Justin's HIV Journal

Monday, April 22, 2019

Justin goes to Cuba, Cuba LGBT laws and ethnoracial groups

Before the arrival of the Spanish, Cuba was inhabited by three distinct tribes of indigenous peoples of the Americas. The Taíno (an Arawak people), the Guanahatabey and the Ciboney people. The ancestors of the Ciboney migrated from the mainland of South America, with the earliest sites dated to 5,000 BP. The Taíno arrived from Hispanola sometime in the 3rd century A.D. When Columbus arrived they were the dominant culture in Cuba, having an estimated population of 150,000. The Taíno were farmers, while the Ciboney were farmers as well as fishers and hunter-gatherers.

Ethnoracial groups
Cuba's population is multiethnic, reflecting its complex colonial origins. Intermarriage between diverse groups is widespread, and consequently there is some discrepancy in reports of the country's racial composition: whereas the Institute for Cuban and Cuban-American Studies at the University of Miami determined that 62% of Cubans are black, the 2002 Cuban census found that a similar proportion of the population, 65.05%, was white.

In fact, the Minority Rights Group International determined that "An objective assessment of the situation of Afro-Cubans remains problematic due to scant records and a paucity of systematic studies both pre- and post-revolution. Estimates of the percentage of people of African descent in the Cuban population vary enormously, ranging from 34% to 62%".

A 2014 study found that, based on ancestry informative markers (AIM), autosomal genetic ancestry in Cuba is 72% European, 20% African, and 8% Indigenous. Around 35% of maternal lineages derive from Cuban Indigenous People, compared to 39% from Africa and 26% from Europe, but male lineages were European (82%) and African (18%), indicating a historical bias towards mating between foreign men and native women rather than the inverse.

Asians makeup about 1% of the population, and are largely of Chinese ancestry, followed by Japanese.[245][246] Many are descendants of farm laborers brought to the island by Spanish and American contractors during the 19th and early 20th century. The current recorded number of Cubans with Chinese ancestry is 114,240.
Afro-Cubans are descended primarily from the Yoruba people, Bantu people from the Congo basin, Carabali people and Arará from the Dahomey as well as several thousand North African refugees, most notably the Sahrawi Arabs of Western Sahara.
In 2010, the Pew Forum estimated that religious affiliation in Cuba is 65% Christian (60% Roman Catholic or about 6.9 million in 2016, 5% Protestant or about 575,000 in 2016), 23% unaffiliated, 17% folk religion (such as santería), and the remaining 0.4% consisting of other religions

Spanish is, of course, the primary language of Cuba

During the mid 1970’s to the late 1980 the Soviet Union helped supply Cuba with military resources but since then Cuba has had to scale back their military because of lack of assistance from Russia.  But Cuba’s law enforcement is headed by the Revolutionary Armed Forces. The Cuban government also has an agency called the Intelligence Directorate that conducts intelligence operations and maintains close ties with the Russian Federal Security Service.
The Cuban government has been accused of nu
merous human rights abuses including torture, arbitrary imprisonment, unfair trials, and extrajudicial executions (also known as "El Paredón"). Human Rights Watch has stated that the government "represses nearly all forms of political dissent" and that "Cubans are systematically denied basic rights to free expression, association, assembly, privacy, movement, and due process of law"

Cuba had the second-highest number of imprisoned journalists of any nation in 2008 (China had the highest) according to various sources, including the Committee to Protect Journalists and Human Rights Watch Cuban dissidents face arrest and imprisonment. In the 1990s, Human Rights Watch reported that Cuba's extensive prison system, one of the largest in Latin America, consists of 40 maximum-security prisons, 30 minimum-security prisons, and over 200 work camps. According to Human Rights Watch, Cuba's prison population is confined in "substandard and unhealthy conditions, where prisoners face physical and sexual abuse".

