 AM GMT
    Thanks to the OP for posting this. Great and interesting stuff!
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    May 09, 2012 2:20 AM GMT
    MuchMoreThanMuscle saidI'd be interested to learn of a comparison study as to why Haiti has so much HIV when it's basically a neighboring island. Isn't like thirty percent or more of the Haitian population infected with HIV?


    Cuba has the highest doctor per capita in the world I believe, they also have one of the highest literacy rates. Education and good health can take you a long a way. This is coming from a country drowned in the longest embargo ever imposed by the USA on a another nation. It takes quite a stubborn government to accomplish what Cuba has done so far in terms of health care. The socialist over controlling power of the government plays a major role on where the available capital is spent and which social plans are prioritized.
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    May 09, 2012 2:25 AM GMT
    charlitos said
    MuchMoreThanMuscle saidI'd be interested to learn of a comparison study as to why Haiti has so much HIV when it's basically a neighboring island. Isn't like thirty percent or more of the Haitian population infected with HIV?


    Cuba has the highest doctor per capita in the world I believe, they also have one of the highest literacy rates. Education and good health can take you a long a way. This is coming from a country drowned in the longest embargo ever imposed by the USA on a another nation. It takes quite a stubborn government to accomplish what Cuba has done so far in terms of health care. The socialist over controlling power of the government plays a major role on where the available capital is spent and which social plans are prioritized.


    That is true.. Cuba is highly respected in the whole region for its success in these matters.
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    May 09, 2012 2:27 AM GMT
    I don't think we can go around quaranting people...
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    May 09, 2012 2:28 AM GMT
    7Famark saidI don't think we can go around quaranting people...


    I know it sounds pretty bad.. but that has been done throughout history with many infectious diseases, including leprosy... people used to get quarantined in Hawaii because of it.... if at any time there were a new outbreak in the US of something quite serious, it would happen there too
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    May 09, 2012 2:29 AM GMT
    7Famark saidI don't think we can go around quaranting people...


    That may be one way to look at it. But whatever it is, the success is still remarkable. I really think Cuba can be one of the most successful Latin American states if fully given access to the world. The image of Cuba being a small backwards island really is far from the truth....
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    May 09, 2012 2:31 AM GMT
    GreenHopper said
    7Famark saidI don't think we can go around quaranting people...


    I know it sounds pretty bad.. but that has been done throughout history with many infectious diseases, including leprosy... people used to get quarantined in Hawaii because of it.... if at any time there were a new outbreak in the US of something quite serious, it would happen there too


    HIV is mainly contracted through sexual intercourse...it isn't the same as an airborne disease that can be contracted at any time, by any person.
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    May 09, 2012 2:35 AM GMT
    jmusmc85 said
    7Famark saidI don't think we can go around quaranting people...


    That may be one way to look at it. But whatever it is, the success is still remarkable. I really think Cuba can be one of the most successful Latin American states if fully given access to the world. The image of Cuba being a small backwards island really is far from the truth....
    Won't speak to the HIV aspect but I agree that the time to let go of the past WRT Cuba is long overdue. Would love to visit there one day.
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    May 09, 2012 2:43 AM GMT
    7Famark saidI don't think we can go around quaranting people...


    Read the whole article before you reach premature conclusions. This happened in 1993, it is not the case today and it has not been the case for over a decade. It was the reaction taken with the first reported cases as the individuals seemed to be dying during a 12 month window because prior to that moment HIV tests were not available. Obviously later on they realized that these people had been infected with the virus for 5 years or more.

    That quarantine period in 1993 helped against the spread but it accounted for a very small percentage of Cuba's action plan to keep AIDS at bay. Today the country mainly focuses on educating the population on the potential risks. There is not religious power or private schools in Cuba so as soon you are old enough to have intercourse you will be taught about penises and vaginas and condoms and how to protect yourself. The fact the country has the highest doctor per capita in the world also helps, a lot.
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    May 09, 2012 2:44 AM GMT
    charlitos said
    7Famark saidI don't think we can go around quaranting people...


    Read the whole article before you reach premature conclusions. This happened in 1993, it is not the case today and it has not been the case for over a decade. It was the reaction taken with the first reported cases as the individuals seemed to be dying during a 12 month window because prior to that moment HIV tests were not available. Obviously later on they realized that these people had been infected with the virus for 5 years or more.

