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To combat AIDS

Cuba mobilized before first diagnosis

Lavender & red, part 98

Published May 21, 2007 9:06 PM

The Reagan administration tried to whip up world anger at Cuba’s handling of the AIDS epidemic. In reality, Cuba took an immediate, scientific and humane approach to people with AIDS.

In the U.S., AIDS was first diagnosed in 1981. By May 1983, simultaneous gay and lesbian protests of tens of thousands had to take to the streets in New York City, San Francisco, Los Angeles, Houston, Atlanta, Chicago and Milwaukee under banners reading “Fighting for our lives!” to demand federal funds to battle AIDS, and for research, services and Social Security benefits.

A day later, activists organized a telephone blitz of the White House to protest government inaction and to demand funds. It was to date the largest number of calls to the Oval Office in a single day in its history. The president had still not publicly said the word AIDS, while theo-cons demonized the emerging health crisis as a “gay plague.”

By contrast, Cuba’s health care workers began preparations to defend the whole population from the AIDS epidemic two years before the first case was diagnosed on the island in 1985. Cuba spared no expense despite the chokehold of the U.S.-led blockade.

Cuba—unlike the U.S.—mobilized against AIDS, not against people with AIDS. Researchers Lourdes Arguelles and B. Ruby Rich observed in the autumn of 1987 that, “Cuba is unusual in publicizing the disease, not as a gay disease, but rather as a sexually transmitted disease regardless of specific sexual practice.”

Planning to protect population

After members of the Cuban Health Ministry took part in a workshop organized by the Pan-American Health Organization in August 1983, they immediately set up a national commission to research and create a plan of action to prevent AIDS in

Cuba. (Karen Wald, Guardian, Oct. 28, 1987)

The National Commission to Face AIDS Syndrome formed in 1983. (Denver Post, Feb. 10, 2003)

The commission immediately blocked the import of all blood products from countries in which the epidemic was already documented.

The commission recommended discarding more than 20,000 vials of imported blood, worth millions of dollars.

Getting rid of all imported blood products greatly burdened the Cuban health system and forced the country to ratchet up local production. However, this urgent action resulted in avoiding HIV transmission to almost all hemophiliacs and others who needed blood transfusions. (Financial Times, Feb. 16, 2003)

A multi-disciplinary team of doctors and researchers was assigned to work full time on AIDS. Political journalist Wald wrote, “Their first move was to prepare a diagnostic screening program based on concrete symptoms that could be seen in hospitals, such as repeated cases of pneumonia or Kaposi’s sarcoma type of cancer, which indicated possible AIDS. Hospitals were asked to give weekly reports on findings of these symptoms.”

Doctors tested more than 135,000 Cubans for HIV in 1983.

Science, not stigma

In 1985, a Cuban who had returned from abroad was the first in the country to be diagnosed with AIDS. The Cuban was one of 300,000 heroes of the revolution who helped defend the people of Mozambique—an African country impoverished by colonialism and battling the forces of imperialism.

In the U.S., Africa and Haiti were being scapegoated as the source of the epidemic, without any scientific proof. In Cuba, however, where many are of African descent because of the history of slavery, health officials did not stigmatize the African continent.

In an interview in Cuba International, circa 1987, Dr. Rodolfo Rodríguez, then the national director of epidemiology for the Cuban Ministry of Health, said that while some of the mass media at that time might have been trying to blame the African continent for AIDS, “It is known worldwide that it is the developed Western countries—Europe and the U.S.—that have the largest number of AIDS cases and the largest number of asymptomatic carriers.”

In the U.S., homosexuality was still against the law and viciously repressed. The right wing labeled AIDS a “gay disease.” This only drove the epidemic deeper into the population. So too did the criminalization of drug addiction and prostitution, both highly profitable industries in the U.S.

There was no known intravenous drug addiction in Cuba, and same-sex love was not against the law.