In July 2010, the unofficial Cuban Human Rights Commission said there were 167 political prisoners in Cuba, a fall from 201 at the start of the year. The head of the commission stated that long prison sentences were being replaced by harassment and intimidation. During the entire period of Castro's rule over the island, an estimated 200,000 people had been imprisoned or deprived of their freedoms for political reasons.

LGBTQ in Cuba
Lesbian, gay, bisexual, and transgender (LGBT) persons in Cuba may face legal challenges not experienced by non-LGBT residents.

Attitudes and acceptance towards LGBT people have evolved significantly, though a culture of machismo and homophobia is quite still present in Cuba. In 2018, the National Assembly voted to legalize same-sex marriage and prohibit all discrimination on the basis of sexual orientation and gender identity, with a constitutional referendum to be held in February 2019. However, same-sex marriage was later removed from the draft Constitution. Discrimination on the basis of sexual orientation and gender identity is illegal in Cuba.

Historically, public antipathy towards LGBT people was high, reflecting regional norms. This has eased since the 1990s. Educational campaigns on LGBT issues are currently implemented by the National Center for Sex Education, headed by Mariela Castro, daughter of former President and current Communist Party First Secretary Raúl Castro. Pride parades in Havana are held every May, to coincide with the International Day Against Homophobia. Attendance has grown every year.

In pre-revolution Cuba, there were a few LGBT-friendly bars in Cuban cities, such as the St. Michel, the Dirty Dick, and El Gato Tuerto in Havana. But Cuba had strict laws that criminalized homosexuality and targeted gay men for harassment. "To be a maricón (faggot) was to be a social outcast."

Discrete lesbian or gay male identities in the modern sense - identities that are based on self-definition and involve emotional as well as physical aspects of same-sex relations - were rare. Erotic loyalty (and, in the case of women, subservience) to the opposite sex was assumed to be normal even by homosexuals. Hence, for many Cubans of this era, homosexuality was a mere addendum to customary marital roles. Among others, it was just a profitable commodification of sexual fantasy. For the vast majority, homosexuality made life a shameful and guilt-ridden experience.

Homosexuality was a component of the thriving industry of prostitution in Cuba, with many gay men drawn into prostitution largely for visitors and servicemen from the United States. Homosexuality also was linked to gambling and crime.

Pre-revolution Cuba
In pre-revolution Cuba, there were a few LGBT-friendly bars in Cuban cities, such as the St. Michel, the Dirty Dick, and El Gato Tuerto in Havana. But Cuba had strict laws that criminalized homosexuality and targeted gay men for harassment. "To be a maricón (faggot) was to be a social outcast.”

Discrete lesbian or gay male identities in the modern sense - identities that are based on self-definition and involve emotional as well as physical aspects of same-sex relations - were rare. Erotic loyalty (and, in the case of women, subservience) to the opposite sex was assumed to be normal even by homosexuals. Hence, for many Cubans of this era, homosexuality was a mere addendum to customary marital roles. Among others, it was just a profitable commodification of sexual fantasy. For the vast majority, homosexuality made life a shameful and guilt-ridden experience.

Homosexuality was a component of the thriving industry of prostitution in Cuba, with many gay men drawn into prostitution largely for visitors and servicemen from the United States. Homosexuality also was linked to gambling and crime.

Post-revolution Cuba
Further information: LGBT rights under communism

Homophobia and labor camps during the 1960s
With the profit motive eradicated by the revolution, the superficial tolerance of LGBT persons by the strongly homophobic Cuban society quickly evaporated. Emigration to Miami began immediately, including lesbians and gay men who had worked for United States firms or had done domestic work for the native bourgeoisie. LGBT people who already had lived largely abroad moved away permanently.

