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Last Updated: Friday, 15 August, 2003, 23:14 GMT 00:14 UK
Threat to Cuba's Aids success

By Stephen Gibbs
BBC correspondent in Havana

Cuba's economy has struggled since the Soviet collapse
A few kilometres outside Havana, set in lush tropical gardens, is the Los Cocos Sanatorium.

It looks a little like an up-market holiday camp.

The neat white houses within the grounds are freshly painted. The lawns have been carefully mown. The residents all seem happy.

As a visitor, you would never guess that this was the setting for one of the world's most controversial Aids prevention programmes.

In the mid-1980s, when little was known about the virus, Cuba compulsorily tested thousands of its citizens for HIV. Those who tested positive were taken to Los Cocos. They were not allowed to leave.

The policy, perhaps only possible in a highly controlled communist society, was condemned by human rights groups across the world.


"We disagreed profoundly at the time when Cuba was quarantining, or locking up people with HIV," says the executive director of UNAIDS, Dr Peter Piot.

"There are norms and values that you have to respect."

But the evidence is that the tactic worked.

Cuba now has one of the very lowest Aids infection rates in the world.

This is despite the fact that its neighbours in this region have been badly hit by the epidemic. Infection rates in the Caribbean as a whole are second only to sub-Saharan Africa.

Over the past 20 years, Cuba has built on its success in containing the disease.

It has also evolved its policy. Patients at Los Cocos are now able to leave if they choose.

Dollar lure

Those who develop Aids are well looked after. Cuban doctors may earn just $15 a month - but the treatment they offer is comparable with the world's richest countries.

Even the drugs are the same - copied by Cuban physicians from the patented versions.

Cubans were once able to depend on the state to provide for almost all their needs. Now, with those Soviet subsidies gone, they are increasingly having to fend for themselves.
But there is a new challenge to Cuba's battle to control Aids: tourism.

Fifteen years ago, only a few thousand tourists came to Cuba every year. This year the government is hoping that two million will visit.

Since the demise of its Soviet benefactor, Cuba has been forced to depend on tourism for its hard currency.

And not all the visitors come for the sun and the salsa. Walk along the beautiful white sand beaches just east of Havana and you'll soon notice plenty of middle-aged European men with young Cubans.

Despite repeated government crackdowns, prostitution is rife here.

The reason is simple. A woman can earn more in one hour with a tourist than she'll earn in a month on her state salary.


Most nights, Lydia strolls along the Malecon, Havana's seafront promenade, looking for customers.

Like many Cuban prostitutes she is aware of the dangers of Aids. But she is also complacent.

"Aids is very bad in other countries," she says. "But here?"

Lydia says she is a prostitute because she needs the money to buy things like food and medicine.

Cubans were once able to depend on the state to provide for almost all their needs. Now, with those Soviet subsidies gone, they are increasingly having to fend for themselves.

Much of Cuba's success in combating Aids can be attributed to that fact this is a society where public good has taken preference over private freedom.

But as Cubans again turn to the oldest private enterprise in the world, can that success last?

The BBC's Steve Gibbs
"A radical policy perhaps only possible in a communist society"

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