A member of the first U.S. delegation to visit Cuba's quarantine center for people infected with the AIDS-causing human immunodeficiency virus Thursday described the detention facility as "pleasant" but "frightening in its implications."
The first detailed picture of what the Cuban government calls its "sanitarium" for all identified HIV carriers was painted by Ronald Bayer, associate professor at Columbia University's School of Public Health, in an interview with The Times.
Cuba is the only nation in the world that has mandated universal HIV testing and enforced isolation of all virus carriers. Bayer said he was told by Cuban health officials that one-third of the nation's 10.2 million people have been tested so far and that 240 Cubans--171 men and 69 women--have been placed in the camp, where they are required to spend the rest of their lives. They are removed from their jobs but continue to be paid.
"We were shown groups of nondescript apartments that looked like typical Cuban suburban housing," Bayer said. "It was neither barracks-like nor dungeon-like, although I have to assume we were shown the best. It was impossible to tell whether the complex was surrounded by a wall or a fence.
"But even if it all looked as good as what we saw, it does not resolve the moral justification of incarceration based on supposed future behavior," said Bayer, a medical ethicist who has long specialized in AIDS, or acquired immune deficiency syndrome.
Bayer said the group was taken to three two-bedroom apartments, each of which housed two married couples.
"They were modestly furnished, and the common living room in each apartment had a large TV set. In one, there was a big picture of Che (Cuban revolutionary Ernesto Guevara)," he said.
"We were told we were the first Americans to visit the 'sanitarium.' The Cubans did not like to use the word 'quarantine.' "
Bayer, who spoke to several detainees, said that, so far, few of the camp's residents had developed clinical symptoms of AIDS. Those who do are usually transferred to hospitals, he was told.
"One couldn't expect candor. Our conversations took place in the presence of the head of the sanitarium and half of the staff. One person said he felt he was doing his part to defend the Cuban revolution," Bayer said.
"There was an enormous desire to convince us--and, through us, American opinion--that what they had done had a good public health pedigree. . . . These were physicians and health workers--not the police."
He said that some of the detainees were occasionally released on weekend passes, but that they always had to be accompanied by chaperones.
Bayer spoke one day after returning from a four-day trip to Cuba. He and six colleagues from Columbia University and the Columbia Presbyterian Medical Center were guests of Hector Terry, Cuba's deputy minister of public health.
Officials at the Cuban mission to the United Nations in New York and at the Cuban Interests Section in Washington could not be reached for comment Thursday. In the past, however, Terry and other Cuban officials have said the principal objective of the quarantine is to prevent the spread of the virus, to hold down costs and to "completely study and treat" each case.
Word of the Columbia delegation's unusual visit circulated quickly through New York's tightly knit community of AIDS experts. Most were stunned that the Cubans had allowed the Americans into the camp and were profoundly disturbed by Bayer's description.
"This type of irrational reaction to AIDS and HIV infection--which science tells us cannot be spread by casual contact--is what we have feared since the start of the epidemic," said Mathilde Krim, founding chair of the American Foundation for AIDS Research.
She noted that Cuba's mandatory testing policy runs against virtually unanimous opinion of U.S. public health officials. They emphasize voluntary testing in order to encourage those who have engaged in behavior associated with high risk of contracting HIV to step forward.
Cuba's approach to HIV infection "can only be termed totalitarian," added Dr. Stephen C. Joseph, New York City health commissioner. "They test people involuntarily. They lock up people who test positive. They take away their employment. And they do so knowing that these people will be locked up for life."
Bayer said his Cuban hosts are well aware "of how you contract HIV and how you don't," and that posters and brochures distributed by public health officials are "just like those in the U.S."
HIV is commonly transmitted through anal and vaginal sexual intercourse, through the sharing of unsterilized hypodermic needles and by mother to fetus during pregnancy.
"I pressed the health officials about the human burdens they were imposing," Bayer said. "They replied, with a little bit of pride in Cuban machismo , that Cuban men could not be expected to control their sexual behavior.
"They said again and again that Cuba had a unique epidemiological situation," Bayer said. "For them, the nightmares were Haiti and Puerto Rico and the U.S.," where the infection rates are much higher.
"I really pressed hard in my conversations with the minister, and I tried to be as polite as I could. Ultimately, I had to acknowledge the basic philosophical issue: How much deprivation of freedom are you willing to tolerate to eliminate the risk--not the certainty--that someone will endanger others?"
Bayer, Krim and Joseph cited the Cuban example in urging California voters to defeat Proposition 102, which if adopted would require doctors to report to state health authorities the names of patients who test positive for HIV infection and would mandate health officers to trace the sexual partners of those infected with the virus.
"Quarantine is the logical extension of the keeping of lists," Bayer contended.
"This kind of chilling scenario of what we hope we will never see here is why it is so important to defeat Proposition 102, which would nudge us in the same totalitarian direction," added Joseph, the New York health commissioner.
But Brett Barbre, a special assistant to California Rep. William E. Dannemeyer (R-Fullerton), the measure's co-sponsor, said, "To say that 102 would start the ball rolling toward quarantine is ludicrous."
Barbre noted that Section 11 of the ballot measure states that "nothing in this section shall be construed to require the use of quarantine or isolation."