The homophobia and heterosexism that already existed ... became more systematized and institutionalized. Gender and sexuality explicitly entered political discourse even as vaguely worded laws increasingly targeted gender-transgressive men who were believed to be homosexual ... whereas lesbianism remained unnamed and invisible. Between 1959 and 1980, male homosexuals suffered a range of consequences from limited career options to detention in street sweeps to incarceration in labor camps. ... Long hair, tight pants, colorful shirts, so-called effeminate mannerisms, "inappropriate clothing," and "extravagant hairstyles" were seen as visible markers of male homosexuality. Such visible markers not only facilitated enforcement of homosexual repression; more broadly, visibility and gender transgressions themselves constituted a central part of the problem identified by the revolution. Even during the severest period of enforcement, Marvin Leiner reminds us, private homosexual expression was never the main target. Rather, "... the major concern, as it had always been, was with the public display of homosexuality."

Many of the progressive LGBT persons who remained in Cuba became involved in counter-revolutionary activities, independently or through encouragement of the Central Intelligence Agency (CIA), and were jailed. The 1961 Bay of Pigs invasion, commando attacks from Florida bases, and internal CIA-sponsored subversion created in Cuba an increased concern over national security. Realistic fears gave rise to paranoia, and anyone who was "different" fell under suspicion. Homosexual bars and La Rampa cruising areas were perceived as centers of counter-revolutionary activities and they began to be systematically treated as such.[8] The gay community was seen as a threat to the military order.

Cuba's new ally, the Soviet Union, had hostile policies towards gays and lesbians, seeing homosexuality as a product of the decadent capitalist society prevailing in Cuba in the 1950s. Fidel Castro made insulting comments about homosexuality. Castro's admiring description of rural life in Cuba ("in the country, there are no homosexuals") reflected the idea of homosexuality as bourgeois decadence, and he denounced "maricones" as "agents of imperialism". Castro explained his reasoning in a 1965 interview:

We would never come to believe that a homosexual could embody the conditions and requirements of conduct that would enable us to consider him a true Revolutionary, a true Communist militant. A deviation of that nature clashes with the concept we have of what a militant Communist must be.

According to Ian Lumsden, traditional Spanish machismo and the Catholic Church have disdained effeminate and sexually passive males for centuries. The homophobia exposed during the revolution was a mere continuation of the well-established culture of machismo and the rigid gender roles of pre-revolutionary Cuba. Barbara Weinstein, professor of Latin American history at New York University and co-editor of the Hispanic American Historical Review, said that gay people were defined as deviant and decadent but not weak or sick. She also claimed that the way that the Cuban revolution came to power gave it a stronger sense of masculinity than other revolutions. The guerrilla experience pervaded the political structure and the guerrilla army itself became the nucleus of a new society.

Cuban gay writer Reinaldo Arenas wrote, "The decade of the sixties ... was precisely when all the new laws against homosexuals came into being, when the persecution started and concentration camps were opened, when the sexual act became taboo while the 'new man' was being proclaimed and masculinity was being exalted." LGBT persons were imprisoned frequently, particularly effeminate males, without charge or trial, and confined to forced labor camps.

Camps of forced labor were instituted with all speed to "correct" such deviations ... Verbal and physical mistreatment, shaved heads, work from dawn to dusk, hammocks, dirt floors, scarce food ... The camps became increasingly crowded as the methods of arrest became more expedient.

In 1965, the country-wide Military Units to Aid Production (UMAP) program was set up as an alternative form of military service for members of pacifist religious groups, such as Jehovah's Witnesses, hippies, conscientious objectors, and gay men. It was believed that the work, together with the strict regimes operating within the UMAP camps, would "rehabilitate" the participants. The camps became notorious both inside and outside Cuba. Although the camps ended up targeting gay men more than most, "there is no evidence that [they] were created with homosexuals exclusively in mind."

A homosexual man who worked in a UMAP camp described the conditions there as follows, “Work is hard because it's nearly always in the sun. We work 11 hours a day (cutting marble in a quarry) from seven in the morning to seven at night, with one hour's lunch break.” Fidel Castro visited one of the UMAP camps incognito to experience the treatment for himself. He was followed by 100 boys from the Young Communist League whose identity was also kept secret. In 1968, shortly after these visits, the camps closed. Castro said, "They weren't units of internment or punishment. However, after a visit I discovered the distortion in some places, of the original idea, because you can't deny that there were prejudices against homosexuals. I personally started a review of this matter. Those units only lasted three years."

