Cuba’s National HIV/AIDS Program

Abstract

As scientifi c data emerged elucidating the pathology of the disease, public health understanding and Cuban policy evolved with it. As of 1993, an ambulatory care system made sanatorium treatment an option rather than an obligation.[1] By then, thanks to the global introduction of antiretrovirals (ARV) in 1987, AIDS was no longer assumed a death sentence. Cuba’s challenge at the time was to fi nd the funds to afford costly medications, and simultaneously turn more attention to nationwide prevention. The pro-active incorporation of people living with HIV in educational campaigns organized within the National HIV/AIDS Program—most notably the founding of the AIDS Prevention Group (GPSIDA, its Spanish acronym) by patients in Havana’s Santiago de Las Vegas Sanatorium in 1991—underscored this effort. Over two decades later, UNAIDS has lauded Cuba for its “exceptionally low 0.1% prevalence rate,”[2] and low rate of AIDS-related mortality.[3] Still, despite systematic efforts to contain the spread of the disease and improve quality of life for those living with it, HIV/AIDS continues to present serious challenges to the Cuban health system and the country’s at-risk populations. HIV/AIDS in Cuba: The Current Picture Today, the pathways of HIV/AIDS in Cuba are different from other countries in some respects: transmission by intravenous drug use is extremely rare, as is infection from blood or blood derivatives, all of which are screened. Rates of mother-to-child HIV transmission are negligible. In Cuba, HIV is largely urban and male, with 99% of cases contracted through sexual relations. The epidemiological profi le of infection has shifted from early predominance of heterosexual transmission to that of men who have sex with men (MSM), who now constitute over 80% of people living with HIV in the country. Provinces with the most new cases in 2010 were Havana City, Isle of Youth (special municipality), Havana, and Cienfuegos.[4] HIV prevalence in Cuba is slowly increasing, partly because people with HIV are living longer. However, more worrisome is the fact that incidence is also increasing: from 13.9 to 16.2 per 100,000 population between 2009 and 2010. Recent national surveys relate low risk perception and social constructs such as machismo to increases in HIV infection in Cubans under age 49. Cuba provides comprehensive care to all people living with the disease, and guarantees antiretrovirals (ARVs) for those needing them. Despite deep fi nancial diffi culties, treatment in Cuba, including medication, is free. In 2003, Cuba achieved universal antiretroviral therapy with domestically-manufactured ARVs for patients meeting international clinical criteria. In 2010, over 5,600 people received ARV therapy in Cuba, more than a 10% increase from the previous year.[4] The Cuban government estimates it costs US $6000 annually to treat each person with HIV/AIDS.[5] A strategy to further decentralize services for HIV/AIDS counseling, testing, treatment and support groups was begun in 2005. Establishing and equipping additional clinical microbiology and pathology laboratories, locating specialized services in Havana City, Villa Clara, Sancti Spiritus, Holguin, and Santiago de Cuba provinces, and closing 11 sanatoria deemed superfl uous are results of this strategy, designed to improve access.