Inter Press Service - October 30, 2000
Dalia Acosta

"The condom is not only for men. You can suggest that your partner use it, or you can put it on him," states a pamphlet drawn up by the Public Health Ministry's National Centre for the Prevention of STDs and AIDS.

The new focus on empowering women to insist on the use of condoms is only one of the Centre's actions targetting women in Cuba, especially those in the 15 to 29 age category. The Centre also provides counselling services and a help-line, and carries out community intervention projects aimed at high-risk groups.

The pamphlet points out that while the acquired immuno- deficiency syndrome (AIDS) is the most dangerous of all known STDs, it is not the only incurable one, as there is no cure for either genital herpes or the human papilloma virus (HPV -- the main culprit in cervical cancer).

"When I told my partner that I could not take the pill and that I would not consider using an IUD, he told me condoms gave him an 'allergic' reaction," said Mariela Rodr guez, a 37-year- old designer.

As is usual in this Caribbean island nation, where the idea that "with the condom it just doesn't feel the same" is widespread, it was Rodr guez who ended up giving in. "I knew I was putting my health at risk, but what could I do," she shrugged, with resignation.

Health authorities warn that the risk of contracting an STD has risen in recent years in Cuba due to several reasons, such as the tendency to initiate sexual activity at increasingly early ages, promiscuous behavior and ignorance regarding the risks.

The Public Health Ministry's Statistics Office reported 23,225 cases of gonorrhea and 12,285 cases of syphilis last year in this country of 11.1 million.

Between 1986 and 1996, the incidence of syphilis climbed from 71.4 to 143.5 per 100,000 inhabitants, while gonorrhea rose from 340 to 368.

Although the data is not broken down by gender, health authorities say most of the cases are still seen among men. They also point to a tendency to contract STDs at younger and younger ages.

Nearly half of the 1,641 patients treated for STDs at the Ramón Gonz lez Coro obstetric-gynecological hospital in Havana from 1993 to 1996 were under 25. The STDs most frequently seen among young women were HPV, followed by genital herpes and trichomoniasis, which appeared as a secondary infection in 92.5 percent of the cases.

A 1996 survey of 1,108 adolescents between the ages of 11 and 15 found that 26 percent of the respondents said they had become sexually active between the ages of nine and 11.

The study also demonstrated that popular beliefs regarding STDs had a negative influence when it came to willingness to seek specialised advice and health care, with 54.3 percent of respondents stating that STDs were only contracted by "immoral" people from "marginal" social groups.

Local experts say the rise in the number of cases of STDs in Cuba is a consequence of a decline in health care coverage due to the economic crisis gripping the country for the past decade, as well as high teen pregnancy rates. Experts also say the rise in prostitution in the 1990s, a result of the economic crisis and the boom in tourism, is another likely contributor to the spread of HIV/AIDS and other STDs.

Cuban prostitutes normally do not insist that their clients use condoms, while tourists come here with the false notion that they can safely engage in sex with locals due to the public health achievements chalked up in the past 40 years. Cuba does still have the lowest incidence of AIDS in Latin America, with 0.03 percent of the population testing positive for the AIDS-causing human immuno-deficiency virus (HIV), according to Rigoberto Torres, an epidemiologist with the Public Health Ministry's STD/AIDS programme.

"People know how to protect themselves, but few actually do so," said Dr. Mirna Villalón Oramas, with the National Centre for the Prevention of STDs and AIDS. "The percentage of people who do not use condoms is high, and many, especially men, have more than one sexual partner."

Indeed, only around five percent of sexually active Cubans use condoms as a barrier or contraceptive method, she added.

The World Health Organisation (WHO) reported in 1995 that 333 million new cases of curable STDs were reported in adults worldwide, 10 percent of which were documented in Latin America and the Caribbean.

Morbidity associated with STDs is, overall, five times higher among women than men. Among women, STDs bring other complications, such as pelvic inflammation, infertility or cancer.

According to the WHO, STDs constitute the second cause of morbidity among women between the ages of 15 and 44, and account for 35 percent of the risk of death in the post-partum period.

Leaving aside AIDS, the burden of STDs on women is more than three times higher than the burden on men, according to the United Nations Fund for Population Activities (UNFPA).

Women's greater vulnerability to STDs is due as much to cultural reasons as to biological determinants, observes the UNFPA State of the World Population 2000 report.

Anatomical differences facilitate the spread of STDs to women and hinder diagnosis, experts warn. Women "need to be better informed, and to learn how to negotiate the use of the condom with their partners," stressed Villalón.

In general, people only worry about AIDS, rather than the potential serious consequences of illnesses like chlamydia, HPV, herpes simplex or hepatitis B, which "sometimes present no symptoms in women, and are generally detected late," she added.

Women have a greater probability of contracting STDs, because semen remains in the vagina for a longer time than vaginal excretions remain on the penis, which means women face higher exposure. (END/IPS/tra-so/da/mj/sw/00)
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