Many gay artists and intellectuals like Reinaldo Arenas were attracted to the socialist promise of an egalitarian society, which would pave the way for cultural and sexual freedom and social justice. Gay writers largely wrote the popular journal Lunes de Revolución. Its radical ideas seemed to enjoy the favor of the Cuban Government. But a couple of years after Castro's rise to power, this journal was closed down amidst a wave of media censorship. Its gay writers were publicly disgraced, refused publication, and dismissed from their jobs. Some were reassigned to work as janitors and laborers.
This period was dramatically documented in the 1980s documentary Improper Conduct, Reinaldo Arenas in his 1992 autobiography, Before Night Falls, as well as in his fiction, most notably The Color of Summer and Farewell to the Sea.

Negative attitudes during most of the 1970s
Homophobia in Cuba persisted in the 1970s, with more tolerant attitudes beginning to appear in the mid-1970s.

Although the UMAP program ended in 1968, the camps themselves continued. They became military units, and the same types of men were sent there as were sent to the UMAP camps. The only difference was that the men were paid a pitiful salary for their long and harsh working hours while living under very difficult and inhumane conditions. A 1984 documentary, Improper Conduct, interviewed several men who had been sent to these camps. In his autobiography, My Life, Fidel Castro claims the internment camps were used in lieu of the mistreatment homosexuals were receiving in the military during the Cuban intervention in Angola and other conflicts. They would do laborious tasks and be housed roughly, but some saw it as better than joining the Cuban military because there, they would often be publicly humiliated and discharged by homophobic elements.

After a discussion of homosexuality at the Cuban Educational and Cultural Congress in April 1971, homosexuality was declared to be a deviation incompatible with the revolution. Homosexuality was considered sufficient grounds for discriminatory measures to be adopted against the gay community, and homophobia was institutionalized. Gay and lesbian artists, teachers, and actors lost their jobs. Gays and lesbians were expelled from the Communist Party. Students were expelled from university. Gays were prohibited from having contact with children and young people. Gays were not allowed to represent their country.

A more tolerant policy slowly began to emerge in 1975.
In 1975, the People's Supreme Court found in favor of a group of marginalized gay artists who were claiming compensation and reinstatement in their place of work. The court's ruling was the initial change in official attitudes towards gays and lesbians. In the same year, a new Ministry of Culture was formed under the leadership of Armando Hart Dávalos, resulting in a more liberal cultural policy. In addition, a commission was established to investigate homosexuality, leading to the decriminalization of private, adult, non-commercial and consensual same-sex relationships in 1979.

Gradual liberalization during the 1980s
Cuban gays were expelled or took the opportunity to leave Cuba during the 1980 Mariel boatlift. From the early stages of the massive exodus, the Government described homosexuals as part of the "scum" that needed to be discarded so the socialist society could be purified. Some homosexuals were given the ultimatum of either imprisonment (or extended terms for those already imprisoned) or leaving the country, although Fidel Castro publicly denied that anyone was being forced to leave.

In 1981, the Ministry of Culture stated in a publication entitled "In Defense of Love" that homosexuality was a variant of human sexuality. The ministry argued that homophobic bigotry was an unacceptable attitude inherited by the revolution and that all sanctions against gays should be opposed.

In 1986, the National Commission on Sex Education publicly opined that homosexuality was a sexual orientation and that homophobia should be countered by education.[10] Gay author Ian Lumsden has claimed that since 1986 there is "little evidence to support the contention that the persecution of homosexuals remains a matter of state policy".

In 1988, the Government repealed the 1938 Public Ostentation Law and the police received orders not to harass LGBT people. In a 1988 interview with Galician television, Castro criticized the rigid attitudes that had prevailed towards homosexuality.

