Cuba's HIV/AIDS Program: Controversy, Care and Cultural Shift

In 1986, Cuba made public health history - and headlines, largely unfavorable[1-3] - when health authorities on the island implemented a quarantine policy for people evidencing symptoms of AIDS. The unprecedented 'sanatoria' policy sparked a turbulent international debate when it was initiated, but received scant attention when it was amended in 1993 and later repealed. Controversy aside, this and subsequent modifications to Cuba's national HIV/AIDS prevention and control program have helped keep prevalence on the island to 0.1%, the lowest rate in the Americas.[4] With just 31 cases of mother-to-child HIV transmission since 1986, and infection through blood and hemoderivatives virtually eliminated,[5] the Cuban response to HIV/AIDS may provide useful strategies to other countries, especially in the Global South. The need for practical, sustainable HIV programs in developing countries, where the disease burden is greatest, is urgent. Of the estimated 33.2 million people with HIV in 2007, 22.5 million were from sub-Saharan Africa, where the adult prevalence rate is 5.0%. Figures for other parts of the Global South are similarly sobering, including the Caribbean, where the 1.0% adult prevalence rate is the world's second highest.[6] Although indicators have stabilized and even improved in some countries (eg Barbados, Trinidad & Tobago, Cuba), AIDS-related mortality remains a leading cause of death among 25-44 year olds in the region.[7] More than any other indicator, AIDS mortality reflects the great divide between north and south: in 2007, 32,000 people from North America, and Western and Central Europe died of AIDS-related causes, compared to over 1.9 million in Latin America, South and Southeast Asia, and sub-Saharan Africa.[6].