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About Just out. (Portland, OR) 1983-2013 | View Entire Issue (July 1, 1994)
J u s t o u t ▼ July 1. 19U 4 ▼ 17 IT’S A QUEER THING — The Cuban solution The United States can learn something from Cuba about ways to make our AIDS policy more humane T by Howard N. Dana uba has done some things right with regard to its AIDS policy, and it has done some things wrong. However— judging from conversations I had with Cuban citizens and government leaders on a recent trip to the island with the Venceremos Brigade— aside from its mistakes, I think the United States can stand to learn a lot from Cuba’s example. When AIDS was first recognized globally as a life-threatening, sexually transmitted illness, members of the world community reacted to the discovery in a vari ety of ways. In the United States, our re sponse to AIDS in the early years of the epi demic can be described as “far too little, way too late.” I do not have to remind anyone that President Reagan re fused to even utter the Gay men camp it up in Havana word AIDS until the very end of his admin lthough many of these changes in the sani istration, and that the tarium system were brought about by a subsequent Bush presi p ro g re s s iv e dency continued to ig policy toward AIDS, nore the disease. From just as many changes very little attention being given to AIDS during came about because of the early years in this country to the approach econom ic reasons. Cuba took, the difference is remarkable. When The 33-year-old U.S. AIDS was first recognized on the island of Cuba blockade against Cuba it was considered, and rightly so, a disease which has worn the country threatened every Cuban citizen. In a socialist ragged. Since the col society such as Cuba’s, the individuals of that lapse of the Soviet society are responsible for the well-being of Union as a trading society as a whole. Recognizing this way of partner for Cuba, food, thinking makes it less shocking to think about the clothing, and espe measures Cuba took to contain HIV. cially medicine have It is true that the entire Cuban populace was been in short supply. tested for HIV. It is also true that all people with The sanitarium system for people with HIV and HIV and AIDS were quarantined in sanitariums. AIDS works on the model of free health care The fact that these sanitariums were built ex offered to all Cuban citizens. In the sanitarium a pressly to offer people with HIV and AIDS better medicine and food, in a stress-free environment, does not discount the fact that people were re quired to enter them and were not permitted to leave. The criticism the rest of the world leveled at Cuba for locking up people with AIDS is just. However, this criticism does not take into ac count the Cuban ideal of putting the benefit of the society ahead of the rights of the individual. For Cubans, this policy was far less a civil liberties issue than it was a public health issue. Given the panic AIDS spread throughout the world in the early years of the epidemic, the Cuban solution, while strict and authoritarian, was effective in keeping the rate of HIV transmission very low. As Cuba and the rest of the world began to learn more about HIV and its transmission, the Cuban AIDS policy became gradually more pro gressive. When it was known that HIV could not be transmitted casually, and that it was predomi nantly spread sexually, restrictions in the sani tariums were eased. Lovers and spouses of people living in the sanitariums were allowed to live there as well. Gay couples were not discrimi nated against by this policy. As people were found to be trustworthy (i.e., they would not spread HIV to anyone else) they were first given day passes to leave the sanitarium, then over night and weekend passes. Eventually people were allowed to leave and return to their homes until such time as they wished to re-enter the * sanitarium. Howard Dana processing tobacco, Pinar del Rio, C HAVANA JOURNAL PART III A stress-free environment, with comfortable hous ing, plentiful food, and all necessary medicine, is offered to the in habitants. Clearly, this is very expensive. It is also logisti- cally impossible under the eco nomic strain the United States is exertin g on Cuba. There is not enough food or medicine to make the sani tarium system work, so it has been modified. The sanitarium system in Cuba is still offered, without charge, to anyone living with HIV or Immediate, decisive action at the beginning of the epidemic, although controversial, has stood Cuba in good stead. Cuba AIDS. Typically what happens is that people go there to live at two stages o f HIV disease— first after testing positive and then during illnesses related to the disease. When a person volunteers to be tested for HIV and is found to be HIV positive, on the recommendation of the family doctor, he or she will temporarily enter the sani tarium for “education about AIDS.” This process lasts a few weeks, during which the person learns what to do to stay healthy and to prevent the spread of the disease. After this the person usu ally goes back home to live and work as usual, following up medically with his or her family doctor. When the person needs more medical attention than the family doctor can provide, she or he will re-enter the sanitarium to receive care. Education about AIDS in Cuba has been re markable. There have been extensive govern ment-sponsored campaigns to educate Cubans on HIV transmission and to prevent discrimina tion against people living with HIV and AIDS. Radio has been an especially efficient way of disseminating this information, since Cubans tend to listen to the radio all day at work and in the home. Everyone I spoke with, from campesinos living in rural areas to gay men living in Havana, was aware of AIDS and could tell me how it was and was not transmitted. The minister for AIDS education met with our delegation one afternoon and answered many questions about Cuban AIDS education. He said gay and bisexual men, who make up half of the HIV and AIDS cases in the country, were some of the easiest people to edu cate. This population was motivated to adopt safer sex practices and had moved on to do peer education to prostitutes and the population at large. Condoms, while not plentiful, are available to those who need them. espite a controversial beginning and a very tough present economic situation, statis tics show that Cuba is doing very well in its efforts to stop the spread of HIV. Up to Jan. 27, 1994, there have been only 998 Cubans (out of a population of over 9 million) who have con tracted HIV. Of these cases 706 are men and 292 are women. Of the total HIV and AIDS cases in Cuba, 44 percent have been among gay and bisexual men and 54.4 percent among hetero sexual men and women. There have been a total of 251 AIDS cases and 154 deaths from compli cations of AIDS. The median incubation time from HIV infection to full-blown AIDS is 10.5 years. The median survival time from onset of AIDS to death is 15 months (source: Cuba Up date, May 1994). This survival rate is on a par with the United States and is considerably higher than Cuba’s Latin American neighbors. Despite the hardships Cuba is facing right now, the country remains dedicated to continuing AIDS research and is exploring some avenues not taken by other countries doing similar re search. Rates of transmission remain low on the island, and public knowledge about the disease is high. Immediate, decisive action at the beginning of the epidemic, although controversial, has stood Cuba in good stead. While it is clear that quaran tining people with HIV was unnecessary, the way Cuba has handled the epidemic beyond that point is commendable. That there are no people with AIDS living on the streets in Cuba, and that the rate of transmission among IV drug users is nearly nonexistent, sends a clear message to the United States that we could be handling the AIDS epidemic much better. We would be wise to look at examples offered by our neighbors for ways to make our own AIDS policy more humane. D