CUBA NATIONAL AIDS PROGRAM - THE FIRST DECADE

There is a high incidence of infection with the human immunodeficiency virus (HIV) in many Caribbean nations. But by 1993 Cuba, with a popul ation of greater than 10 million people, had fewer than 1,000 seroposi tive persons and less than 200 cases of the acquired immunodeficiency syndrome (AIDS). To investigate Cuba's approach to the AIDS epidemic, we visited Cuba, reviewed published statistics, spoke with health care officials, interviewed HIV-positive patients, and toured medical faci lities. Cuba established an extensive HIV surveillance program in 1983 , and more than 15 million HIV antibody tests have been done. The sexu al contacts of all infected persons are closely observed. A national e ducation program is evolving. Since 1986, all known HIV-positive patie nts have been placed in sanitariums, which is the most controversial a spect of Cuba's program. We review available information on AIDS in Cu ba and describe that nation's attempt to prevent the spread of disease . We discuss how the political system and Cuba's relative isolation ha ve influenced this approach. Strategies have been developed that may b e of limited efficacy and would not be acceptable in most Western nati ons.