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Cuba!

Cuba!. Terry C Wuerz. The Cuban AIDS Response. Terry C Wuerz. HIV/AIDS Early History. 1981: Health community is baffled by a ‘new’ disease causing opportunistic infections and Karposi’s sarcoma emerging in the USA 1982: Disease is termed Acquired Immunodeficiency Syndrome

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Cuba!

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  1. Cuba! Terry C Wuerz

  2. The Cuban AIDS Response Terry C Wuerz

  3. HIV/AIDS Early History • 1981: Health community is baffled by a ‘new’ disease causing opportunistic infections and Karposi’s 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

  4. Disease of the Century

  5. 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

  6. 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 Cuba’s 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

  7. 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

  8. Cuban sanitoriums: thinly veiled prisons, or humane isolation?

  9. 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

  10. Was Cuba’s 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 Cuba’s 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

  11. Confounding Factors • Geographical, social, and political isolation • Guaranteed minimum levels of income, education, and housing

  12. 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).

  13. Individual Rights vs. Rights of the Community Individuality Communalism ------------------------------------------------------ • Consent for testing • Voluntary contact tracing • HIV testing required • Mandatory contact tracing and quarantining

  14. Lessons From Cuba • Focus on disease education • Mandatory HIV testing • Extensive contact tracing programs • Quarantine?

  15. 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

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