CTNow.com. By Vanessa
Bauza And Tim Collie. South Florida Sun-Sentinel. June 19, 2001
HAVANA - From a comfortable two-bedroom house that he shares with his
partner and another couple, Raudel Hernandez Diaz lives a life far removed in
style from that of most Cuban men. Especially gay Cuban men.
Just a few steps from his door is a small clinic, part of the Santiago de
las Vegas sanitarium, where Hernandez, 36, works. The clean, well-stocked clinic
also provides the free medical care that helps keep him and other HIV-positive
patients alive.
The government-provided homes are well-furnished. Each has a television and
a kitchen in which patients can prepare meals from generous allotments of milk,
meat, vegetables and cooking oil that far surpass the diets of average Cubans.
In return for all this, Hernandez gives up his freedom. He's allowed to
leave the sanitorium on weekends, but others deemed less trustworthy must remain
there for months.
"It's not so much that I like to live here," says Hernandez, who
returned to the sanitorium last year after he broke up with his boyfriend and
had no other place to live. "On some days I feel stressed and I need to
leave. But because of my housing situation, I had no other option. I would work
here even if I didn't get paid. It eases my stress and makes me feel useful.
"There comes a moment when this is your family," he adds. "There
is no difference between the patients and the [sanitorium] workers. It becomes a
collective."
Cuba has the distinction of having one of the smallest HIV infection rates
in the world, in a region with one of the highest. It also is the most populous
country in the region and has some of the most liberal attitudes toward sex,
according to surveys.
Given its size, if Cuba had the same infection rate as some neighboring
countries, the epidemic in the region would be even more dire, experts say.
Elsewhere in the Caribbean, the effort to curtail the epidemic has been hampered
by poverty, inadequate health systems and unstable governments.
In other major countries of the Caribbean - Haiti, the Dominican Republic,
the Bahamas, Barbados and Guyana - the AIDS virus has crossed from traditional
risk groups such as prostitutes and intravenous drug users into the general
population. It is spreading primarily through heterosexual contact, meaning
everyone is at risk.
In the English-speaking Caribbean, AIDS is now the largest cause of death
among young men ages 15 to 44. In some parts of the Spanish-speaking Dominican
Republic, it has become the leading cause of death among women in the same age
group. In Haiti and Guyana, as many as 7 percent and 8 percent of expectant
mothers are HIV-positive, an alarming spread that suggests a rapidly growing
epidemic.
But in Cuba, the infection rate has remained well below 1 percent. Last
year, 0.09 percent of blood donors, and 0.004 of pregnant women surveyed, tested
positive for the AIDS virus. This has been accomplished even as sex surveys
indicate that Cubans use condoms less and have sex with casual partners at rates
that would be considered high-risk.
In many parts of the Caribbean, those with AIDS are denied medical treatment
by doctors and nurses who fear the disease. Men, no matter what their sexual
orientation, are labeled gay. Women, who have little economic or legal
protection, are denounced as prostitutes.
That can happen in Cuba, too. But in the years since the Cuban government
first tried to curtail the epidemic by quarantining those who carry the AIDS
virus, its attitude has evolved into something resembling tolerance. Many gay
Cubans find acceptance at the sanitoriums that is lacking in the rest of
society, where homophobia prevails.
Early on, the government of Fidel Castro took steps to contain the
contagion, creating a nationwide system of sanitoriums for those diagnosed with
the virus.
It wasn't that difficult. Because of its isolation during the Cold War, Cuba
was cut off from the sexual tourism that probably took the AIDS virus to Haiti
and other countries two decades ago.
The spread to Cuba was linked to the country's military involvement in
Africa. The oldest of Cuba's 14 AIDS sanitoriums, Santiago de las Vegas was
originally conceived as a retreat for Cuban army officers recovering from
psychological breakdowns. It switched to treating HIV patients exclusively after
the first cases were diagnosed in soldiers returning from the Congo in 1986.
"We didn't know how the disease would spread through the population,"
says Alberto Rosabal, sub-director for social assistance at the sanitorium. He
still bristles at foreign media coverage that criticized Cuba for its quarantine
policy. "Our initial thought was to give [patients] complete attention and
keep them in a type of quarantine to observe them," Rosabal explains. "We
would demand and pressure people to come. ... Most people accepted coming
because they were afraid for their lives."
Controversial as the sanitoriums were, involving serious violations of civil
liberties, the measures worked. Cuba has screened all blood donors for HIV since
1986, well ahead of other Caribbean countries. In 1987, it began screening all
pregnant women, people diagnosed with sexually transmitted diseases and just
about anyone else who showed up at a government health center.
"The Cuban point of view is that you have the right to be sick, but not
to transmit it to anyone else," says Dr. Jorge Perez, who diagnosed Cuba's
first AIDS patient and helped shape the policies of the Santiago sanitorium as
its director for 11 years.
But faced with international criticism over the forced quarantines, the
government realized it had to alter its approach.
In January 1998, officials created a "day hospital" program in
which patients were bused in for classes on HIV and AIDS, then returned to their
homes at night. Many now have an option to go to the Santiago sanitorium as
outpatients for checkups and medications. Still, the decision rests with
physicians, not patients. "We learned that not everyone is the same,"
Perez says. "We started to differentiate between people who are responsible
with their health and those who are not."
The Santiago sanitorium has capacity for 300 patients, and a wing under
construction will be able to house another 80. New partnerships and romances
regularly bloom among gay couples, who live together openly.
"Some people trust the health care here. Others say the quality of life
is better here than in their homes. From my point of view there is another
factor ... gay people, who are a majority here, feel more uninhibited,"
Rosabal says.
They also feel less hungry. For many with AIDS in other Caribbean countries,
getting adequate food is a problem, but in Cuba, infected patients are getting a
better diet than much of the general population.
Compared with most Cubans, who scrape and save to buy meat, vegetables,
cooking oil and other staples often missing from bodega shelves, sanitorium
patients are given rich meals that include beef, ice cream and milk.
Patients get three meals and three snacks a day - a feast in a country where
the economic crisis has severely eroded diets since the end of the Cold War.
Many Cubans routinely skip breakfast or drink sugar water because they lack
food.
"What a patient eats here in one week would last me and my family a
month," jokes Rosabal.
Some patients also receive expensive anti-retroviral drugs, medicine that is
out of reach to many in developing countries. Cuba began producing some of the
components of the medical "cocktail" this year. It imports other drugs
and receives donations from organizations and individuals abroad.
Cuba is able to provide, free, cocktail medications for about 157 of its
more than 300 AIDS patients, Rosabal said.
"We haven't covered all the needs," Rosabal said. "We hope to
expand the number of patients receiving the cocktail this year."
Still, despite housing, food and medicine, the lack of freedom bothers some
who have lived in the sanitoriums. They argue that the government still
quarantines people against their will.
"The sanitorium works for people who have no place to eat, who can't
take care of themselves," says one HIV-positive man, who fought doctors who
tried to coerce him into moving to the sanitorium. "But for someone who is
functioning ... despite the fact their blood has a virus, I don't think that's
any reason to take away their freedom."
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