Cuba leads the way in HIV fight

HIV medication has been made widely available

By Molly Bentley BBC News Online science writer in Denver

Few stories about HIV/Aids infection bring hope. But in the Caribbean, where communism takes its last gasp, there is encouragement in the fight against Aids.

"Cuba has a lid on the HIV/Aids problem," said Byron Barksdale, the director of the American Cuban Aids Project, a non-profit organisation that provides humanitarian aid to the island.

There has been no dramatic increase in HIV transmission in Cuba since the beginning of the epidemic, said Dr Barksdale at the at the annual meeting of the American Association for the Advancement of Science in Denver.

Cuba's 0.03% infection rate is one of the lowest in the world.

In addition, certain forms of HIV transmission that plague the rest of the globe are almost non-existent on the island.

There is virtually no transmission of the virus through intravenous drug use, blood transfusion or to newborns at birth.

Drugs available

The country now produces enough anti-retroviral medicines to supply the country's patients. As a result, the 25% predicted mortality rates for patients with Aids in 2002 were instead 7%.

While mother-child transmission is a huge problem in African countries, for example, in Cuba, the government ensures that all HIV-positive mothers are treated with prophylactic AZT therapy up to delivery and then the babies are delivered by caesarean section.

No infants contract the virus through the birth canal, according to Dr Barksdale, who added that Cuba's prevention measures are not likely to be implemented in other countries.

"It would be difficult to mandate Caesarean sections on all HIV-positive mothers in the United States," he said.

Cuba's low HIV infection rate is due largely to the country's extraordinary response in early years of the epidemic.

Stigma

Cuba established the National Commission on Aids in 1983 to provide education on the disease, a full two years before the first Cuban national contracted the virus, and at a time when the word "Aids" carried such stigma, US President Ronald Reagan refused to use it in public speeches.

But in Cuba, said Dr Barksdale, people had lived under socialism long enough to have "an idea of classlessness," which made educating the public and providing medical attention fairly straightforward.

Under Cuba's socialised health care system, all HIV/Aids patients receive medical care and drugs free of charge.

But some requirements of the programme pinch personal liberties.

In the late 1980s, Cuba implemented a classic public health measure and began quarantining patients.

The quarantine system includes eight weeks of education and drug support, after which the patient is free to leave - although, many choose to stay, according to Dr Barksdale.

Surveillance

In addition, a national surveillance system tracks all infected people and their partners.

As a result, the government has an extensive database on all HIV/Aids infections, including their source, whether from overseas or within the country.

While the authoritative response helped contain the spread of the virus, Cuba's political isolation initially prevented access to life-saving anti-retroviral drugs. Then Cuba got innovative.

Unable to afford the expensive anti-retroviral medicines produced in developed countries, Cuban chemists analysed the drugs' chemical components and set about recreating their own.

Cuba now produces sufficient quantities of seven anti-viral medications for all its patients.

Because it is self-sufficient in drug production, said Dr Barksdale, the country's next step is to export medication.

He predicts that Cuba will soon offer to sell the anti-retroviral drugs at cost to other countries.

"I suspect there will be countries in Latin America, the Caribbean basin, and in Africa that will purchase these drugs directly from Cuba," he said.

In this, Cuba has set an example of political leadership in its response to the Aids crisis, according to Monica Ruiz, from the US National Institute of Allergy and Infectious Diseases.

"It's an example of what a country can do on it's own shores," she said.

"While each country will provide a different response, this shows that political will has to be there."