HIV/AIDS treatment in Cuba: a rights-based analysis; Lessons and challenges

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One of Cuba's many neighbourhood health clinics, centrepieces of Cuba's health system.

By Tim Anderson

Cuba has achieved the lowest rate of HIV infection and the highest level of AIDS treatment in the Caribbean region. Yet the Cuban HIV program — part of its famous health system — has been subjected to many criticisms, usually linked to the themes of “freedom” and “rights.” These criticisms must be seen in the broader context of demands for economic “freedoms” in Cuba and in the context of US demands for the dismantling of Cuban socialism and for widespread privatisation, including privatisation of the public health system. Outside understandings of the Cuban health system are further undermined by the US economic blockade of Cuba, roundly condemned each year by the United Nations General Assembly, which prevents normal scientific and cultural exchange between the US and Cuba.

In view of the global search for lessons on best practices for containing the HIV/AIDS pandemic, particular criticisms of the Cuban HIV program deserve closer attention. A rights-based analysis could be one useful way of examining the Cuban experience. Such an approach might address some of the criticisms directed at Cuba, whether through a selective focus on particular rights issues or through general, utilitarian notions that Cuba has forced “trade offs” between personal liberties and the protection of public health.

This paper introduces the Cuban experience with HIV/AIDS by reference to historical developments and recent Cuban perspectives. It draws on data from interviews with a number of Cuban peer educators and HIV professionals in 2005–2006. Following discussion of these interviews, the paper then uses the United Nations International Guidelines on HIV/AIDS and Human Rights to apply a rights-based analysis to several themes in the way Cuba approaches HIV/ AIDS treatment: quarantine and personal freedom; privacy in testing and tracing; education, participation, and non-discrimination; and the availability of AIDS treatment. It concludes with a rights-based assessment of the Cuban program.

Continue reading or download this paper:

``HIV/AIDS in Cuba: a rights-based analysis'', Health and Human Rights, Vol. 11, No.1, 2009, or at Tim Anderson's site HERE.

HIV/AIDS in Cuba: lessons and challenges

By Tim Anderson

Cuba, a relatively poor, socialist, developing country has the lowest rate of HIV infection in the Caribbean subregion and a rate among the lowest in the world. Yet when we look at the published explanations for this, outside Cuba, we face a wall of controversy and disdain. A fair amount of the criticism seems due to ideological wars and the economic blockade by the United States of America (US) imposed on Cuba. The latter certainly undermines communication, scientific exchange and understanding.

Cuba’s achievements in public health and its relative success in containing the HIV/AIDS pandemic deserve restating, but they are relatively uncontroversial. This paper suggests that it is Cuban methods and the understandings of those methods that deserve greater attention. Particular ideas persist, outside Cuba, about the Cuban HIV program: that its success has been due to policies of isolation, coercive testing and an anti-homosexual approach. Very little of this forms part of the perspective of contemporary Cuban health professionals, who typically say that their program has both drawn from and contributed to global themes of health promotion, participatory education, sexual inclusiveness, contact tracing, and targeted and voluntary testing. There is also a broader Cuban theme called “intersectoral cooperation” that stresses a coordinated social response to health challenges.

This paper takes a historical perspective on Cuba’s achievements in HIV/AIDS control, seeking to identify key elements of its relative success. The analysis covers international literature, Cuban medical reports, epidemiological data, and current health promotion materials and manuals, as well as interviews with Cuban health professionals and HIV-positive patients.

Continue reading or download this paper:

``HIV/AIDS in Cuba: lessons and challenges'', Pan American Journal of Public Health/Rev Panam Salud Publica, 2009; 26(1): 78–86, 2009); or at Tim Anderson's site HERE.

[Tim Anderson is a senior lecturer in political economy at Sydney University. He recently made Doctors of Tomorrow, a film about Cuba's assistance to train doctors in Timor Leste.]