Toward the end of the 1980s, literature with gay subject matter began to re-emerge.
More rapid liberalization since 1990

In a 1993 interview with a former Nicaraguan Government official, Tomás Borge, Fidel Castro declared that he opposed policies against LGBT people as he considered homosexuality to be a natural tendency that should be respected. The same year, a series of sex education workshops were run throughout the country carrying the message that homophobia was a prejudice. That same year, the Government lifted its ban on allowing LGBT persons from serving openly in the military. Since 1993, lesbian, gay, bisexual and transgender persons may serve openly in the Cuban Revolutionary Armed Forces. However, discrimination is still common in the Cuban military so LGBT people serving tend to hide their sexual orientation.

In 1994, the feature film Strawberry and Chocolate, produced by the government-run Cinema of Cuba and Tomás Gutiérrez Alea, featured a gay main character. The film criticized the country's narrow, doctrinaire ways of thinking in the 1970s and discussed anti-gay prejudice and the unjust treatment suffered by gays. The film provoked a great deal of comment and discussion among the public.

In 1995, Cuban drag queens led the annual May Day procession, joined by two gay delegations from the United States.

According to a Human Rights Watch report, "the government [in 1997] ... heightened harassment of homosexuals, raiding several nightclubs known to have gay clientele and allegedly beating and detaining dozens of patrons." Spanish filmmaker Pedro Almodóvar was reported to be among several hundred people detained in a raid on Havana's most popular gay discothèque, El Periquiton. According to a United States government report, Cuban customers of the club were fined and warned of imprisonment if they did not stop publicly displaying their homosexuality. The foreigners who were detained were released after a check of their documents. Many of the Cuban gay and lesbian clientele were reportedly beaten by police. This crackdown extended to other known gay meeting places throughout the capital, such as Mi Cayito, a beach east of Havana, where gays were arrested, fined, or threatened with imprisonment.

After this crackdown, Cuban gays and lesbians began keeping a lower profile amid intermittent sweeps of gay and lesbian meeting places. Castro's apparent criticism of Tomás Gutiérrez Alea and his last film Guantanamera during a speech in February 1998 seemed to cast a further chill over Cuba's gay community. Still, a number of clandestine gay clubs continued to operate sporadically in private homes.

In December 2000, half of all the Latin American films shown at the Havana Film Festival had gay themes. Gay and lesbian film festivals are now run in a number of Cuban cities, and in October 2005, a Sexual Diversity Cinema Week was held in Pinar del Río.

Yet, in 2001, the police operated a campaign against homosexuals and transvestites, and prevented them from meeting in the street, fined them and closed down meeting places.

In 2004, the soap opera El jardín de los helechos (Garden of Ferns) included a lesbian couple as part of its plot.[10] That same year, however, the BBC reported that "Cuban police have once again launched a campaign against homosexuals, specifically directed at travestis (transvestites) whom they are arresting if they are dressed in women's clothing."

Carlos Sanchez, the male representative of the International Lesbian, Gay, Trans and Intersex Association for the Latin America and Caribbean Region, visited Cuba in 2004. While there, he asked about the status of lesbians and gays in the country and asked the Cuban Government why it had abstained from the vote on the "Brazilian Resolution", a 2003 proposal to the United Nations Commission on Human Rights that would symbolically recognize the "occurrence of violations of human rights in the world against persons on the grounds of their sexual orientation." The Government argued that the resolution could be used to further attack and isolate Arab countries, consistent with "North American aggression against Afghanistan and Iraq". Sanchez also asked about the possibility of creating an LGBT organization in Cuba. The Government said that the formation of the organization would distract attention from national security in light of constant threats from the United States. After meeting with some Cuban LGBT people, Sanchez reported the following observations:

"Neither institutional nor penal repression exists against lesbians and homosexuals."
"There are no legal sanctions against LGBT people."

