Controlling AIDS in Cuba. The logic of quarantine
Bayer, R.; Healton, C.
New England Journal of Medicine 320(15): 1022-1024
1989
ISSN/ISBN: 0028-4793 PMID: 2927477 DOI: 10.1056/nejm198904133201529Document Number: 359438
Cuba has initiated a program to control Acquired Immune Deficiency Syndrome (AIDS) that is designed to limit the spread of infection with the human immunodeficiency virus (HIV) by implementing compulsory elements of the public health tradition. Widespread screening for HIV infection began 3 years ago, and persons identified as infected have been sent to a sanatorium located in a Havana suburb. The program also reflects concern over the marked increase in prevalence of sexually transmitted diseases. Educational effects in Cuba stress that AIDS is not a disease exclusively of homosexuals and can affect any individual. Condoms are recommended for protection. In contrast to virtually every other nation, Cuba has not made education the key focus of its anti-AIDS strategy. Education is relegated to a marginal role. Key to the policy is identifying infected individuals and bringing them under medical control. Cuba's HIV surveillance program has been carried out with use of an enzyme-linked immunosorbent assay (ELISA), Western blot assay, and antigen tests that have been developed domestically. The director of the Cuban AIDS Investigations Laboratory reports that nearly 3 million Cubans have been tested. It is estimated that among the 7 low-infection groups tested in Cuba, between 21 and 53 persons may have been inaccurately considered positive as a result of testing. Cuban authorities have expressed much interest in obtaining commercially available HIV screening kits -- both ELISA and Western blot assays -- as a standard against which to measure their own test. Despite the inevitability of continued viral transmission, Cuba's policy of a modified quarantine certainly will limit the toll of HIV infection markedly yet comes at a great price. For other nations, the imperatives of prevention, however important, are not the only values to be considered in the battle against AIDS.