Cubas AIDS program shows results

Cuba’s progress in fighting HIV/AIDS was recently on display at a national conference in Havana titled “Assuming the Challenge.”

From April 26-29, health care providers and people living with HIV infection heard presentations on public education, prevention strategies and treatment advances. The week was divided into eight hour-long sessions devoted to topics like psychiatric complications of AIDS, palliative care, epidemiology, opportunistic infections and nursing care.

Faced with the U.S. blockade and the high costs of importing drugs, Cuba has turned to manufacturing its own anti-HIV medicines. On average, anti-HIV drugs are 87 times cheaper to manufacture in Cuba than to buy from abroad.

The results of the Cuban drugs have been impressive. All HIV-positive people receive treatment if they need it, and over the past four years the annual mortality rate has fallen from 25 percent to less than 7 percent. For several years no infected babies have been born because pregnant HIV-positive women receive anti-retroviral therapy and their babies are delivered by Caesarian section.

But drugs are only part of the picture. Cuba’s approach includes individualized, comprehensive care and preventative strategies that include public teaching about sexuality and the disease itself. These make for an effective combination.

Over the past 20 years, 5,906 Cubans have been diagnosed with HIV infection, 2,474 of them have developed clinical AIDS, and 1,194 have died. The incidence of the illness among adults, age 15-49, is 0.05 percent. Only 20 children have been diagnosed with HIV infection during the same period.

By contrast, 9 percent of the people on the African continent are infected; in the Caribbean, 2.3 percent. Last year at least 500,000 pre-teenage children died from AIDS worldwide, while only 25,000 were provided with medicine.

Cuba sells the HIV drugs it makes to other nations at very low cost. In an interview, Dr. Jorge Perez, director of Cuba’s AIDS program since 1989, condemned rich nations and drug manufacturers for restricting access to generic drugs. The corporations, he said, “are making fortunes on people’s lives.”

Political leadership has played a big role in Cuba’s success. Fidel Castro spoke of combating “the disease of the century” at a 1983 meeting of the Institute of Tropical Medicine. That same year Cuba created a National Commission on AIDS, destroyed existing stores of blood products, banned the importation of foreign blood products, devised a quarantine system and began clinical surveillance. Cuba’s first AIDS patient appeared two years later.

By 1985, Cuba had 750,000 blood testing kits on hand to screen donated blood. Beginning in 1986, all Cubans who were in prison or pregnant, or who had lived in Africa, were tested for the disease. Cuban scientists have been working on an anti-HIV vaccine since 1993.

According to Dr. Byron Barksdale of the U.S.-based Cuba AIDS Project, Dr. Perez defined the preventative and educational aspects of the Cuban program and adapted it to individual patient differences. “He dispelled a lot of myths and fears people had about HIV/AIDS” and removed the stigma of the illness, Barksdale said.

Journalist Susan Hurlich, writing in the Toronto-based People’s Voice, attributes Cuba’s success to basic principles. “They are really quite simple,” she said. “Medical care is a right rather than a business, prevention is the best and most cost-effective way to maintain good health, and an educated population is the best protection against illness.”