"People are afraid of meeting and organizing themselves. It is mainly based on their experience in previous years, but one can assume that this feeling will disappear in the future if lesbians and gays start to work and keep working and eventually get support from the government. (The National Center for Sexual Education is offering this support)."

"'Transformismo' (drag performance) is well accepted by the majority of the Cuban population."

"There is indeed a change in the way people view homosexuality, but this does not mean the end of discrimination and homophobia. The population is just more tolerant of lesbians and homosexuals."

"Lesbians and gays do not consider fighting for the right to marriage, because that institution in Cuba does not have the same value that it has in other countries. Unmarried and married people enjoy equal rights."

In 2006, the state-run Cuban television began running a serial soap opera titled La Otra Cara De La Luna (The Other Face of the Moon) in which a married man "discovers himself" through a sexual relationship with a male friend.

In 2012, Adela Hernandez became the first known transgender person to hold public office in Cuba, winning election as a delegate to the City Council of Caibarien in the central province of Villa Clara.

Fidel Castro takes responsibility
In his autobiography My Life, Fidel Castro criticized the machismo culture of Cuba and urged for the acceptance of homosexuality. He made several speeches to the public regarding discrimination against homosexuals.

In a 2010 interview with Mexican newspaper La Jornada, Castro called the persecution of homosexuals while he was in power "a great injustice, great injustice!" Taking responsibility for the persecution, he said, "If anyone is responsible, it's me. We had so many and such terrible problems, problems of life or death. In those moments, I was not able to deal with that matter [of homosexuals]. I found myself immersed, principally, in the Crisis of October, in the war, in policy questions." Castro personally said that the negative treatment of gays in Cuba arose out of the country's pre-revolutionary attitudes toward homosexuality.

Legality of same-sex sexual activity
Private, non-commercial sexual relations between same-sex consenting adults 16 and over have been legal in Cuba since 1979.

Recognition of same-sex relationships
The Cuban Constitution does not ban same-sex marriage. Until 2019, Article 36 contained language defining marriage as between a man and a woman. This was repealed in a February 2019 referendum. The current Constitution states that "marriage is a social and legal institution. It is based on free will and equality of rights, obligations and legal capacity of the spouses." Nonetheless, statutory laws still contain prohibitions on same-sex marriage, and the country does not recognize civil unions or any other kind of partnership.

A major public campaign by LGBT groups began in late 2017 to amend the Constitution to allow same-sex marriage.[39] In July 2018, the National Assembly approved a new draft constitution which recognized same-sex marriage, though the proposal would need to go to a referendum on 24 February 2019. In September 2018, President Miguel Díaz-Canel expressed his support for same-sex marriage.
Media outlets have spoken of a "revolution within a revolution" or of a "rainbow revolution", and have pointed out how quickly the landscape for LGBT rights has changed, as just a few decades back Cuba imprisoned gay men in labor camps.
On 18 December 2018, it was announced that the National Assembly had removed the language from the draft. This means that same-sex marriage would be neither prohibited nor regulated by the new Cuban Constitution. The National Assembly and Mariela Castro have stated that same-sex marriage will be legalized through a Family Code amendment instead. In March 2019, the Government began popular consultations to look into legalizing same-sex marriage in the Family Code.

Discrimination protections
Employment discrimination on account of sexual orientation is prohibited by law. The Labor Code (Código de Trabajo) does not cover gender identity, and LGBT discrimination in other sectors of society – such as education, housing and public accommodations – is not addressed by the law. Mariela Castro, director of the National Center for Sex Education, had also sought to ban employment discrimination on the basis of gender identity, HIV status and disability, but this was rejected.
In July 2018, a same-sex couple, Brian Canelles and Arián Abreu, were kicked out of a Havana bar after taking a selfie of themselves kissing. A worker at the bar asked them to leave, saying: "The bar isn't interested in the gay public. We don't want that reputation." The case was widely criticized. Merely two days after the incident, Cuba's official gazette published a decree outlining that any private business found to discriminate against clients based on their gender or sexual orientation can be fined 1,000 Cuban pesos (around 860 euros/1,000 U.S. dollars) and shut down.

