Cuba's AIDS Embargo
Cuba's Policies May Be Correct, Not Cruel
My trip has been sponsored by the U.S.-Latin American Aid Foundation, a fledgling organization founded by Charles Hornung, a recent Yale graduate and an MBA student at the University of Texas. Hornung intends to send 200 people a year to Cuba with medical supplies. In addition to helping Cubans, he wants Americans to see how ridiculous the U.S. economic embargo is. And indeed, the effects of the embargo are everywhere apparent here. The shoulders of the highway are lined with Cubans commuting to work on bicycles; trucks ahead of us that burn low-grade gas are laying down trails of exhaust fumes as if they were dusting crops; and huge trailer trucks that have replaced buses in Cuba are so crammed with passengers that they bring to mind nightmarish visions from Graham Wilson cartoons. It's a disturbing scene, more so for the doctors who have invested their adult lives in a revolution on the verge of collapse. With brave gallows humor, one of them tells a joke about how hard it is to separate the revolution from the U.S. blockade; then they drop us at the gate in front of Los Cocos.
Sanitario Santiago de Las Vegas, as Los Cocos is officially named, has been depicted in the American gay press as a concentration camp for HIV carriers, where guards administer "brutal beatings" to the inmates. When I start to take a photo of the front gate, the guard says it isn't permitted. Buttrey explains that we have an appointment, and we're waved through to a long gravel drive lined with palms that leads up to a large white stucco building. Buttrey has made several visits to Los Cocos. A history teacher at St. Andrew's school in Austin, Buttrey speaks fluent Spanish and travels frequently to Latin America to follow political developments. He served as an international observer for elections in Nicaragua, El Salvador, and Guatemala, and he has been going to Cuba for the last five years to do historical research. He has made an extensive network of friends in Cuba.
The sanitarium looks like a tropical country club with perfectly kept grounds. Before the revolution, it was a finca, or country estate, and what was once the owner's home now serves as an administration building. In an air-conditioned office we find two of the sanitarium's directors -- Jose Joanes Fiol, a doctor and epidemiologist, and Alberto Rosabal Socarrás, the subdirector for social affairs. Both affable men, they take us on a tour of the sanitarium, which covers 28 acres and houses approximately 200 patients.
Marañon, the newest section of the sanitarium, is across the highway, connected to the main grounds by a tunnel. It's a bit like a small housing development with a nurses' office as the hub of the community. We stop at a bungalow where patients are at terminal stages of the disease, at another where they are confined to their beds. Most of the patients, however, look healthy and appear to be living relatively ordinary lives in apartments that are pleasant by any standard and luxurious by Cuban standards. Everyone has air conditioning in their bedrooms and there's even cable TV. One part of the complex was designed by an architect living there as a patient. Joanes and Rosabal say that many of the patients have formed relationships at Los Cocos -- 40 straight couples and seven gay. No one at Los Cocos is required to work, but everyone is encouraged to do something to keep themselves stimulated. Patients toil in the organic gardens, help in the offices, and a few even have jobs in town.
As we walk, Los Cocos begins to seem like an ideal community that ironically is based upon a shared disease. I'm aware, of course, that we're getting an official tour, but Joanes and Rosabal don't appear to be on guard, nor are they intent on controlling and listening to every conversation. They know all the staff members and many of the patients by name, and they assure me that I can take all the pictures I want, as long as the patients agree. In one part of the complex, a youngish gay man volunteers to show his apartment and a couple of his neighbors come in to visit. While everyone is talking in the living room, he takes me into the bedroom and invites me to sit down for a visit. He says that he tested positive two years ago and that he moved to Los Cocos from Havana because there was "menos ansiedad." Less anxiety. He doesn't have to worry about medicine, food, or money.
"He could be here for years without getting sick," I say to Rosabal a few minutes later. "Isn't this expensive?"
Rosabal shrugs. "It's cheaper than if he infected other people." He goes on to tell us that the gates at Los Cocos aren't locked and that most of the residents are free to come and go. When a patient first arrives, he or she goes through a period of evaluation that lasts until the staff is convinced that the new resident can be trusted to practice safe sex and not infect others. "People who can't be trusted -- the mentally imbalanced, alcoholics, prostitutes -- it would be irresponsible to let them infect others."
Cuba's health policies regarding AIDS have evolved over the last 10 years. In 1986 when Los Cocos opened, it was run by the army, and most of the patients were soldiers returning from Africa. For the first three months, patients were prohibited from leaving the premises. In 1987, the Public Health Administration took over, and patients were allowed to leave for 18 hours, four times every three months, but only if accompanied by a chaperone. During the third phase, which began in 1989, some patients were permitted to leave the sanitarium without a chaperone. Los Cocos has now moved to an ambulatory care program. After an initial evaluation and treatment, most residents, if they want, are allowed to return to their communities. Cuba has 14 different sanitariums spread throughout the provinces. The government spends approximately $14,000 a year on each patient who is asymptomatic, $24,000 on those who are ill.
