On May 7, 2012, the New York Times, a major global newspaper, published two
articles by Donald c McNeil, Jr. on the issue of the AIDS epidemic in Cuba and
its management by the Cuban regime. At the Finlay Medical Society we
organized the Finlay AIDS Working group in 1985. Since then, we have been
monitoring the Cuban HIV and AIDS epidemic despite semiofficial and official
attempts to discourage our work. In the interest of informing all interested
parties, including the NYT, I have collected the following comments for our
current Proyecto SIDA.
Antonio M. Gordon, MD, PhD
May 8, 2012
NYT: Yudelsy García O’Connor, the first baby known to have been born with H.I.V. in Cuba,
is not merely still alive. She is vibrant, funny and, at age 25, recently divorced but hoping to
remarry and have children… And since 1986, only 38 babies have been born with the virus.
In Cuba’s cradle-to-grave health care system, pregnant women get up to 12 free prenatal
checkups, during which they are tested for H.I.V. at least twice.
Proyecto SIDA: Cuban health officials used abortion discriminately during the early
years of the HIV epidemic in the island to prevent the birth of anyone with HIV infection.
It was known that the virus was transmitted form infected mother to child. Cuba reported
the first children with a syndrome identical to AIDS long before the syndrome was defined
by the USPHS in the summer of 1981. It was back in 1977 when 8 children when Cuba first
documented its AIDS epidemic. It was presented in a paper in the Cuban journal Revista
de Medicina Tropical, where 8 cases of children with pneumocystis pneumonia were
reviewed in detail. No known illness or immunosuppressive drugs could explain the
syndrome that led these children to develop the type of pneumonia that soon thereafter
became the hallmark of HIV advanced disease, AIDS.
NYT: Whatever debate may linger about the government’s harsh early tactics — until 1993,
everyone who tested positive for H.I.V. was forced into quarantine — there is no question
that they succeeded.
Proyecto SIDA: If the Cuban HIV and AIDS epidemic would not have begun years before
the quarantine was organized and enacted, then the method of control proposed by the
Cuban military may seem to have a chance to succeed in controlling the spread of the
epidemic. However, the “sanatorial treatment” of HIV infected patients was only begun in
1986. By that time, Cuba had already reported 8 original cases of pneumocystis
pneumonia in 1977. Furthermore, in 1980, the HIV prevalence in Cuba was estimated at
0.4% of the general population. The latter study was carried out in 1985-86 with blood
samples collected from families who entered the US in 1980. It may be conclusively
deducted that HIV was already circulating in the island of Cuba long before any
quarantine was organized and enacted.
Secondly, the tests to determine the presence of HIV in the Cuban population were not
100% sensitive or 100% specific. Therefore, despite the massive testing of the population
beginning in 1985, many individuals with the illness were not diagnosed (sensitivity of
tests used was of the order of less than 90%). Also, individuals with no HIV disease
(specificity in the low 90% range) were misdiagnosed as having the disease and therefore
quarantined with others who were infected. Obviously, the sanitaria became nests for the
spread of the disease.
NYT: Cuba now has one of the world’s smallest epidemics, a mere 14,038 cases. Its
infection rate is 0.1 percent, on par with Finland, Singapore and Kazakhstan. That is one-
sixth the rate of the United States, one-twentieth of nearby Haiti. The population of Cuba is
only slightly larger than that of New York City. In the three decades of the global AIDS
epidemic, 78,763 New Yorkers have died of AIDS. Only 2,364 Cubans have.
Proyecto SIDA: While HIV and AIDS have not been controlled in Cuba, as noted in the
argument developed above, the information on HIV and AIDS and the movement of
persons with any suspicion of HIV or AIDS has been greatly successful. The only persons
known to have escaped the island with HIV since 1987 were 5 individuals who attempted
to escape by raft in 1994-95. They were all rescued at sea with 30,000 other Cubans and
taken to the Guantanamo Naval Base camps. Soon after the HIV patients arrived there,
they were deported back to Cuba.
Cuba’s epidemiologic data on HIV and AIDS is considered a state secret. There has never
been an independent investigation of the incidence and prevalence of HIV or AIDS in the
island of Cuba. The only known attempt to study the epidemic from outside Cuba, was
quickly made to dismantle as some specialists were invited to the island to listen and
discuss the HIV epidemic but not to actually study it by collecting samples and raw data
on Cubans. Therefore, Cuba’s claim to have presently an HIV rate in the population at
0.1% is not confirmed. Estimates based on the 1980 data and other unpublished studies
performed later suggest that the actual rate in Cuba was of the order of 5% in 2000.
