Miami Herald; Sunday, November 10, 1991
Elinor Burkett, Herald Staff Writer

The reason is simple enough: Every individual found to carry HIV, sick or not, is locked away.

Practically everyone old enough to have sex is tested for the virus. Government decree. No exceptions.

As of Oct. 1, the Cuban government held in confinement 478 men and 192 women.

Carlos Alfonso, 23, is one. He resides, rent free, in an air-conditioned apartment in a small-town paradise.

In a land of severe shortages, steak and chocolate ice cream are plentiful. If he doesn't show up at his weekly doctor's appointment, his doctor shows up at his doorstep.

He hates it. "They pulled me out of my life and put me here," he said as he sat on the front porch of a house in a government-controlled sanatorium.

"In Cuba, AIDS is not a disease. It's a crime."

"This is not a sanatorium. It's a prison."

Few Cubans here agree with him, even the 299 other residents confined in the same institution. "If I were outside, I'd be dead," said Eduardo Ramos, sitting on the same steps as Alfonso. Six other residents nodded their heads in agreement.

Patients, the government labels them -- even though most appear perfectly healthy. Each has an AIDS number.

Seemingly, the vast majority of populace supports the policy.

THE DOCTOR

Cuban AIDS patients better off, he says

Dr. Jorge Perez, director of the sanatorium in Santiago de las Vegas, believes his patients are better off than AIDS patients in the United States.

"I simply don't understand how anyone can talk about respecting human rights, about liberty, when there are AIDS patients waiting hours to see doctors, AIDS patients who can't afford the latest medicine, AIDS patients living on the streets without housing, food or medical care."

AIDS in Cuba is the tale of an ethical dilemma that confronts every nation as the AIDS epidemic infects the globe:

How does a society balance the rights of the infected against the need to contain a lethal disease?

All countries -- except Cuba -- allow people to make their own decisions about AIDS. To test or not test. To make love or not make love.

Cuba is the international exception.

Here, all hospital patients, blood donors, pregnant women, fishermen, sailors and international travelers, as well as entire towns and neighborhoods, are tested for the AIDS virus. Consent is never mentioned.

Everyone who tests positive is interned -- indefinitely -- in one of seven sanatoriums. Everyone is interviewed about past sexual partners who, in turn, are tested. If positive, they, too, are put away.

Ergo, Cuba has achieved what no other country has dared to attempt: seizure of "the epidemiologic moment," in the words of Cuba's AIDS czar, Dr. Hector Terry Molinert. Only Cuba has contained the 20th-Century plague.

The ethical dilemma remains: At what price?

THE WAR HERO

After routine physical, he became patient No. 1

Reinaldo Morales, war hero, is patient No. 1. For two years, he fought South African troops in Angola and, as he put it, "had sex with cheap hookers."

He returned to Havana Jan. 17, 1986, and, unaware of any problems, underwent a routine physical.

Twenty days later, the "crazy poet-musician," as his wife, Maria Julia, calls him, ended up in a secret ward at the Naval Hospital.

Hepatitis B, a doctor informed him. It was a lie.

Soon others, all seemingly healthy, joined him. For a while, it was all a lark -- a dozen macho men in green hospital gowns, swapping stories, pulling practical jokes, sneaking out to get drunk.

In April 1986, the Cuban government shipped two dozen men to an old estate, Finca Los Cocos, on the outskirts of Havana.

Thus began the sanatorium. It was a secret.

AIDS in Cuba, in fact, was a secret until May 1986, when Granma, the Communist Party newspaper, reported the death of a theatrical set designer it didn't name. He was Carlos Vejuilla. The newspaper accurately identified him as a gay man who had been infected in New York.

No one mentioned Angola or the men stashed away in the sanatorium. All were heterosexual.

At that time, they lived in a big house on what had been a 500-acre Catholic retreat. They lived behind a five-foot cemented wall with a heavy wooden gate. A small guardhouse opened upon a long formal drive leading to an ornate administration building.

"Every afternoon new patients arrived," said Morales. "Every day new people came, going stir crazy with the rest of us."

Everyone interned had to wear pajamas -- to make any escape more obvious. The laundry ironed them once a week for visiting day.

No one was permitted to walk within 50 feet of the wall. A military guard monitored all telephone calls, limiting conversations to five minutes.

Even so, some managed to flee. Unfailingly, police caught them, Morales said.

Outside the sanatorium walls, the Cuban government began what would become the world's most massive AIDS testing program.

THE FIRST GAY MALE

Artist was separated from others

Shortly after May Day 1986, the first gay man arrived at the sanatorium. Tomas Borbonet had designed book covers for Fidel Castro's speeches. He had been the lover of the first Cuban to die.

Borbonet, now 43, was separated from other patients -- ostensibly for having a "different type of virus," he said. Administrators gave him private quarters, an old house littered with dead cockroaches and an empty swimming pool with lots of dead spiders.

On the 26th of July, Cuba's most important holiday, Borbonet had to stay in his room. Everyone else celebrated.

At year's end, the sanatorium population reached 99. A few were women. Even those married to male patients were assigned separate quarters.

