When it comes to trying to control the AIDS epidemic, America might find a few useful pointers from -- of all places -- Cuba.
The nation has combined political will, a well-coordinated healthcare system and an intensive, mandatory education program to achieve a rate of infection from the human immunodeficiency virus that is one of the world's lowest.
Cuba's HIV-infection rate is 0.03 percent of the population -- about 3,500 people. In the United States, the rate is 10 times higher. About 0.3 percent or about 1 million Americans are infected with HIV, the virus that causes AIDS. On other Caribbean islands, such as Haiti, infection rates are hundreds of times higher than on Cuba.
"The U.S. can learn a lot of things from Cuba about HIV/AIDS," said Dr. Byron Barksdale, a pathologist in North Platte, Neb., and director of the Cuba AIDS Project. It is a non-governmental organization that helps to provide drugs, diagnostic equipment and other humanitarian aid to the island, as well as licensed travel. The U.S. government permits the efforts despite its decades-long prohibitions against contact or trade with Cuba.
Speaking Sunday in Denver at the annual meeting of the American Association for the Advancement of Science, Barksdale said the key element that could be exported from Cuba to the United States is the concept of educating people intensively if they are newly diagnosed with HIV infection.
In Cuba, such individuals must spend six to eight weeks at a sanitarium where their infection is treated with anti-retroviral drugs manufactured in Cuba. There, he explained, patients are instructed about AIDS: what the disease is, how it affects the person who has been infected and how a person can prevent transmitting the disease to others, using safe sex practices that include proper use of condoms as well as abstinence.
"I don't know if six weeks or eight weeks are the magic numbers," Barksdale told United Press International, "but that is certainly a longer time than is given to people in the United States who received such a diagnosis. They may get about five minutes' worth of education."
Barksdale said the Cuban government has mandated the following:
-- Pregnant women must undergo an HIV test. If they are found to be HIV-positive, they are given anti-retroviral drugs to prevent transmission to their newborn. They also deliver via Caesarean section -- a known method of reducing possible HIV transmission. Since 1985, only 12 HIV-positive babies have been born in Cuba.
-- HIV-infected people must provide the names of all sexual partners in the past six months, and those individuals must be tested for HIV.
-- People found to have sexually transmitted diseases must undergo an HIV test as well.
-- Voluntary HIV screening is encouraged.
"In the United States, the rights of the individual are foremost," Barksdale said, "but in Cuba the individual is expected to do what is necessary to protect the collective society." That is why people are willing to roll up their sleeves and not protest blood tests to determine their HIV status, he said.
From 1985 to 1994, the Cuban government quarantined all people found to be HIV-infected. Under the direction of Dr. Jorge Perez, a Cuban infectious disease expert, those infected were allowed to leave the sanitarium after completing the required education courses, Barksdale explained, adding that because food, housing, medication, social services, privacy and other services are provided in the sanitarium, about half the people decide to stay.
Dr. Monica Ruiz, a health scientist administrator at the National Institute of Allergy and Infectious Diseases in Bethesda, Md., said AIDS prevention projects seem to work in places such as Cuba and Uganda, where education and de-stigmatization of AIDS-infected people become goals of the government.
For example, she noted in Uganda, government officials always discuss AIDS in their speeches. Although AIDS continues to sweep across most of sub-Saharan Africa, Uganda's infection rates have plummeted in the past few years after the country's active prevention campaign.
"There are no vaccines that will be made available to treat or prevent HIV/AIDS any time soon," Ruiz said. "Prevention is the thing we have left, and that is driven by behavior."
In Cuba, Barksdale said, if patients who decide to leave the sanitarium engage in unsafe sex, they are likely to find themselves in permanent quarantine. He said the goal of his project is to help Cuban authorities keep HIV infection at bay. An ironic challenge might arise because thousands of American tourists might head for Cuba if the U.S. government lifts its trade embargo against the island nation.
"There are 21 different strains of HIV in Cuban patients," he said, "and all are of African origin." He suggested that if American tourists become infected with those strains -- which are uncommon in the United States -- it could cause a new explosion of infection and disease in North America. "We want to help Cuba keep a lid on this problem." he said.
"We can use prevention tactics to control HIV infection," said David Holtgrave, professor of behavioral science and health education at Emory University in Atlanta.
"It is a matter of will. We know what kind of interventions that work. We know what needs to be done. We know what it will cost."