In terms of NYC, our estimates through studies published in the medical literature suggest
that back in 1980 Cuba had 4 times greater prevalence of HIV in the general population
than the estimated level of infection for NYC that year.
NYT: Other elements have contributed to Cuba’s success: It has free universal basic health
care; it has stunningly high rates of H.I.V. testing; it saturates its population with free
condoms, concentrating on high-risk groups like prostitutes; it gives its teenagers graphic
safe-sex education; it rigorously traces the sexual contacts of each person who tests positive.
Proyecto SIDA: Indeed, Cuba organized a health system that covered the entire island and
its society since the early 1960s. The model was partly due to WHO and partly the Semashko
type of health system of the former Soviet Union. Until 1989, during the years when Soviet
subsidies supported Cuba, the health system was indeed open and accessible. However, soon
after 1989 the Cuba health system began to decline to the point where at present most facilities
are physically deplorable and an appreciable number of physicians are serving other countries,
in particular Venezuela. See for example “Health and Health Care in Cuba: The Transition from
Socialism to the Future at
A survey on knowledge and attitudes towards HIV and AIDS carried out in Key West with
Cuban rafters in 1993 revealed that more than half of those interviewed did not think that
HIV or AIDS was a dangerous illness that required the use of any protection or abstinence
from multiple sexual relations.
NYT: Cuba has succeeded even though it has the most genetically diverse epidemic outside
Africa. Almost all American cases are of one strain, subtype B. Cuba has 21 different
strains.The genetic diversity is a legacy of its foreign aid. Since the 1960s, Cuba has sent
abroad thousands of “internationalists” — soldiers, doctors, teachers and engineers.
Stationed all over Africa, they brought back a wide array of strains. According to a study in
2002, 11 of Cuba’s 21 strains are unknown elsewhere, formed when two others mixed.
Proyecto SIDA: It is actually erroneous from an epidemiology standoint to suggest that
Cuba has many more types of HIV virus circulating, that there is evidence of ample mixing
of the viruses to the point where hybrids of many sorts have appeared in Cuba that do not
exist anywhere else, and then propose that “Cuba has succeeded” in controlling the
epidemic. Cuba has indeed succeeded in controlling the information on its epidemic and
the movement of those infected with HIV or thought to be infected with this chronic virus.
But it makes no scientific sense whatsoever to suggest that a virus transmitted through
sexual contact, unable to be objectively diagnosed by tests on blood or body secretions
until 15 years or later after its introduction into the country, has been controlled despite
the fact that the epidemic continues to increase in the island without reaching a plateau.
NYT: And Cuba’s success has come despite its being a sex tourism destination for
Europeans and Canadians
Proyecto SIDA; Cuba’s authorities do check periodically all persons involved in sexual
activities with foreigners. Since Cuba is a closed society all media is controlled by the
single party in power and the press is widely known to be not free (See Human Rights
Watch journalism report May 2012), it is easy to understand how Cuban prostitutes and
“jineteros” and “jineteras” are said to be “the cleanest the the world” by Fidel Castro
himself when he was able to speak.
Another angle to this issue, however, is that nobody knows exactly what happens to a man
or a woman involved in sex with foreigner when they are found or thought to be found
positive with HIV. Are they simply placed in sanatoria? Are they sent to a prison far form
their home? Are they sent to a University again? Are they sacrificed through one kind or
another of murder? No one actually knows.
NYT: The few Cuban women who are infected usually get the virus from partners who are
secretly bisexual, experts said.
Proyecto SIDA: The Cuban epidemic has been, since it began, back in the 1970’s a
heterosexual epidemic. The epidemiologic data have been manipulated in order to explain
the official story about its epidemiology. However, it makes no sense whatsoever to state
and appreciate that the HIV virus arrived in Cuba through the internationalistic workers,
men and woman, and then state that the epidemic spread through homosexuals. The
epidemic did spread originally in the male homosexual community in other countries, but
not in Cuba.
NYT: As broken as it is economically, Cuba still points proudly to one legacy of its 1959
revolution: Basic health care is universal and free. Cuba has 535,000 health care workers
(“We’re all either doctors or baseball players,” one hospital microbiologist joked) and each
citizen is officially registered with a family doctor nearby; if a patient skips a checkup, the
doctor is expected to find out why.
Proyecto SIDA: Cuban health care is presently, universally lacking. The physical plant
of hospitals and polyclinics are in shambles. More than 30,000 physicians are serving the
“Barrio Adentro” program in Venezuela. Therefore, health services are often obtained
through under the table payments for services and or favors of one kind or another. This is
simply corruption or another form of prostitution. The role of the CDRs and mass
organizations in carrying out the health policies of the Cuba regime are well documented.
