Surviving HIV Despite Cuba's Embargos & Sanctions

Cuba defies the odds when it comes to HIV and AIDS. During the initial outbreak of the AIDS epidemic of the 1980's, Cuba quarantined anyone who contracted HIV or had AIDS. These people were housed in institutions where care and monitoring took place. The practice of quarantine lasted until the 1990's.

Today, Cuba sees itself as a leader in the fight against AIDS and AIDS research. In spite of sanctions, embargos, and a poor economy Cuba has done well in controlling the spread of HIV among its citizens and keeping the numbers of new infections to a relatively low number compared to neighboring Caribbean islands. According to the World Health Organization, Cuba has approximately 22,000 people infected with HIV and a total population of just over 12 million.

Cuba has been a mysterious, forbidden place for Americans for nearly 60 years, but with a stroke of a pen, under the Obama Administration, some of the veil of mystery has been lifted. Under that veil is a country of poverty, hardships and strict government control on communications and dissemination of information. Today under a new American administration that fragile veil is again being lowered, leaving many questions unanswered.

On my second visit to Havana, I was arriving no longer as a global traveler but as a journalist. Would I see the country differently from my first visit? On my incoming flight, I sat next to Maykel Galindo, a former soccer star who defected to the U.S. in 2005 while playing for the Cuban National Football League.

I asked Galindo what contrasts he sees today in Cuba as opposed to when he lived here. He told me, "growing up playing soccer if I got a split or tear in my shoe, I had to find tape to fix it. Kids I coach in America take everything for granted. Growing up in Cuba, you take nothing for granted, not even food. That's what I remember about Cuba."

His statements sum up the hardships of Cuba. The embargos and lack of trade partners have created an environment of scarcity of everyday necessities, yet Havana remains one of the most seductive, romantic cities with an intoxicating, raw, vibrant energy.

In spite of so much scarcity of everyday things and so much hardship under communist social control, the creativity, talents and joy that Cubanos exude is like nothing that I had ever experienced, especially in the gay community Mariela Castro, the daughter of President Raul Castro and niece of Fidel, has led the way with her organization CENESEX to bring equality to the Trans community and for LGBTQ. The gay bars and establishments are alive with music, dance, and celebration of these new freedoms.

Lacking Resources

Cuba, like many developing nations, has a lack of resources to help stop the spread of HIV. When I inquired of my friends in Havana about their knowledge of PrEP (Pre-Exposure Prophylaxis) or Truvada, many were not aware of this drug. Even if they knew about it, the chances of any advanced preventative medication coming to Cuba is highly unlikely.

One source explained that with the embargos and lack of funds to enter into joint ventures with pharmaceuticals of developed nations or with the U.S., they have no access to these drugs risking the rise of new HIV infections in Cuba. Their only measure to help prevent the spread of HIV is with the use of condoms -- and condoms are too expensive for the locals to purchase. Even if they have access to them, they are usually of such poor quality that they easily break.

Unguided frustration was evident when speaking to the LGBTQ activists in Havana about the issues of AIDS, HIV, and PrEP. They had nowhere to place the blame and no avenues to resolve the problem. Perhaps it's the closed-off, restrictive Cuban government that doesn't want to ask for health resources in the form of aid from other countries or possibly the cost of treatment and prevention makes this topic so difficult.

But the common thread is that we are one global family looking for a way to survive, stay healthy and love life. The poverty, lack of resources, and struggles are often quickly dismissed by Cubans as being a result of the sanctions. It is legal to blame outside forces such as embargos, sanctions, and world economies, but it is not legal for a Cuban to speak poorly about the Cuban government or place blame on them.

It's a balancing act, requiring me to reading between the lines and asking questions that do not incriminate, in order to get accurate forthcoming answers from my sources. It was in these short tete-a-tetes with my LGBTQ friends that I was reminded that I was in a communist country with strict laws against speaking freely.

This trip took on a more personal and horrendous note for me as a series of events unfolded, from some bad judgment that resulted in being drugged, violated, and robbed. I came to be evermore grateful that I had started on Truvada a year prior. The biggest takeaway for me is that this crime does not define the Cuban people or Cuba. The police officers and detectives who worked on this case showed the utmost respect, non-judgmental attitude and professionalism like I had never seen. Perhaps Cuba has become the utopian example of gay acceptance. I found a society that was void of judgment and discrimination towards me and the gay community.

Homegrown ARVs

Cuba and Havana have made great strides in equality for the LGBTQ community and the treatment of those with HIV/AIDS. But Vice.com reports that "Cuba's capacity to produce the latest HIV drugs is unclear."

The website for Cuba's Center for State Control of Drugs, Equipment, and Medical Devices lists at least six antiretroviral drugs that are currently produced domestically. Absent from the list is tenofovir, one of the three drugs in the World Health Organization (WHO)-preferred first-time regimen. (Several WHO-recommended "alternate" first-line regimens can be constructed out of drugs produced domestically in Cuba).

Cuba has currently been able to treat HIV-infected persons with a combination of aggressive pathology, constant contact with the infected person, and providing domestically-manufactured antiretroviral HIV drugs to those infected. But it has been reported that some of the unique HIV strains in Cuba have been resistant to the HIV drugs, perhaps due to the quality and effectiveness of the drugs manufactured locally.

According to Karen Landman, a practicing physician who specializes in infectious diseases and public health, "CRF19_cpx strain is the third most common HIV subtype in Cuba, and has been associated with rapid progression to life-threatening disease -- within three years of infection, instead of the usual six to ten years." Meaning that patients with this strain of HIV are dying faster as the disease is far more aggressive and drug-resistant to HIV antiretroviral drugs currently available in Cuba, making the need for the flow of medical and research information, along with pharmaceuticals to flow freely from the United States and Cuba.

In confidence, after hearing about Truvada and its effectiveness, a few LGBTQ community leaders told me they hoped that someday soon, both the U.S. and Cuba could put politics aside and enter into a joint venture agreement that would make Truvada available to those Cuban people at high risk of contracting HIV.

The global gay community is very resourceful and powerful, and perhaps it is within the LGBTQ communities that the key to diplomacy, joint ventures on medical breakthroughs, and communications between the U.S. and Cuba lies. Perhaps one day all countries and peoples will have the same access to the same high-quality HIV and AIDS medications.