When we return to the administration building, Joanes and Rosabal invite us to lunch in the employee dining room. It's a huge and sumptuous meal by Cuban standards -- pork, rice, beans, plantains -- but they say that the residents actually eat better. All of the residents are on high protein diets, and receive between 4,000 and 6,000 calories a day. After lunch, while Joanes, Rosabal, and Buttrey are talking, I walk off on my own into a separate, enclosed section of the sanitarium that is near the dining room. I have read in The Advocate that visitors are always shown Marañon, but that in another section, Arcoiris, patients are locked into cells with barred windows. Indeed, the rooms that all face onto a courtyard are smaller, but they certainly aren't locked and they aren't cells. Several children are playing in the courtyard, and a resident is talking on a pay phone. The rooms are about what you would find in a college dormitory.
What I find truly extraordinary at Los Cocos is not the quality of care, but the fact that Cuba has been the only country in the world to successfully control the spread of AIDS. In 1993, in all of Cuba, a country with over 10 million people, only 187 people had AIDS. That same year, Puerto Rico, with one-third the population, had 8,000 cases of AIDS, and New York City, with 7.3 million residents, had 43,000 AIDS cases. Today, only 1,303 people in Cuba test positive for HIV; 490 of those have AIDS. Only five babies have been born with HIV over the past decade, and only two hemophiliacs have been infected. Altogether, 332 people in Cuba have died of AIDS.
Cuba succeeded in controlling the epidemic by taking decisive action. In the
early Eighties, before Reagan ever acknowledged that AIDS existed, Castro
instructed the director of Cuba's Institute of Tropical Medicine to start
researching AIDS and to come up with a policy. Cuba stopped importing blood
products, and in 1985 started testing everyone who had been out of the country
since 1981. In 1987, testing was extended to all pregnant women, people with
sexually transmitted diseases, and all sexual contacts of HIV carriers. Cuba
enforces partner notification, and altogether has given approximately
18 million tests. Cuba also benefited from being relatively isolated from the rest of the world. Few Cubans left the country, and until recently Cuba received relatively few tourists.
Why don't more people in the U.S. know about Cuba's success? The answer is easy. Not only is it politically incorrect information, but it's almost too painful to contemplate what Cuba managed to do with its limited resources, and what the rest of us might have avoided. The political right in the U.S. doesn't want to hear anything good about Cuba, and the gay press isn't going to publish anything positive about Cuban AIDS policies. The Advocate "covered" Los Cocos without ever indicating whether the policy had been effective, or giving any statistics on the spread of the disease in Cuba. Gays in the U.S. mounted an impressive educational campaign about HIV and AIDS, but, acting on their understandable desires for privacy and fears of straight society, they fought mandatory testing and partner notification, which are traditional ways of controlling contagious diseases. Mandatory testing might have short-circuited a lot of fatalistic promiscuity during the early years of the epidemic, and kept people from acquiring and spreading the disease. While the gay community worked to prevent such a governmental response, the right responded by doing nothing, dismissing AIDS as a life style choice.
Cuba, of course, is far from being a model of tolerance. In the Sixties and Seventies, the Cuban government imprisoned homosexuals and sent them to work camps. But over the course of the epidemic, Castro's regime has become less oppressive while the religious right in the U.S. has become increasingly strident -- which says something fundamental about taking care of one's responsibilities. The responsibilities you neglect are the ones you resent. When I asked Joanes and Rosabal about persecution in Cuba today, they said it was mostly cultural. Cuba is a "machista" society, meaning that traditional masculinity is exalted, yet as in many Latin American countries, a man can have sex with another man and still be considered macho as long as he stays on top. Homosexuality is a part of life and is tolerated as long as it doesn't ask to be acknowledged.
To check out what I saw and heard at Los Cocos, I managed to get myself invited to a gay party in Havana. I figured that if there were horror stories to be told, I would hear them here. There are no gay clubs in Havana, but there is a circuit of parties in private houses that one pays to get into. Block committees -- the watchdogs for the regime -- obviously know that the parties take place, but nothing is done.
When I arrived just before midnight, the front of the house looked abandoned, and the neighborhood was so dark and quiet as to be surreal. I was sure I had the wrong place until I walked through several empty rooms and came to the back garden where a sound system was booming and about a hundred people were dancing. I spent most of my time talking to a group of gay men who work in the show at the Tropicana. They knew about Los Cocos, and they didn't think it was a bad place. When I asked about what sort of problems gays had, they talked about the same things that all Cubans talk about -- economic problems, wanting one's own apartment, wanting dollars, wanting out.
Watching them dance, it slowly occurred to me that AIDS simply wasn't much of an issue for them. They didn't have friends who had died. They didn't know people who were sick. Cuba has avoided what are considered unsolvable problems in the U.S. -- AIDS, homelessness, violence, drugs. But here's the lesson about authoritarian governments: Cubans are still dying to leave.