HIV/AIDS in Cuba: lessons and challenges.

Tim Anderson1 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.