By Vanessa Bauza and Tim Collie. South Florida
Sun-Sentinel. NewsDay.com. 07/07/2001 -
Saturday - Page A 4
Havana - From a comfortable two-bedroom house he shares with his partner and
another couple, Raudel Hernandez Diaz lives a life far different from that of
most Cuban men. Especially gay Cuban men.
Just steps from his door is a small clinic, part of the Sanatorium Santiago
de las Vegas, where Hernandez, 36, works. The clean, well-stocked clinic also
provides the free medical care that helps keep him and other HIV-positive
patients alive.
The government-provided homes are well furnished. Each has a television and
a kitchen in which patients can prepare meals from generous allotments of milk,
meat, vegetables and cooking oil that far surpass the diets of average Cubans.
In return for all this, Hernandez gives up his freedom. He is one of
hundreds of Cubans whom the government quarantines in a controversial - but in
some ways effective - policy to fight AIDS.
Cuba has one of the world's smallest HIV infection rates in a region with
one of the highest, even though it has the region's biggest population and,
according to surveys, some of its most liberal attitudes toward sex.
In other Caribbean countries - Haiti, the Dominican Republic, the Bahamas,
Barbados and Guyana - HIV has crossed from high-risk groups such as prostitutes
and drug users into the general population. It is spreading primarily through
heterosexual contact, meaning everyone is at risk.
In the English-speaking Caribbean, AIDS is the largest cause of death among
men between the ages of 15 and 44. In parts of the Dominican Republic, it has
become the leading cause of death among women in the same age group. In Haiti
and Guyana, an alarming 7 percent to 8 percent of expectant mothers are
HIV-positive.
But Cuba's infection rate has remained well below 1 percent. Last year, 0.09
percent of blood donors and 0.004 of pregnant women tested positive for the AIDS
virus.
In much of the Caribbean, fearful doctors and nurses refuse to treat people
with AIDS, and relatives or neighbors may stigmatize or reject them. That can
happen in Cuba, too.
But in the years since the Cuban government first tried to curtail the
epidemic by quarantining those who carry the AIDS virus, its attitude has
evolved into something resembling tolerance. In Cuba's sanatoriums, many gay
Cubans find acceptance that is lacking in a society where homophobia prevails.
The government of Fidel Castro acted early to contain the contagion,
creating a system of sanatoriums for those diagnosed with the virus.
Cuba has screened all blood donors for HIV since 1986, much longer than
other Caribbean countries. In 1987, it began screening all pregnant women, and
just about anyone else who showed up at a government health center.
"The Cuban point of view is that you have the right to be sick, but not
to transmit it to anyone else," said Dr. Jorge Perez, who diagnosed the
country's first AIDS patient and ran the Santiago sanatorium for 11 years.
While the policies contained AIDS, critics complained that the forced
quarantines violate patients' civil liberties. The government varied its
approach, launching a day program in 1998 in which patients were bused in for
classes on AIDS and returned home at night.
"We learned that not everyone is the same," Perez says. "We
started to differentiate between people who are responsible with their health
and those who are not." Many patients now can go to the Santiago sanatorium
as outpatients for checkups and medications, although doctors - not patients -
decide who is permitted such freedom.
The Santiago sanatorium has room for 300 patients, and a wing under
construction will house an additional 80. New partnerships and romances
regularly bloom among gay couples.
"Some people trust the health care here. Others say the quality of life
is better here than in their homes. From my point of view there is another
factor.
...Gay people, who are a majority here, feel more uninhibited," Rosabal
says.
They also feel less hungry. For many with AIDS in other Caribbean countries,
getting adequate food is a problem, but HIV-positive Cubans have a better diet
than much of the population. While most Cubans scrape and save to buy meat,
vegetables, cooking oil and other staples often missing from store shelves,
sanatorium patients are given rich meals that include beef, ice cream and milk.
Some patients also receive expensive anti-retroviral drugs that are beyond
the reach of many in developing countries. Cuba can provide free anti-retroviral
"cocktails" for about 157 of its more than 300 AIDS patients, Rosabal
said. "We hope to expand the number of patients receiving the cocktail this
year," he said.
Despite the housing, food and medicine, the lack of freedom bothers some.
"The sanatorium works for people who have no place to eat, who can't
take care of themselves," said one HIV-positive man, who fought doctors'
orders to move to the sanatorium. "But for someone who is functioning...the
fact their blood has a virus, I don't think that's any reason to take away their
freedom." The man, a volunteer AIDS counselor, was able to evade living at
the sanatorium only after lobbying his boss for a favorable letter to officials.
"Why should I be surrounded by guards?" he asked. "When you
can't live the way you want to, at what point are you still alive?"
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