Cuba’s HIV prevention model might be SADC last resort

Southern African Development Community leaders have suggested that Africa adopt the principle of universal compulsory testing for HIV/AIDS, rather than leaving it up to individuals to decide.

During the recent SADC Summit held in Lilongwe, Malawi, heads of member states suggested that the continent implement an HIV programme similar to that of Cuba, as the best way to manage the HIV/AIDS pandemic, which is one of the most pressing health issues of our time. 

The leaders are of the opinion that since HIV/AIDS has become the greatest threat to human development, it is important that new and innovative ways of combating the spread of the epidemic be considered. 

Among leaders calling for universal compulsory testing are Zimbabwe’s Robert Mugabe and Joseph Kabila of the Democratic Republic of Congo (DRC) and the AU Commission Chairperson, Nkosazana Dlamini-Zuma.

President Mugabe says it was time to move away from voluntary to universal testing. Since the HIV spreads from person to person, and to deal with it efficiently, all the carriers of HIV should be treated, lest they involuntarily pass the lethal virus on to others.

But incoming SADC Chair, Malawian President Joyce Banda, says the question of resources should be dealt with separately from the principle of universal testing. 

She says while some countries might be able to embark on universal testing immediately, others would have to make an effort to obtain the necessary resources.

Cuba was one of the first countries to take HIV/AIDS seriously and provide a comprehensive response combining both prevention and care.  

The country’s HIV infection rate stands at 0.05 percent, on par with Finland, Singapore and Kazakhstan.

Cuba took drastic action in public health even before HIV/AIDS had reached the country. 

On the advice of Dr Jorge Perez, who was the country's leading infectious diseases specialist at that time, Cuba established a National AIDS Commission in 1983 and destroyed all foreign-derived blood products.

Although this action put a strain on the country's blood supply, it enabled Cuba to escape transmission of HIV to haemophiliacs and other blood recipients.

The moment virus reached Cuba, the government, through the Ministry of Public Health, designed and implemented a national programme aimed at controlling its spread. 

When the first cases emerged, the government treated HIV/AIDS as a public health emergency, with infected patients quarantined indefinitely and their sexual partners traced and tested.

Cubans who had visited Africa were also tested. HIV-positive women were given drugs to prevent transmission to their unborn children and delivered by caesarean section.

Cuba's strategy was legally founded in already existing regulations to protect citizens' health. 

These included a decree ‑ Law 54 of 1982, which among others permitted the authorities to isolate individuals suspected of suffering from a communicable disease if necessary.

Under Article 20 of Law 41 of 1983, the Ministry of Public Health would determine which diseases posed a risk to the community, and adopt diagnostic and preventative measures as well as establishing methods and procedures for mandatory treatment. 

These regulations led to the lawful creation of the Santiago de Las Vegas AIDS Sanatorium in Havana for HIV-positive individuals. 

Similar sanatoria were created in other areas of the country. Therefore, from 1986, when the first case of HIV appeared on the Caribbean island, the Cuban government quarantined all people found to be HIV infected. 

In the sanatoria, patients learn about HIV and AIDS, how it is transmitted, how a person can prevent transmission to others and safe sex practices. 

Food, housing, medication, social services, privacy, and other services are provided in the sanatoria, as well as the intensive educational and preventative programmes.

In 1994, compulsory quarantining was relaxed, but all new people who test positive for HIV still have to go to a sanatorium for eight weeks of thorough education on the disease. 

After the education programme, patients are allowed to stay in the sanatorium (many stay because of the free services and good care), but they are also permitted to return to their communities, families and jobs while making regular outpatient visits to their physician. 

All HIV-positive Cubans also receive anti-retroviral drugs manufactured in the country. 

Cuba started manufacturing generic anti-retroviral in 2001 for all the country's AIDS patients. It produces drugs such as Zidovudine, Stavudine, Lamivudine, Didanoside, and Indinavir while combination therapy is carried out by specialists.

Besides mandatory educational treatment in sanatoria, Cuba also uses other HIV/AIDS related regulations, among them that all pregnant women must undergo HIV testing. 

And if positive, they (mothers) are given anti-retroviral drugs to prevent transmission to newborns and also deliver by caesarean section, which is known to reduce HIV transmission. 

HIV infected people are also required to provide the names of all sexual partners in the past six months and those individuals must be tested for HIV. 

Although the Cuban model of dealing with HIV/AIDS might be considered an infringement of human rights by some, I believe it is the last option available, as it has long-term benefits especially in SADC – one of the world’s most affected by HIV/AIDS.

September 2013
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