Inter Press Service - June 26, 2001
Dalia Acosta

"We are not giving away medicine, we are providing it as a loan," Armando Alvarez, one of the founders of the initiative, told IPS. The project has the backing of the governmental Centre for the Prevention of Sexually Transmitted Diseases and AIDS.

A doctor by training and diagnosed with HIV in 1988, Alvarez recognises that "the situation is still complicated as far as the availability of certain medications for all people who are living with HIV/AIDS."

"The project does not have financing. We work with products that arrive through donations and we provide services to people coming from all over Cuba. We do not sell or give away medicines, (rather) we conduct loans or exchanges," Alvarez explained.

"We loan the medications to some people, and later they replace it. For others, we provide it in exchange for items the have in excess or that they can no longer use. And, of course, they always have to have a medical prescription," he added.

The community pharmacy initiative is an attempt to prevent treatment from being interrupted due to lack of imported drugs or a delay in the delivery of a package with medications that the HIV/AIDS patient might be receiving from family members living abroad.

"Nobody has priority over anyone else. Here we are all equal: men and women, homosexuals and heterosexuals," said Alvarez.

"The most important thing is that this is a project with the participation of people living with HIV who make decisions about the distribution of the medications," commented the specialist, who has spent the last 10 years working on AIDS-prevention initiatives here.

Until the early 1990s, all HIV-positive individuals, as was the case for Alvarez, were required to be hospitalised. At these specialised health centres, they received housing, meals and treatment free of charge.

That controversial system was liberalised and now hospitalisation is complemented with outpatient treatment for those who show they are "responsible with their own life and with the lives of others."

Cuba's national programme to fight HIV/AIDS, which encompasses 15 hospitals, includes the testing of all blood donations and of pregnant women, and follow-up on the sexual history of each new case detected.

For all cases, the public health system guarantees free treatment. However, the situation has become touchy in recent years with the arrival on the market of new anti-retroviral drugs - which are extremely expensive.

In the mid-1990s, the Cuban government spent approximately 14,000 dollars for every person with HIV and 24,000 dollars for each person with AIDS, according to reports at that time by the Public Health Ministry.

Jorge Pérez, director of the Pedro Kouri Institute of Tropical Medicine, which also treats AIDS patients, announced last December that Cuba this year would begin to manufacture a combination of three drugs to treat people who are HIV-positive.

Faced with lack of funds to pay for imported drugs, Cuba produces AZT, D4T, DDI and DDC, reverse transcriptase enzyme inhibitors, and will begin to produce two protease inhibitors, Saquinavir and Nelfinavir, reported Pérez.

The reverse transcriptase enzyme helps the virus to enter the cell, while the protease works to kill the virus once inside the infected cell.

The so-called "cocktails" of drugs that link the inhibitors of the two enzymes have so far proven to be the most effective formula for improving the quality of life of people with AIDS, halting HIV's damage to the immune system and, as a result, reducing mortality.

Local manufacture of the medications is the route Cuba and other countries, like Brazil, have chosen so that they can ensure that HIV/AIDS patients have access to treatment. The costs average 10,000 to 15,000 dollars annually per person and are largely covered by the state.

A controversial element of the Cuba's initial approach to handling the disease was the medical recommendation that infected women who become pregnant should undergo abortions, a procedure legalised here in 1965. But now, pregnant women with HIV/AIDS are given specialised treatment.

Efforts to avoid the transmission of the virus to the foetus begin after the first month of the pregnancy. Under the new approach, caesarean delivery is required and mothers are told not to breast feed their newborns. If these precautions are followed, the chance that a child of an HIV-positive mother will become infected is reduced to 15 percent.

Cuban doctors continue recommending abortion to pregnant women with HIV/AIDS, but the decision is made by the future mothers, who are increasingly opting to carry their pregnancies to term.

"More than 60 Cuban women with HIV have decided to give birth and there have been less than 10 cases of perinatal transmission of the virus," said Alvarez. "The level of support for people with HIV/AIDS in Cuba has no comparison in any other country," said Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

The United Nations General Assembly is holding a special three- day session (Jun 25-27) this week on HIV/AIDS, the first time the international body has dedicated a session to a single disease.

According to statistics from the Santiago de las Vegas Hospital, located in the outskirts of Havana, 3,481 people in Cuba had tested positive for HIV as of May 2001. Of this total, 1,254 had developed AIDS and 887 had died - 54 from non-AIDS-related causes.

There have been a total of 2,701 men and 784 women who have tested HIV-positive in Cuba. Homosexual men continue to be the majority, representing 82.7 percent of the men infected.

With more than 11 million people, Cuba reports 0.03 percent HIV infection, the lowest rate in Latin America and the Caribbean, according to international studies.

At the end of last year, there were 36.1 million people around the world with HIV or AIDS and 21.8 million had died from the disease since it first appeared two decades ago. During 2000, 5.3 million people contracted the virus and three million people died of AIDS-related causes.

Nearly 90 percent of the people consulted for a 1996 survey backed by the World Health Organisation believed they had no chance of contracting the AIDS virus, despite having had casual sex within the 12 months prior to the poll.

The survey showed that women were much less aware of the risks than were men. Just 14.4 percent of the women respondents reported using a condom in their most recent casual sexual contact, compared to 23.4 percent of the men surveyed.

Meanwhile, just five percent of the men and women surveyed had used a condom during their most recent sexual relations with a stable partner.

Most Cuban women do not demand that their male partners use a condom during sex because, in this culture, doing so amounts to an insult. This attitude even survives among many women who make their living as prostitutes. (END/IPS/tra-so/da/ff/ld/01)
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