The Cuban Constitution, amended in 2019, prohibits all discrimination on the basis of gender, gender identity and sexual orientation, among others. Article 42 reads as follows:

“All people are equal before the law, receive the same protection and treatment from the authorities, and enjoy the same rights, liberties, and opportunities, without any discrimination for reasons of sex, gender, sexual orientation, gender identity, age, ethnic origin, skin color, religious belief, disability, national or territorial origin, or any other personal condition or circumstance that implies a distinction injurious to human dignity.”

Gender identity and expression
Since June 2008, qualifying Cubans have been able to have free sex reassignment surgeries.

Blood donation
Individuals seeking to donate blood must be in good health, have a regular pulse and must not have had a viral injection (catarrh or pharyngitis) within the past 7 days. Men who have sex with men are not explicitly banned from donating.

Social conditions

Freedom of association
According to the International Lesbian, Gay, Bisexual, Trans and Intersex Association and other sources, Cuba's only gay and lesbian civil rights organization, the Cuban Association of Gays and Lesbians, was formed in 1994 by eighteen people but was effectively shut down and its members arrested in 1997.
Since 2008, the National Center of Sex Education has sponsored some LGBT festivals and pride events.

In 2013, a week of drag shows, colourful marches, and social and cultural events in Havana culminated with celebrations of the International Day Against Homophobia.[60] Events have been held every year since.

Nosotros también amamos
In 2015, the project Nosotros también amamos (We love too) which advocates for the legalisation of same-sex marriage, was funded by the human rights organisations Corriente Martiana (Martian Current), Fundación Cubana por los Derechos de la comunidad de Lesbianas, Gay, Bisexuales, Trans e Intersex (LGBTI) (Cuban Foundation of Rights of the cummunity of Lesbizns, Gay, Bisexuals, Trans, and Intersex (LGBTI)) and the gay project SHUI TUIX.

In June 2016, Babel, a socio-cultural Cuban LGBT project, declared: "All people are equal in dignity and rights beyond what differentiates us as race, skin color, sex, national origin, political, religious, ideological or sexual preferences, amongst other things"

Here is a piece from good friend Dan Duran from Positively Aware

From quarantine camps to medical accomplishments

It’s a tiny island 90 miles off the coast of Florida, easily dismissed by many as a communist country with a depressed economy. Like many other places in the world, HIV remains a serious concern. But what some people don’t know is that Cuba has achieved a milestone in HIV prevention that has made the world stand up and take note.

Early in the AIDS epidemic, Cuba was notorious for its mandatory HIV quarantine program. Seventeen facilities dotted the island, housing anyone who tested HIV-positive. The largest facility was the sanatorium at Santiago de las Vegas, located just outside of Havana.

From 1986 to 1993, Santiago de las Vegas segregated people living with HIV from the general population, an action that was highly politicized by the rest of the world in a time when HIV and AIDS fear was most rampant. Forced quarantine ended in 1993, but for years afterward, the government continued to maintain strict control over anyone living with HIV. Those that were permitted to live outside of the camps had to disclose their sexual partners and encounters had to be reported to the government. On the world stage, Cuba’s approach towards those living with HIV only served to further tarnish its already diminished reputation throughout the world.

Fast forward more than 20 years later and Cuba is suddenly leading in breakthrough studies and most recently was the first country to receive what can be considered as a global seal of approval—the World Health Organization (WHO) validation —for essentially eliminating transmission of HIV from a mother to her baby. By 2014, more than 40 countries, including the United States, Canada, Anguilla, and Barbados, were testing and treating pregnant women in programs and studies to achieve the same, but Cuba was the first to go through the WHO monitoring program. The program requires data on transmission for a period of at least two years as well as onsite visits by WHO members who examine care in all parts of the country, including even the most remote and underserved parts of a country.