    That quarantine period in 1993 helped against the spread but it accounts for a very small percentage of Cuba's action plan to keep AIDS at bay. The country mainly focuses on educating the population on the potential risks. There is religious power or private schools in Cuba so as soon you are old enough to have intercourse you will be taught about penises and vaginas and condoms and how to protect yourself. The fact the country has the highest doctor per capita in the world also helps, a lot.


    I didn't reach any premature conclusions, it was just an attempt a comical comment.
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    May 09, 2012 2:46 AM GMT
    7Famark said
    charlitos said
    7Famark saidI don't think we can go around quaranting people...


    Read the whole article before you reach premature conclusions. This happened in 1993, it is not the case today and it has not been the case for over a decade. It was the reaction taken with the first reported cases as the individuals seemed to be dying during a 12 month window because prior to that moment HIV tests were not available. Obviously later on they realized that these people had been infected with the virus for 5 years or more.

    That quarantine period in 1993 helped against the spread but it accounts for a very small percentage of Cuba's action plan to keep AIDS at bay. The country mainly focuses on educating the population on the potential risks. There is not religious power or private schools in Cuba so as soon you are old enough to have intercourse you will be taught about penises and vaginas and condoms and how to protect yourself. The fact the country has the highest doctor per capita in the world also helps, a lot.


    I didn't reach any premature conclusions, it was just an attempt a comical comment.


    From your other response above where you posted trying to explain why HIV is not the same as other diseases it gave the impression that you didnt put the context of what you read in 1993. Thats all.
  • swimbikerun

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    May 09, 2012 2:50 AM GMT
    intensity69 saidHardly strange. Haiti is essentially a failed state, with little infrastructure, extraordinarily poor educational standards and rates of participation, and as far as I know little in the way of public health programs. People there struggle just to get clean water.

    Is it any wonder that an epidemic can really need roughshod over that sort of nation?
    Isn't it strange that they share an island with the Dominican Republic. Is that a failed state too?
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    May 09, 2012 2:52 AM GMT
    swimbikerun said
    intensity69 saidHardly strange. Haiti is essentially a failed state, with little infrastructure, extraordinarily poor educational standards and rates of participation, and as far as I know little in the way of public health programs. People there struggle just to get clean water.

    Is it any wonder that an epidemic can really need roughshod over that sort of nation?
    Isn't it strange that they share an island with the Dominican Republic. Is that a failed state too?


    I wouldn't say the DR is a failed state, though it certainly needs improvements.
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    May 09, 2012 3:14 AM GMT
    jmusmc85 said
    swimbikerun said
    intensity69 saidHardly strange. Haiti is essentially a failed state, with little infrastructure, extraordinarily poor educational standards and rates of participation, and as far as I know little in the way of public health programs. People there struggle just to get clean water.

    Is it any wonder that an epidemic can really need roughshod over that sort of nation?
    Isn't it strange that they share an island with the Dominican Republic. Is that a failed state too?


    I wouldn't say the DR is a failed state, though it certainly needs improvements.


    ^^this. plus...not being run by the Duvaliers for decades also helps.
  • waccamatt

    Posts: 1918

    May 09, 2012 3:26 AM GMT
    southbeach1500 saidHow do we reconcile the fact that in the USA where most guys are circumcised, that the rate of HIV infection is 6x more than in Cuba, where most guys are not circumcised?


    Studies have found that uncircumcised guys are at slightly more risk. Has anyone ever thought that Cuba is lying or locked people up? This is Cuba we're talking about...with a dictator...the country where people risked their lives in small boats to get away. We should not be emulating Cuba.
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    May 09, 2012 3:27 AM GMT
    Uh...I don't think it has anything to do with circumcision. I'm against circumcision personally, but in this case, I think its pretty clear that it has to do with the Cuban government's fast response plus its progressive outlook on sexual healthcare. We can barely teach our kids how to use a condom.
  • musclmed

    Posts: 3274

    May 09, 2012 3:34 AM GMT
    charlitos said
    7Famark said
    charlitos said
    7Famark saidI don't think we can go around quaranting people...


    Read the whole article before you reach premature conclusions. This happened in 1993, it is not the case today and it has not been the case for over a decade. It was the reaction taken with the first reported cases as the individuals seemed to be dying during a 12 month window because prior to that moment HIV tests were not available. Obviously later on they realized that these people had been infected with the virus for 5 years or more.

