Cuba has, for decades, been an isolated nation with high poverty. But in one important way–its health care system–it’s actually equal to or even beyond much richer economies. With universal care provided by the nation’s cadres of dedicated, well-educated doctors, Cubans live even longer lives than Americans, despite a profound lack of advanced medicines.
The latest evidence of what researchers have called the “Cuban paradox” comes in the form of a dramatic announcement from the World Health Organization (WHO) this week: Cuba has become the first nation in the world to eliminate the transmission of HIV and syphilis from pregnant mothers to their children. The organization called it “one of the greatest public health achievements possible” and “an important step towards having an AIDS-free generation.”
The history of HIV in Cuba is a fascinating one. It was one of the first countries in the world to take the epidemic seriously–setting up a national AIDS commission in 1983, before its first case was even diagnosed. But it’s response was controversial for trampling on human rights. For almost a decade until 1994, HIV patients were required by law to live in quarantine. That policy was relaxed, but still later, newly infected patients had to spend eight weeks in a sanatorium and all pregnant women were required to be tested for the virus. And because antiretroviral drug treatments were hard to get due to the U.S. trade embargo, the government went as far as to manufacture its own drugs. Today, the payoff is that, in adults, Cuba has lower HIV prevalence rates than even the United States. This is remarkable considering the rest of the Caribbean’s high infection rates.
Cuba’s victory in ending mother-to-child HIV transmission came from a combination of relatively simple measures, such as testing, education, drug access, and Caesarean deliveries for HIV positive mothers. It was successful because it provided these services as part of an “equitable, accessible, and universal health system,” WHO health officials said.
The broader context of the WHO announcement is an ongoing global push to drastically reduce new childhood HIV infections.
Stephen Lee, a global HIV expert with the Elizabeth Glaser Pediatric AIDS Foundation, says the world is making good progress: Today, some 67% of women who get pregnant each year have access to antiretroviral drugs, whereas just two or three years ago, that number was half. Treating a mother and child with antiretrovirals all but eliminates the chance a child will contract HIV from his or her mother. “With each year, the number of women who are accessing treatment for prevention will increase. The big challenge is scaling up,” he says.
Much of the very hard work must be done in 22 countries that account for 90% of new childhood infections, and all of these countries are in sub-Saharan Africa, except for India. Around the world in 2013, about 240,000 children were born with HIV, or almost 700 a day–this is already a big improvement from 2009, when there were 400,000 new infections. But it’s still not near the world’s goal to reach only 40,000 new infections by 2015.
In reality, Lee says, Cuba is probably not the first country to eliminate mother-to-child HIV transmission, and other developed nations, including the United States, might also meet the WHO’s criteria (defined not as zero new cases, but as such as small number of cases that they are no longer a public health threat). But Cuba was the first country to go through the organization’s new verification process. He says that several countries in Africa, such as Zimbabwe or possibly South Africa, might be ready to undergo verification in the near future.
In addition to drug access, expansion of preventative health care systems in these nations and ending stigmas associated with HIV will be important to achieving the goal. And in the long-term, ending new childhood cases could go a long way to lowering the overall HIV rates in Africa. “We have the knowledge and expertise,” Lee says.