Sun Sentinel

The Cuban point of view is that you have the right to be sick, but not to transmit it to anyone else.


June 8, 2001


From a comfortable two-bedroom house that he shares with his partner and another couple, Raudel Hernández Díaz lives a life far removed in style from that of most Cuban men. Especially gay Cuban men.

Just a few steps from his door is a small clinic, part of the Sanatorium Santiago de las Vegas, where Hernández, 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, Hernández gives up his freedom. He's allowed to leave the sanatorium on weekends, but others who are deemed less confiable -- trustworthy -- must remain for months.

"It's not so much that I like to live here," says Hernández, who returned to the sanatorium last year after he broke up with his former boyfriend and had no other place to live. "On some days I feel stressed and I need to leave. But because of my housing situation, I had no other option. I would work here even if I didn't get paid. It eases my stress and makes me feel useful.

"There comes a moment when this is your family," he adds. "There is no difference between the patients and the [sanatorium] workers. It becomes a collective."

Cuba has the distinction of having one of the smallest HIV infection rates in the world in a region with one of the highest. It also is the most populous country in the region and has some of the most liberal attitudes toward sex, according to surveys.

Given its size, if Cuba had the same infection rate as some neighboring countries, the epidemic in the region would be even more dire, experts say. Elsewhere in the Caribbean, the effort to curtail the epidemic has been hampered by poverty, inadequate health systems and unstable governments.

In many parts of the Caribbean, those suffering from AIDS are denied medical treatment by doctors and nurses who fear the disease. Men, no matter what their sexual orientation, are labeled gay. Women, who have little economic or legal protection, are denounced as prostitutes. All can be rejected by families and driven out of their neighborhoods.

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. Many gay Cubans find acceptance at the sanatoriums that is lacking in the rest of society, where homophobia prevails.

Early on, the government of Fidel Castro took steps to contain the contagion, creating a nationwide system of sanatoriums for those diagnosed with the virus.

It wasn't that difficult. Because of its isolation during the Cold War, Cuba was cut off from the sexual tourism that likely brought the AIDS virus to Haiti and other countries two decades ago.

The spread to Cuba was linked to the country's military involvement in Africa. The oldest of Cuba's 14 AIDS sanatoriums, Santiago de las Vegas was originally conceived as a retreat for Cuban army officers recovering from psychological breakdowns. It switched to treating HIV patients exclusively after the first cases were diagnosed in soldiers returning from the Congo in 1986.

"We didn't know how the disease would spread through the population," says Alberto Rosabal, sub-director for social assistance at the sanatorium. He still bristles at foreign media coverage that criticized Cuba for its quarantine policy. "Our initial thought was to give [patients] complete attention and keep them in a type of quarantine to observe them," Rosabal explains. "We would demand and pressure people to come. ... Most people accepted coming because they were afraid for their lives."

Controversial as the sanatoriums were, involving serious violations of civil liberties, the measures worked. Cuba has screened all blood donors for HIV since 1986, well ahead of other Caribbean countries. In 1987, it began screening all pregnant women, people diagnosed with sexually transmitted diseases 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," explains Dr. Jorge Pérez, who diagnosed the country's first AIDS patient and helped shape the policies of the Santiago sanatorium as its director for 11 years.

But faced with mounting international criticism over the forced quarantines, the government realized it had to alter its approach.

In January 1998, officials created a "day hospital" program in which patients were bused in for classes on HIV and AIDS, then returned to their homes at night. Many now have an option to go to the Santiago sanatorium as outpatients for checkups and medications. Still, the decision rests with physicians, not patients.

"We learned that not everyone is the same," Pérez says. "We started to differentiate between people who are responsible with their health and those who are not."

The Santiago sanatorium has capacity for 300 patients and a new wing under construction will be able to house another 80. New partnerships and romances regularly bloom among gay couples, who live together openly.

"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 in Cuba infected patients are getting a better diet than much of the general population.

Compared to most Cubans, who scrape and save to buy meat, vegetables, cooking oil and other staples often missing from bodega shelves, sanatorium patients are given rich meals that include beef, ice cream and milk.

Patients get three meals and three snacks a day -- a feast by Cuban standards, where the economic crisis has severely eroded diets since the end of the Cold War. Many Cubans routinely skip breakfast or drink sugar water because they don't have enough food.

"What a patient eats here in one week would last me and my family a month," jokes Rosabal.

Some patients also receive expensive anti-retroviral drugs, medicine that is out of reach to many in developing countries. Cuba began producing some components of the medical "cocktail" this year. It imports other drugs and receives donations from organizations and individuals abroad.

Cuba is able to provide, free of charge, anti-retroviral medications for approximately 157 AIDS patients, Rosabal said. "We haven't covered all the needs," he said. "We hope to expand the number of patients receiving the cocktail this year."

Still, despite housing, food and medicine, the lack of freedom bothers some who have lived in the sanatoriums. They argue that the government quarantines people against their will.

"The sanatorium works for people who have no place to eat, who can't take care of themselves," says one HIV-positive man, who fought doctors who tried to coerce him into moving to the sanatorium. "But for someone who is functioning ... despite 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 get out of living at the sanatorium only after lobbying his boss and receiving a favorable letter from her.

"I'm one of the privileged people in this country," says the man. "I'm a professional. I have contacts and telephone numbers.

"Why should I share a room with four people when I have my own?" he says. "Why should I be surrounded by guards? When you can't live the way you want to, at what point are you still alive?"