SANTIAGO DE LAS VEGAS, Cuba — When H.I.V. testing began in Cuba in 1986, infections were found first in soldiers who had been in Africa. Initially locked in the national Naval Hospital, they were frustrated, since they were still healthy. There were escapes on bedsheet ropes; rum was smuggled in.
As their numbers grew and more civilians tested positive, the government opened sanitariums — both to keep the infected from having sex with anyone uninfected and to help them die comfortably.
At first the institutions were run by military doctors and guarded by soldiers; patients had home visits only with escorts.
But life inside was not brutal. Inmates got food, medical care and their old salaries; theater troupes and art classes formed. Gay men could live together, which was not true in the macho culture outside.
The network of sanitariums grew to 14. They were harshly criticized — Dr. Jonathan Mann, the first AIDS director at the World Health Organization, called them “pretty prisons” — but they had a huge damping effect on the early epidemic. Fewer than 150 new cases were detected in the country each year through 1990.
The policy had a few unintended consequences. To stay out, some Cubans tried to avoid testing. But a few others, usually teenagers estranged from their families, deliberately got themselves infected to get in.
The policy also affected the virus; researchers believe Cuba’s 11 unique recombinant H.I.V. strains emerged from intra-sanitarium sex.
Starting in 1989, a new director of the network, Dr. Jorge Pérez Ávila, who is now Cuba’s leading AIDS physician, slowly eased restrictions. Trusted patients could leave without escorts.
In 1993, the gates were opened and outpatient care became the norm. Initially, however, 40 percent of the inhabitants stayed. With the Soviet Union’s collapse, “those were really bad days,” Dr. Pérez said. “The economy was destroyed.”
Now, however, just three sanitariums remain. A reporter was allowed to visit two.
Santiago de las Vegas, the first to open, still has 200 patients, down from 340 at its peak. It is about a half-hour drive southwest of Havana, on the grounds of Los Cocos, an estate that belonged to a relative of the ousted dictator Fulgencio Batista. (The large oil of a flamenco dancer in the hacienda, according to snickering but unverifiable sanitarium lore, was the former owner in drag.)
Some of its buildings are rundown, but it is still lush, with fountains, lawns and towering palms.
Patients like Carlos Emilio García, a nurse who also works inside, live rent-free in white bungalows with TVs, air-conditioning, refrigerators and stoves. In the psychiatric ward, five patients watched TV under the eyes of two nurses.
The sanitarium in Sancti Spíritus, in central Cuba, is more disheveled but is being spruced up. A former vacation camp for the Ministry of Construction, it has 63 employees. But the patient population is down to 21.