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 in Havana.

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," he added.

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 past decade.

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 medical treatment.

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 patient.

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 causes.

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..