AIDS, public health, and human rights in Cuba.

Only Cuba has met the problem of AIDS with a traditional public health approach, which includes routine testing, contact tracing, partner notification, close medical surveillance, and partial isolation of infected individuals. The social behavior of Cubans (an absence of iv drug use, hostility toward homosexuals, and sexual puritanism) as well as access to abortion have contributed to the low incidence of the disease. Puerto Rico, with one-third the population of Cuba, has more than 8000 cases of AIDS, whereas Cuba has 927 cases of HIV seropositivity (as of May 31, 1993) and 187 cases of AIDS. Cuba acted promptly and decisively to control the epidemic, banning the importation of blood products in 1983 and administering the first of 12 million HIV tests in 1985. Whereas health screening is a familiar activity for Cubans, the isolation of HIV seropositive individuals in the Santiago fe las Vegas sanatorium was new. What began as a military-style hospital for HIV-infected soldiers returning from Africa was quickly transformed into a community which grants "leaves" to trustworthy residents who have completed a 6-month probationary period. Residents receive their old salaries whether or not they are working and are offered a choice of treatment regimens. As of July 1993, trustworthy residents can return home to live. If Cuba could have contained AIDS through a public educational campaign (and it has the infrastructure to have done so), then the human rights of the confined individuals were violated beyond restitution. International criticism of Cuba centers on this and largely ignores the equally troubling fact that abortions are universally recommended in HIV-positive women. In the parts of the world where AIDS has been regarded as primarily a human rights challenge instead of a public health crisis and preventive actions were dictated by a fear of further stigmatizing certain groups, personal freedoms have been protected, but many lives have been lost.