Cuba was able to achieve this accomplishment mainly because its health care system is so highly regulated. HIV tests are commonplace during routine doctor visits and patients who are HIV-positive are put on a treatment regimen and monitored. When a Cuban national goes to see their doctor, they will eventually, at some point, have an HIV test, regardless if they ask for one or not. Women who become pregnant and are HIV-positive are referred to a clinic with a higher level of expertise in HIV, where they will be monitored closely and started on oral antiretroviral treatment, which has shown to reduce transmission to newborns to less than 2%.

At approximately 38 weeks into pregnancy, at the discretion of the doctor and the woman, the mother gives birth via cesarean section, another method proven to reduce transmission of HIV, instead of through the birth canal.* Women are also instructed not to breastfeed their newborns. Additionally, the infant receives antiretroviral treatment for up to six weeks after birth.

The United States has achieved the elimination target at a national level as the rate of transmission of HIV through pregnancy and childbirth is below the two percent mark, which meets the standards of WHO. The problem is that criteria for validation must be met in an equal manner, even in subgroups of the lowest performing areas, and in the United States, the rates of HIV transmission to infants are higher in poor and underserved areas, and communities of color.

Things have dramatically changed for those living with HIV in Cuba since the days of the quarantine. Over the past four years, according to research documented on the government’s official websites, new infections of HIV have been maintained at the same level, and have neither declined nor risen. With regards to the number of new infections, when compared to the small population of the island, the numbers are low. Of every 10 new infections, eight are men, and of those, 88.6% are men who have sex with men, which is the group most at risk.

Beyond the free medical treatment and resources provided by the government, various organizations offer assistance and support. Linea de Apoyo (“helpline” in English) is an organization made up of volunteers, which is funded by Fondo Mundial (known in English as The Global Fund to Fight AIDS, Tuberculosis, and Malaria) and ON USIDA (UNAIDS). Those organizations all come under the umbrella of the government’s Plan Estratégico Nacional (PEN, “national strategy plan” in English), which is now the law, created in response to the HIV epidemic. PEN has been approved through 2018. It was developed in cooperation with the public and Cuba’s Ministry of Public Health. Through PEN, the government pays 100% of all HIV services, including medications and lab work.

Beyond medical care and services, those living with HIV in Cuba are given supplementary rations of food. Cuban nationals receive rations of food each month as mandated by the government. It typically is very little, and includes rice, beans, and a very small amount of meat. Those living with HIV are put on a special diet plan that includes three bags of powdered milk, six pounds of fish, thirty eggs, and two pounds of beef. The additional food is considered to be needed by someone on antiretroviral medications.

Cuba still faces stigma because of its form of government and its history since its revolution, but the country has drastically changed in the past decade since Raúl Castro took power. More rights have been granted to its citizens, including the right to travel outside of Cuba. LGBT advancements have also taken place within the island nation, and now with improved relations with the United States, there may be better days to come for the Cuban people. The country is still under a dictatorship and although treatment and care for those living with HIV is more civilized than it was in the past, people there are still being controlled. But under that control, fortunately, those living with the virus are generally living a normal life and receiving proper medical care. The country as a whole is working towards lowering and perhaps one day ending HIV transmission in Cuba.

Duran’s article can be found here

Sunday, April 21, 2019

Testicular Cancer: Checking one’s own “eggs” is paramount to staying healthy

TESTICULAR CANCER: This April, the month when we think about Easter egg hunts, Justin B Terry-Smith - Drph suggests we go on our own “egg hunt”! Why? Testicular cancer is serious business. Checking one’s own “eggs” is paramount to staying healthy. CHECK THOSE EASTER EGG BASKETS! A&U: America's AIDS Magazine @JustnTerrySmith #JustinBTerrySmith

To see the article Click Here

or follow this link