Cuba’s Quarantine of Victims Typifies Aggressive Campaign on AIDS : Health: Blood tests are mandated for all hospital patients, pregnant women, medical workers, foreign residents, Cubans who have spent time abroad.
On a sprawling estate outside Havana, some 300 people live in airy, comfortable homes shaded by tropical fruit trees. All are infected by the AIDS virus and none can leave without permission. The quarantine represents one of the world’s most aggressive campaigns against AIDS--and, outside of Cuba, one of the most controversial.
While AIDS cases in neighboring Latin countries are doubling each year, health officials here say Cuba’s tough approach has limited growth from 200 cases in 1986 to 676 cases today, with 54 deaths.
“We have in some way controlled the crisis,” notes Dr. Jorge Perez, director of the sanitarium. Critics abroad condemn the system for violating the freedom of the afflicted.
In addition to the quarantine, the government mandates blood tests for all hospital patients, pregnant women, health care workers, foreign residents and Cubans who have spent time abroad. Because the U.S. trade embargo includes medical supplies, Cuba produces its own Interferon and testing kits. AZT, purchased from third countries at high prices, is free to patients who want it.
The sanitarium spreads over 54 acres at the edge of this town known for its shrine to St. Lazarus, where tens of thousands of Cubans come yearly to pray for cures. It feels at first like a rural resort: Patients live in their own houses with TVs and kitchen appliances and the tools of their trades. Some work alongside employees from the outside who do not have AIDS. Among Perez’s staff are five doctors, eight nurses and four medical students who are also residents because they are HIV-positive. “This makes the level of trust very deep with other patients,” says Perez.
But there is anxiety and regret too at being separated from loved ones, the kind of human cost that makes critics question whether Cuba’s more drastic measures are warranted.
“I cried a lot at first and lost weight because I had never been separated from my mother and father,” said 22-year-old Odalin Reyes, a nursery school teacher who has lived at the sanitarium for 10 months with her 2-year-old daughter. On arrival, she divorced her husband who had infected her. “I know not everybody can be trusted not to give the disease to someone else, but for me it’s not necessary to be here.”
Patients such as Reyes, who are deemed “responsible” by medical staff and a board of fellow residents, are now given weekend passes--a change from the near-total isolation mandated when the sanitarium opened in 1986. Rosa Gonzalez, 28, who has lived here since then, watching her husband die, then marrying another patient, wants more.
“The atmosphere is better than before,” said Gonzalez, while a nurse, who is also a patient, treated her ingrown toenail. “But I feel good and I think I’ll live long, so meanwhile why stay here?”
That is a question some Cuban doctors themselves are beginning to ask. When Perez, who earned his medical degree in Canada, became director in 1989, he tore down a thick wall that hid the sanitarium and began sending the patients back into the world. “The person with AIDS belongs to society if you know he is not promiscuous,” he says.
Juan Carlos de la Concepcion, 29, a medical doctor who is HIV-positive, remembers feeling “like a prisoner” in his first days at the sanitarium, but now defends it.
“In those days we still thought mosquitoes might carry the disease,” he said.
Like other patients, De la Concepcion continues to receive the salary he earned on the outside. The house he shares with his longtime partner, an economist who serves as the sanitarium’s chief accountant, is decorated with modern Cuban art and lined with bookshelves. The food in his kitchen is more plentiful than other Cubans are getting--some in Havana can’t remember when they last ate meat. The yearly cost per patient in the sanitarium is about $15,000 in a country where the average wage is about $250 a month.
Despite mounting public criticism of Cuba’s severe food shortages, ordinary Cubans voice little resentment over the privileged treatment AIDS patients receive. “I know it’s a mortal disease wherever it is,” mused Antonio Yanez, a 60-year-old cigar maker whose nephew recently died of AIDS in San Francisco. “But with the sanitarium, I think if he were in Cuba he might still be alive.”
Authorities established the facility in 1986 to isolate dozens of men who became infected while working for the military in Africa. Some of their monogamous wives who stayed home--like Rosa Gonzalez--tested positive too and joined their husbands. The disease spread next among Cubans who had traveled in the West or whose sex partners had. Health ministry records show no cases of AIDS contracted from intravenous drug use.
For all its zeal in treating the infected, Cuba lags in educating the public about prevention, health counselors admit. Condoms are widely available but disdained in Cuba’s machismo culture. In a tricky bet, the medical Establishment is putting less emphasis on condoms than on personal “responsibility.”