HAVANA, Jun 22 (IPS) - Although all HIV/AIDS patients in Cuba
are to receive free treatment from the state, therapy is
sometimes interrupted due to a delay in imports, and not all
patients have access yet to the latest anti-retroviral
combination drugs, several of which have begun to be produced
To guarantee continuity of treatment, a group of HIV-carriers
has set up a "community pharmacy." Armando Alvarez, one of the
creators of the initiative, which has the support of the
governmental Centre for Prevention of Sexually Transmitted
Diseases and AIDS, told IPS that "we don't give the medicine
away; we lend it."
Alvarez, a medical doctor who was diagnosed as HIV-positive in
1988, said that in Cuba, "the situation is still complicated in
terms of making certain medicines available to all persons
living with HIV/AIDS."
He explained that "our project has no financing. We work with
donated medicines, which we provide to people who come from all
over Cuba. We neither sell nor give away medicine; we make
loans or swaps," said Alvarez.
"In some cases, we lend the medicine to the patient, who later
replaces it. Others swap extra or unused supplies for another
kind of medicine. Of course everyone must have a prescription,"
The idea behind the initiative is to avoid interruption of
treatment caused by a delay in imports or the late arrival of a
package expected from family members abroad.
"No one is given privileged treatment. Here we are all the
same: women and men, homosexuals and heterosexuals," said
Alvarez, who has worked in the field of AIDS prevention for the
Until the early 1990s, every individual diagnosed with HIV in
Cuba - including Alvarez - was committed to a specialised
sanatorium where patients received free housing, meals and
That controversial procedure was later replaced by a more
flexible system under which those who demonstrated that they
could act responsibly with respect to their own life and the
lives of others are allowed to receive out-patient treatment.
Besides the 15 sanatoriums in this country of 11 million,
Cuba's national AIDS programme entails mandatory blood testing
for pregnant women and blood donors, as well as the tracing of
the past sexual contacts of each newly diagnosed patient.
All treatment is provided free of charge by the public health
system, although the situation has become more difficult in
recent years, with the appearance on the market of new
high-cost anti-retroviral drugs.
According to Public Health Ministry statistics, in the
mid-1990s the state spent around 14,000 dollars a year per
asymptomatic HIV- carrier and 24,000 dollars for each patient
with full-blown AIDS.
Jorge P�rez, director of the Pedro Kouri Institute of Tropical
Medicine, which attends AIDS patients, announced last December
plans to produce a triple anti-retroviral cocktail for people
living with HIV.
Given the lack of funds for importing anti-retroviral drugs,
Cuba is producing AZT, d4T, ddI and ddC, and will begin to
manufacture saquinavir and nelfinavir, said P�rez.
Combination therapy is the most effective treatment for
improving the quality of life of HIV patients and curbing the
disease's impact on the immune system, thus reducing mortality.
Cuba, like Brazil and South Africa, has opted for producing
such drugs locally, in order to guarantee access to treatment
that currently costs 10,000 to 15,000 dollars a year per
Another controversial aspect of Cuba's anti-AIDS programme is
the medical recommendation that pregnant women diagnosed with
HIV interrupt their pregnancies. (Abortion has been legal in
Cuba since 1965).
Treatment aimed at keeping HIV-positive expectant mothers from
passing the disease to their babies includes birth by caesarean
and bottle- rather than breast-feeding. Babies born to
HIV-carriers have an estimated 15 percent risk of infection -
somewhat lower among women who receive treatment, and higher
among women who do not.
Doctors in Cuba continue to recommend abortion, although the
decision is left up to the expectant mothers, who are
increasingly deciding to go ahead with their pregnancies.
"More than 60 women living with HIV in Cuba have decided to
give birth, and less than 10 cases of perinatal transmission
were reported," said Alvarez. Peter Piot, executive director of
the joint UN Programme on HIV/AIDS (UNAIDS), has stated that
the level of support provided to people living with the disease
in Cuba is unequalled by any other nation.
Data from the Santiago de las Vegas Sanatorium outside Havana
indicates that 3,481 HIV-carriers had been diagnosed in Cuba by
late May, 1,254 of whom had developed full-blown AIDS and 887
of whom had died - including 54 who died of non-AIDS-related
Of the total number of cases, 2,701 were men and 784 women.
Homosexuals accounted for 82.7 percent of the male patients,
and 64.2 percent of all patients.
Cuba's 0.03 percent HIV infection rate is the lowest in Latin
America and the Caribbean, according to international reports.
By late 2000, 36.1 million people worldwide were living with
HIV/AIDS, and 21.8 million had died of the disease. In
addition, some 5.3 million new cases were reported last year,
along with three million deaths.
A February report by UN Secretary-General Kofi Annan observed
that the Caribbean was the region with one of the highest rates
of HIV, second only to sub-Saharan Africa.
The document underlined that in the Caribbean, the epidemic was
spreading particularly fast through heterosexual transmission,
due to increasinglyearly age of sexual initiation, frequent
changes of partner, and a growing trend in which young women
are having sex with older men.
In Cuba, on the other hand, homosexual transmission remains the
main route, although Dr. P�rez pointed out that the number of
infected women rose last year, chiefly as the result of
bisexual conduct by their male partners.
A 1996 survey carried out in Cuba with World Health
Organisation support found that nearly 90 percent of women who
had engaged in casual sex in the previous 12 months believed
they had no chance of catching AIDS.
In addition, just 14.4 percent of female respondents had
insisted on the use of a condom the last time they had casual
sex, compared to 23.4 percent of men. And just five percent of
the men and women interviewed had used condoms the last time
they had sex with their stable partner.
Most women here do not insist that their partner use a condom,
which is regarded almost as an insult in Cuba. That is true
even among prostitutes. (END/IPS/tra-so/da/sw/01)
* Editors Advisory. This is one in a series of IPS features
previewing the United Nations Special Session on AIDS, to be
held in New York June 25-27. It is the first-ever Special
Session devoted to a single disease..