This is done both willingly and unwillingly. However, he role of the average Cuba
physician in the management of a patient with HIV or AIDs is negligible. In Cuba,
physicians who do have an expertise with HIV infection are individuals who work through
the Ministry of the Interior (secret Service) and higher governmental institutes.
NYT: He (Dr. Perez Avila) treated Ms. García’s parents on their deathbeds and heard her
father beg, “Do whatever it takes to help my daughter live.” (Her father, who had been a
soldier in Angola, was a truck driver. He had nine girlfriends in different towns, five of
whom he infected.)…In 1983, Fidel Castro visited the Pedro Kourí Institute, Cuba’s top
tropical disease hospital, to hear a presentation on malaria and dengue fever. …As it ended,
he suddenly asked the director, “Gustavo, what are you doing to keep AIDS from entering
Cuba?”… The medical establishment reacted quickly. The first step was to throw out all
imported blood — 20,000 units. That avoided the devastation that the hemophiliac
populations in the United States and France suffered…Doctors were sent to Brazil and
France to study cases… All of the country’s family doctors were ordered to watch for
infections that indicate AIDS like Kaposi’s sarcoma or Pneumocystis carinii pneumonia.
Proyecto SIDA: The book written by Dr. Perez Avila is not readily available in Cuba or
outside the country. It is not available through Amazon.com for example. The behavior of
the soldier described in Angola is typical. Therefore, the HIV epidemic must be more
serious than the Cuban authorities report. Cuba did know early about this illness and the
epidemic. That is why Fidel Castro and the Cuban military ordered the dumping of the
bloods stored. They were aware in the early 1980s before a specific blood test was
available, just on epidemiologic data, that the illness was transmitted by blood.
NYT: Because there was no H.I.V. test yet, the first cases were found late in the disease,
leading doctors to think most patients died within a year — an erroneous assumption that
helped justify the quarantine policy….In 1986, blocked by the embargo from buying
American test kits, Cuba bought 750,000 French ones…According to Dr. María Isela
Lantero, AIDS chief at the Health Ministry’s, Cuba’s 11 million citizens have been tested 43
million times; last year, more than two million tests were done. That is the equivalent of
testing the sexually active population every three years, though in reality the focus is on
high-risk groups, who are tested more often…Cubans returning from abroad are routinely
tested, as are pregnant women, prisoners, soldiers, hospital patients, health workers and
anyone treated for venereal disease. So is anyone whose family doctor suspects he or she is
gay, a sex worker or otherwise at risk.
Proyecto SIDA: The kits originally used in Cuba in the mid 1980s for massive population
testing were termed the MICROELISA. It was a test of domestic production. Blood were
obtained and sent to a laboratory thought to be near Havana. Some experts, however, have
suggested that the blood samples were sent to a laboratory in Mexico. The test results were first
reviewed by the State Security officers. Then, the patient and the physician were notified of the
results. Obviously, in a closed society, this management of a new illness lends itself to hiding the
illness form some who do have it and puishing others who may be used as “social examples” of
the official agenda. The Cuban test, the MIrcoelisa, was noted to be the worset of all tests used
in the Soviet block. See for example: Can Human Health and Public Health Be at Odds?
NYT: Haydee Martínez Obregón, 33, who has lived in the AIDS sanitarium in Sancti
Spíritus, in central Cuba, since she was 19, is an example of that. (She lives there by choice,
she said, because she has no home outside.)…With mandatory quarantine long gone and the
virus now mostly in gay and bisexual men, new infections are slowly but steadily rising.
They now approach 1,000 a year, “and we’re waiting for the plateau,” said Dr. José Joanes
Fiol, the Health Ministry’s chief epidemiologist.
Proyecto SIDA: When Jonathan Mann visited the Cuban AIDs sanatoria, he asked:
“How long are these people going to be quarantined?” Indeed, many injustices have been
committed in Cuba in the HIV and AIDs epidemics. In fact, injustices have been committed
in all countries because it was a new illness, an illness without much in the way of
symptoms at the onset, and thought to be exclusively a disease of male homosexuals by
some. However, most societies have been able to express their feelings on these issues and
begin to resolve their feelings. Cuba is still under the official and totalitarian story that is
depicted in most of the report reviewed here appearing in the New York Times (NYT). See
for example: La Odisea del SIDA en Cuba
Justicia Revoclucionaria en Los Cocos