HIV/AIDS Early History 1981: Health community is baffled by a new disease causing opportunistic infections and Karposis sarcoma emerging in the USA 1982: Disease is termed Acquired Immunodeficiency Syndrome 1985: FDA approves HIV seroantibody test 1987: FDA approves AZT, the first disease- modifying drug effective against HIV/AIDS
A Brief Look at the Cuban Response to AIDS 1983: National Commission on AIDS established before any Cuban is known to be infected. 1985: Newly implemented AIDS policy mandatory testing and contact tracing programs. 1986: Patients diagnosed with AIDS quarantined for life in a sanatorium 1994: Mandatory long-term confinement ends New policy favours intense education, treatment with ARVs, and close follow up of infected as outpatients
Dr. Jorge Perez Avila Cuban Infectious Disease specialist, trained in Pharmacology at McGill Ordered the destruction of all foreign-derived blood products in 1986 on a hunch Placed huge strain on Cubas already poor health care system In 2002, blood product transmission of HIV in Cuba is extremely rare Provincialized sanitoriums & destigmatized AIDS in Cuba Helped to prove lifetime quarantine of HIV+ individuals ultimately unnecessary using improved treatment and education pilot programs
Why Cuban HIV/AIDS Policy Was Possible Cuba is geographically and to some extent politically isolated from surrounding nations Greater protection from international transmission Local government does not view protection of autonomy impediment to public health policy Well-developed health infrastructure with a primary care doctor for every person allowed for comprehensive HIV testing
Cuban sanitoriums: thinly veiled prisons, or humane isolation?
Number of known HIV- infected individuals in Cuba Ying-Hen Hsieh, Hector de Arazoza, Shen-Ming Lee and Cathy WS Chen. 2002. Estimating the number of Cubans infected sexually by human immunodeficiency virus using contact tracing dataInternational Journal of Epidemiology. 31:679-683
Was Cubas AIDS Response Effective??? In 2002, the Cuban government reported HIV prevalence of 0.03%, 11 times lower than that in the US. Between 10 and 60 times lower than any of Cubas Caribbean neighbours HIV/AIDS in Cuba today is essentially a sexually transmitted disease. Blood product, maternal to child, and IV drug related transmission are very uncommon
Confounding Factors 1. Geographical, social, and political isolation 2. Guaranteed minimum levels of income, education, and housing
AIDS & the Western Response In the early 1980s, AIDS was quickly adopted as a human rights protection of autonomy issue Historically… HIV testing required express consent A positive test result was not reportable Contact tracing programs optional Change is being implemented, slowly and with much resistance Such value placed on autonomy over public protection exceptional to AIDS among other STIs and IDs in the US, as opposed to Cuba. Ronald Bayer. 2004. Ethical Challenges of the Global AIDS Epicdemic. In AIDS and Other Manifestations of HIV Infection Fourth Edition, edited by Gary P. Wormser. 1045-1054 (Chapter 43).
Individual Rights vs. Rights of the Community IndividualityCommunalism ------------------------------------------------------ HIV testing required Mandatory contact tracing and quarantining Consent for testing Voluntary contact tracing
Lessons From Cuba Focus on disease education Mandatory HIV testing Extensive contact tracing programs Quarantine?
References Helena Hansen, Nora Groce. 2003. Human Immunodeficiency Virus and Quarantine in Cuba. JAMA. 2003;290:2875. Ronald Bayer. 2004. Ethical Challenges of the Global AIDS Epicdemic. In AIDS and Other Manifestations of HIV Infection Fourth Edition, edited by Gary P. Wormser. 1045-1054 (Chapter 43). Ying-Hen Hsieh, Hector de Arazoza, Shen-Ming Lee and Cathy WS Chen. 2002. Estimating the number of Cubans infected sexually by human immunodeficiency virus using contact tracing dataInternational. Journal of Epidemiology. 31:679-683 Anne-Christine d'Adesky. 2003. Cuba Fights AIDS Its Own Way. The Body: The Complete HIV/AIDS Resource Ed Susman. US could learn from Cuban AIDS policy. AIDS: Volume 17(13) 5 September 2003 pp N7-N8