San Francisco Chronicle - Tuesday, September 15, 1992

Dr. Jorge Perez, a tropical disease specialist who directs the Santiago de Las Vegas sanatorium in the Cuban capital, said. "We do not regard this as an isolation system."

He credited the nation's network of specialized AIDS health centers, where nearly everyone in the country with HIV lives, as one reason that the nation of 11 million people has recorded only 883 cases of HIV infection and 144 AIDS cases, including 77 deaths, since 1986 -- the year he was the first Cuban physician to report an AIDS case. His lecture yesterday on the Berkeley campus was sponsored by two professors of medical anthropology, Nancy Scheper-Hughes and Paul Rabinow.

His appearance came as something of a surprise, as the U.S. State Department did not grant him a visa to make the visit until Friday afternoon.

SANATORIUM VIOLATES RIGHTS?

Many observers in the United States have criticized the sanatorium system, which was created in 1986, as a violation of basic human rights.

When the system first opened, Scheper-Hughes said, it amounted to mandatory quarantine for anybody who tested positive for the virus.

Perez asserted yesterday, however, that the rules have loosened considerably since 1989, when he took over the Havana sanatorium, which is the centerpiece of a system of about a dozen similar centers in Cuba.

Now, he said, typical residents are able to go home to visit their families several times a week, attend sporting events, and generally come and go as they please. "There are no machine guns and guards," he said. Rabinow, who said the Fidel Castro regime is an "authoritarian dictatorship," said he regards Perez as a "humane doctor trying to provide medical care in the best way he can, but that doesn't mean that we can believe everything he says."

Nonetheless, Rabinow said, the system raises the issue whether the tightly controlled health care system and semi-quarantine is why the AIDS infection rate is so low, or whether it may simple reflect the general isolation of Cuba due to the U.S.-led economic embargo.

EMBARGO'S AFFECT ON AIDS RATE

Perez said the embargo has been one reason for the low rate of AIDS in Cuba, because it kept out American blood products during the early 1980s before testing of blood bank supplies for the virus began.

Perez has been described by many U.S. health specialists as an advocate within the Cuban government of eventually dismantling the sanatorium system, but he would not go that far yesterday.

"The system is evolving, and the rules are changing," he said. One reason for the relaxation of the previously strict quarantine, he said, has been the realization that people who are positive for HIV may go 10 or more years before showing signs of the disease, and belief that intensive education when they first arrive in the centers drastically reduces their risky sexual behavior during subsequent visits back to their home communities.

Another reason that the centers have not inspired much resistance within Cuba, said Scheper-Hughes, is that they are luxurious by Cuban standards, with private rooms, good food and color televisions. Furthermore, under the centralized system of the country, residents still draw their full salary from their state jobs.

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