    That quarantine period in 1993 helped against the spread but it accounts for a very small percentage of Cuba's action plan to keep AIDS at bay. The country mainly focuses on educating the population on the potential risks. There is not religious power or private schools in Cuba so as soon you are old enough to have intercourse you will be taught about penises and vaginas and condoms and how to protect yourself. The fact the country has the highest doctor per capita in the world also helps, a lot.


    I didn't reach any premature conclusions, it was just an attempt a comical comment.
    From your other response above where you posted trying to explain why HIV is not the same as other diseases it gave the impression that you didnt put the context of what you read in 1993. Thats all.


    7aFarmark is right.

    If you watched Micheal Moores documentary it would seem that Cuba is the Cleveland Clinic in the Caribbean.

    It is hardly that. Although westerners can obtain simple procedures for nearly no cost. The population faces rationed care , and even ENFORCED care.

    Last if the medical care was so stellar. Why then did dear Leader Castro have to import his Surgeon from Spain?
    Why did they not perform the colostomy he needed for his advanced colon cancer?

    Only the uniformed believe this blog entry which lacks any real sources for its data.

    Hindu Express
    The genetic diversity is a legacy of its foreign aid. Since the 1960s, Cuba has sent abroad thousands of “internationalists” — soldiers, doctors, teachers and engineers. Stationed all over Africa, they brought back a wide array of strains. According to a study in 2002, 11 of Cuba's 21 strains are unknown elsewhere, formed when two others mixed.




    One simple point.

    Cuba has contributed 0 , yes 0 to HIV research. And I am involved in HIV research.

    Basically its a floating prison. You know on occasion some prisons give great medical care. Does that mean we should flock to a prison for medical care?

    Not one piece of data can be trusted from that country. Simply because they will only let out useful information. This is not a free society.

    Oh and BTW, you get SIDA stamped on your national ID card if you have HIV. Yes the ID card required to access any service.

    Yes they give you a scarlet letter for HIV...... why is that left out of the article?

    Ex:

    Many young cancer patients reportedly have become infected with Hepatitis C after their surgeries. Contracting Hepatitis C after surgery indicates a lack of proper blood screening prior to administering transfusions. All blood should be screened for Hepatitis B, C, HIV and Syphilis prior to use.


    So romanticize a country that is essentially stuck in the 1950's for medicine. See how healthy you get.
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    May 09, 2012 4:27 AM GMT
    north_runner said
    MuchMoreThanMuscle saidI'd be interested to learn of a comparison study as to why Haiti has so much HIV when it's basically a neighboring island. Isn't like thirty percent or more of the Haitian population infected with HIV?


    A good author to look up is Dr. Paul Farmer. He's a medical anthropologist whose work in Haiti and Latin America, Africa and Russia has made a major impact on how the world fights tuberculosis and HIV. His particular focus has been Haiti, where he first became interested in social justice and specifically, medical anthropology and epidemiology.

    AIDS and Accusation: Haiti and the Geography of Blame, Berkeley: University of California Press, 1992, 1993, 2006 edition: ISBN 978-0-520-08343-1

    Infections and Inequalities: The Modern Plagues, Berkeley: University of California Press, 1999, revised 2001 edition: ISBN 978-0-520-22913-6

    Pathologies of Power: Health, Human Rights, and the New War on the Poor, Berkeley: University of California Press, 2003, 2005 edition: ISBN 978-0-520-24326-2

    His nonprofit, Partners in Health, is a pretty amazing organization. After the earthquake, they were pretty much the most sophisticated healthcare organization with boots on the ground.

    http://www.pih.org/pages/who-we-are/

    http://en.wikipedia.org/wiki/Paul_Farmer



    Thanks for posting and providing this information - It always gives me a bit of hope that there are some individuals that have such degree of being a doctors, nurses, etc and sacrificing for others. Its a shame in the US that we care more about the business of medicine than the actual patient.
  • commoncoll

    Posts: 1222

    May 09, 2012 4:39 AM GMT
    You guys missed the part about the Department of Revolution where in every neighborhood, there is someone there who spies on the other people. If they suspect you, they knock on your door, you will be forced to get tested and treated. You will be forced to release all your previous partners. How many of you are going to put up with that?

    You also missed the part about how their medications are several decades behind the US.

    You also missed the part where people have sex responsibly.

    It's easy to blame government, but the truth is keeping yourself healthy and safe is more your responsibility than your government's.

    The article also mentioned that their infant mortality rate is about as good as the US rate. You know why? Because they invent more babies and they save less of the underdeveloped ones.