Cuban health workers tested all pregnant women, people with sexually transmitted diseases, and anyone who might have had sexual contact with someone who was HIV positive. Testing equipment was installed in blood bank centers. (Denver Post)

By the end of 1985, Wald wrote, the Cuban government had purchased, despite great expense, all the technical means to screen the island’s entire blood supply. “Cuba spent more than $3 million to buy the reactive agents and equipment, and to set up labs in blood banks and hygiene and epidemiology centers around the country.”

That year, the Cuban public health system allocated $2 million for the National HIV/AIDS Prevention and Control Program, which focused on providing the first 750,000 diagnostic kits and centers. (MEDICC Review, Vol. II, No. 1, 2—2001)

Capitalism and contraception

The years of sex education that preceded the outbreak of the epidemic helped to create the basis for a more scientific and compassionate approach to people with AIDS.

However, when faced with a sexually transmissible epidemic like AIDS, Cuba had to overcome a particular capitalist legacy regarding safer-sex education and practices.

Dr. Celestino Álvarez Lajonchere, a gynecologist and ground-breaking sex educator in Cuba, reminded interviewers in 1988, “You know this country inherited a system in which the rural areas and small towns had little or no medical care before the revolution.”

He added that before the revolution, illegal abortions were common. They were most often performed by doctors, without anesthesia, in unsanitary conditions.

Álvarez Lajonchere explained: “At the triumph of the revolution, the majority of these abortion doctors left the country. There was no habit in the country of using contraceptives, and contraception did not even appear in the medical school curriculum. ... The private physicians at the time didn’t give contraceptive services to their patients because they could charge much more doing abortions.”

As a result, he said, “Since people didn’t have contraceptive habits, we encountered serious difficulties in the first years after the triumph of the revolution.”

While half of all Cuban doctors left the island and went to capitalist countries, 97 percent of the physicians in obstetrics and gynecology emigrated. As a result, Álvarez Lajonchere noted, overnight he became the oldest gynecologist/obstetrician in the country.

Álvarez Lajonchere said that, in addition, within months after the workers and peasants took state power, “[A]ll of the professors at the medical school quit voluntarily, thinking mistakenly that the government could not replace them. The government accepted their resignations. It was a policy in the country, and still is, that if you really don’t want to live in this country under socialism you should leave. You can’t create a socialist society with people who are disaffected.

“So the Ministry of Education and the Ministry of Public Health got together a course for new professors,” he continued, “people who could never have been professors before the revolution because of their low social class origins—they didn’t come from the upper middle classes.”

The medical school faculty was replaced with new professors. “We all left private practice and went to teach. It was an extraordinary advantage that we knew the conditions of medical practice in the country. I became chief of the department of obstetrics and gynecology at the one and only medical school. The first thing I did was to put contraception into the medical school curriculum. There were never any restrictions about who could have access to contraceptives in this country: not by age, not by race, not by anything.”

Álvarez Lajonchere added, “Medical services from the very beginning have been free.” And the new medical teachers received a higher salary than the president. (International Journal of Health Services, Vol. 18, Number 2, 1988)

“The habit of using contraceptives,” Álvarez Lajonchere explained, “is a habit that takes time to build. For a population that was accustomed to having abortions, it was easier for them to go to the hospital and have an abortion.”

After the revolution, underground abortions in unsanitary conditions increased until 1965. “When we started to do all of them in hospitals, obviously deaths as a result of abortion disappeared.”

He added that the number of abortions began to decrease in 1974 as a result of mass education about sex and contraception.

Álvarez Lajonchere concluded: “Our current policy on population is the same policy that we’ve had from the first day of the revolution. It’s a policy of principle. A woman has the right to have the number of children she wants, and to have them when she wants. The government is obligated to assure that her right becomes a reality. So we educate people about all of the contraceptive methods. We include abortion, even though we don’t view it as a contraceptive method, so that people will know about it. We have never said that having a small family is good; we have never pressured people to reduce the birth rate.”

Next: Cuba directed war against AIDS, not people with AIDS.

To read more about Cuba, read parts 86-97 of Lavender & Red at workers.org.

E-mail: lfeinberg@workers.org