Colisteros: No es un secreto mis sentimientos sobre el gobierno actual de Cuba y su lider. Pero como dijo Jesucristo: 'Darle al Cesar lo que es del Cesar...", hay que felicitar a Fidel y su gobierno por ser responsables con la populacion de la isla y no dejarse ir por el argumento ilogico que utiliza 'argumentun ad miseriocordium' como su base. Saludos Mi General, bien hecho! Dario ++++++================================================================ Cuba: HIV Paradise Lost? 10.37 a.m. ET (1537 GMT) February 17, 1999 (*) By Marian Jones Imagine every HIV-positive person in America was locked up in a special prison. Once there, the HIV patients would be pressed to reveal the names of all of their sexual contacts in the previous five years so that these people could be tracked down and tested. But the prison would not be a concrete-and-bars type of facility. It would offer better-than-average housing, medication, special high-nutrition meals and safe-sex education. When the prison staff deemed a patient no longer a health risk to the surrounding community, the patient would be let out on a day pass to go to school, work or to see family. After a period of months or years, the patient could be paroled. In America, such a system would doubtless spark riots in the streets and spawn a subspecies of civil liberties lawyers to challenge its constitutionality. But this system has been reality for a number of years just 90 miles away from American soil � on the sunny socialist shores of Cuba. The Cuban government, of course, does not refer to these facilities for HIV-positive citizens as prisons; instead, they are called sanatoria. The government says the sanatoria system, along with mandatory HIV testing for large segments of the population begun in 1986, are the reason why Cuba has the lowest rate of HIV in the Caribbean. Among the 11 million residents of the island, there are less than 2,300 cases of HIV. Per capita, this is 1/35 the rate of HIV infection in the United States. This statistic is all the more remarkable given the influx of workers coming home from former marxist countries in Africa (where 30 million people have HIV), Cuba's recent struggles with rampant prostitution, and the tendency of gay Cuban men, influenced by Cuban machismo, to lead double bisexual lives and engage in furtive anonymous encounters with one another. In fact, while human rights organizations have argued that sanatoria violate Cubans' human rights, some foreigners who have visited these facilities have found them remarkably humane. "The sanatoria are communities where people who are HIV-positive can feel good about eating differently than their grandmothers and baby brothers and sisters," said Shad Reinstein, a Seattle acupuncturist who has visited Cuban sanatoria on numerous occasions to instruct staff on acupuncture. Under Cuba's austere food rationing system, Reinstein explained, most Cubans face severe limits on their groceries, which HIV-positive people get special coupons for extra food. "At home, when HIV-positive people get extra food coupons, they share the food with everyone else in their family rather than eating it themselves. At sanatoria, they will eat the food themselves." On her first visit to a sanatorium, Reinstein said she was wandering around on her own and met a resident who had escaped to the United States during the Mariel Boat exodus but had been deported back to Cuba because he was HIV-positive. Far from saying he felt imprisoned, "He [was] totally clear that the treatment he gets in Cuba is much better than [he would be getting] in the United States," Reinstein remembered. "He said there was much less AIDS phobia in Cuba than in the U.S. And this was not someone that the government arranged for us to meet." Dr. Vera Bensman, a volunteer working in Havana with the international aid organization Doctors Without Borders, agreed that many sanatoria were high-quality AIDS care centers. "If you look at the sanitaria from the medical aspect, the food, the lodging, the board, they are excellent treatment facilities," Bensman said. "They have good psychological programs. And they have improved tremendously over the past several years." Lately, though, the system has been changing. Until three years ago, HIV-positive Cubans were required to live in sanatoria for their entire lives. Now, most require an initial stay of only six months, after which a person can leave if deemed safe for release into the community. In Havana, the reforms go even further. Someone who is diagnosed with HIV can avoid a stay in a sanatorium as long as health care officials approve. Over 300 people with HIV are now in the "ambulatory care" program, where they are monitored but can live on their own, said Helena Hansen, an M.D. Ph.D. student at Yale Medical School who recently went to Cuba to research its HIV programs. Even with this new freedom, many Cubans are still electing to stay at the sanatoria. Not only can they get high quality care � and access to special health programs like the acupuncture treatment � but sanatoria also provide, free of charge, medications that are otherwise almost impossible to obtain due to the U.S. embargo (the United States bans companies, including pharmaceutical makers, from exporting products to Cuba). The New Strategy: Prevention The government, meanwhile, has realized that sanatoria alone aren't going to contain HIV in Cuba forever � especially not with the recent influx of tourists. Five years ago, facing a steep drop in its gross domestic product due to the collapse of the Soviet Union, which had been its main export market, the Cuban government allowed foreign investors to build tourist hotels on its shores. Tourists, mostly from Europe, flocked to Cuba. Now, despite the continuing embargo from the United States, the number of American visitors to the island is on the upswing. A new charter service from Miami is expected to double the number of U.S.-Cuba flights by the end of March, and Louisiana lawmakers are lobbying for a New Orleans-Cuba flight as well. Cuban health officials fear these American visitors will bring much-feared HIV infections along with their much-coveted dollars. With 30,000 Americans coming to Cuba every year, "We cannot test people coming and going," Jorje Perez, director of the sanatoria, told Hansen. "And [Cubans are] also traveling more freely. Many people who go to the U.S. get infected there and come back to Cuba for health care." Three years ago, as it saw the number of HIV cases double in a single year, the Cuban government decided to initiate more intensive prevention efforts and invited an international nonpartisan group, Doctors without Borders, in to the country to set up HIV-prevention programs. In 1996, the organization did a focus group study and found that many family doctors in Cuba still believed that a person could contract HIV from riding in an elevator with an HIV-positive person or that prostitutes and sailors were the only ones at risk for HIV infection. As a result, the organization�s prevention efforts "mostly involve training health care personnel and decision makers," said Dr. Bensman. Over the past two-and-a-half years, Bensman said, Doctors without Borders has also spearheaded HIV education campaigns through Cuba�s national television station, produced brochures and leaflets on HIV and conducted research on sexually transmitted diseases. In September, Doctors Without Borders helped Cuba set up its first anonymous HIV telephone hotline (a major feat in a country where the telephone system is about as old as the 1950s cars the people drive). "We now average 50 calls a day," Bensman reported. But these prevention efforts face an uphill battle. Due to the success of the sanatoria and testing programs, many Cubans don't believe they risk getting HIV from a sexual encounter with another Cuban, Hansen found in her research. As a result, many Cubans don't use condoms. The one exception to this trend has been the Cubans who have begun working as prostitutes for the European tourists. But this January, the government initiated a severe crackdown on prostitution. Crackdowns like this one, which have happened periodically over the past several years, may put this group at greater risk, Hansen found in her interviews with prostitutes, because condoms now can get a person arrested. "If they see you have condoms," the prostitute told Hansen, "they take you in [to charge you with prostitution] because Cubans never use condoms with other Cubans." (*) Sacado del web en Ingles