"Waiting to die, I didn't do anything for the first month and a half," said Raul Llanos, patient No. 97, a senior economist for the Ministry of Basic Industry. "When I realized I felt fine, I said, 'What am I doing here? I might as well get my life in order.' "

Llanos watched the Soviet-made TV -- "whatever garbage was on." He read Thomas Mann, Mario Benedetti and The Holy Bible.

Not so his companions.

"Like all Cubans with limited movement, we dedicated ourselves to drinking and looking for fights," said Juan Carlos de la Concepcion, patient No. 93, a physician. Someone was always sneaking in a bottle -- or two -- of rum, Havana Club.

As the sanatorium population gradually rose, the internees began raising holy hell, complaining, threatening, fleeing. The government made concessions. It relaxed visiting privileges -- and allowed inmates to go home. First for 12 hours, then 24, always accompanied by a medical student.

A CHANGE COMES

Canadian-trained MD unmakes rules

In July 1989, with the population at 300, the National AIDS Commission ordered satellite sanatoriums opened in other provinces and replaced military administrators with medical professionals.

That's when Dr. Jorge Perez, an MD trained in pharmacology in Montreal, took over Los Cocos -- and unmade all the rules.

A workaholic and consummate politician, he tools around town in a chauffeur-driven faded blue Lada, smokes cigars as a pick-me-up and exudes the easy charm of a Hispanic Welby.

His first order: Knock down the wall. Down it came.

His next order: Put people to work. Morales, patient No. 1, opened a fix-it shop. Patient No. 97 became the in-house comptroller. Patient No. 40 began raising rabbits.

Almost half those interned, though, didn't want to work. "Why should I work?" said Jose Jesus Acosta. "It has no impact on my life here." Fine, no problem, said Perez.

The government pays every sanatorium resident the salary he made prior to confinement, work or not. Almost all send money home to their families. The only sanatorium expense: cigarettes.

Everything else is free: pots and pans, coffee makers, phone calls, detergent, toothpaste, rice, beans, AZT, antibiotics and, specifically, condoms.

BUCKING A TREND

Infection rates in Cuba actually on decline

Within the sanatorium, condoms are as common as a cup of coffee. No one teaches abstinence. No one expects people to give up sex.

So, the medical professionals preach the fundamental truths of AIDS, as if they were 20th-Century commandments:

For an HIV-infected individual to have unprotected sex with an uninfected individual is murder.

For an HIV-infected individual to get reinfected is suicide. Sex without a condom is criminal.

Today, 44 of the 670 have AIDS. The rest are healthy -- for the moment, week, year or decade. The 19 health workers at Los Cocos treat them with aggressive preventive care: the latest tests, the latest drugs, the latest nutritional plans. It doesn't always work. Fifty-four have died.

But unlike in any other nation in the world, the HIV infection rate for new cases in Cuba is actually decreasing.

In the United States the infection rate is rising steadily. In 1986, three of every 1,000 Americans had the AIDS virus, according to estimates from the Centers for Disease Control. In 1990, the number of infected was six per 1,000.

That's 100 times greater than the Cuban infection rate. In 1989, six of every 100,000 tested were positive, according to the Cuban Ministry of Public Health. In 1990, it was four of every 100,000.

Perez qualified the statistics. "We certainly have not yet discovered everyone. And there will always be new cases as people have unprotected sex" -- primarily with foreigners.

FOLLOWING COMMANDMENTS

'Responsible' residents sometimes rewarded

At Los Cocos, Perez now permits "responsible" residents to go home for weekends -- unaccompanied.

So, who is responsible?

The standard is simple enough: anyone unerringly faithful to the commandments.

Perez and the four psychologists on his staff decide who. They are not always right. "We have a thorough evaluation system, but it's not flawless.

"We've let a couple of people leave and then gotten word back that they weren't totally responsible."

Nonetheless, about 150 residents now leave Los Cocos on weekends. The sanatorium gives some residents passes to come and go freely. Seven are back at their old jobs, sleeping at the sanatorium.

Carlos Alfonso is not one of them. Considered "irresponsible," he doesn't go anywhere.

He's a Freekie. Freekies are a Cuban cult, a '90s version of American hippies. Alfonso looks like a punk rocker, spiked bleached blond hair, heavy metal chains, three ornate rings on his fingers.

"They'll never trust me," he said, both bragging and defiant. "The government has a psychosis against us."

"I have no future. I'm condemned to whatever they decide. The food here is good. The medicine is very good. But I prefer to be free, even if it means no medical care."

Alfonso entered the sanatorium in August 1990. According to conventional medical wisdom, he won't develop any symptom of AIDS for at least seven years.

Elinor Burkett, The Herald's AIDS specialist, is the first journalist for a North American newspaper to visit Cuba's largest AIDS sanatorium without escort or censorship.

CAPTION: PHOTO

Dr. Jorge Perez with a young male patient, Maria Julia wife of patient Reinaldo Morales (AIDS-FOREIGN); color photo: Reinaldo Morales rides a bike in front of a Cuban AIDS sanatorium (AIDS), Juan Carlos de la Concepcion shares a laugh with Abel and Armando and Chino (AIDS)

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