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by Coco Jervis

Cuba boasts model health outcomes but at what costs to human rights?

In November 2009 TAG’s senior policy associate, Coco Jervis, attended the Global Forum for Health Research meeting in Havana, Cuba, under a special license that permits U.S. citizens to go to Cuba for professional meetings sponsored by international organizations. The forum brought together more than 900 researchers, clinicians, advocates, entrepreneurs, and government health ministers from over 85 countries to discuss global health research innovation to improve health equity for the poor and disadvantaged.

As a leader in TB/HIV research and development investment tracking, TAG was invited to a preconference satellite meeting organized by the Global Forum to discuss the challenges of tracking resources for health research. Speakers focused on the need for more research investment in health systems strengthening and neglected diseases, the current backlash against global HIV spending and other disease specific research investments, the need for better guidelines for cross-country comparisons of investments in health research, and how to leverage health research investment data more effectively in health research advocacy.

As the hosts of the Global Forum, Cuban government officials showed little humility showcasing their own remarkable achievements in the public heath sector despite limited resources. With the guarantee of free and universal heath care for everyone—which many conference goers duly noted as doctors pounced on anyone who dared to enter the country with a sniffle or flushed face—the entire Cuban health care system is tiered with a reliance on wellness, holistic care, prevention of disease realized via watchdog zeal, and, at times, draconian measures. Case in point: Cuba boasts the lowest HIV rate in the Western Hemisphere, with only 2,700 HIV-positive people in the entire country as of 2007, according to UNAIDS statistics. Cuba’s shockingly low HIV rate (whatever the true prevalence) belies a haunting reality that Cuban officials still firmly argue to justify the widespread violations of human rights which took place during the forced quarantine programs that lasted until the early 1990s. (Other violations of human rights including institutionalized homophobia are also well documented). Nowadays, treatment for HIV-positive people is said to take place at the community level, with daily clinic visits required for all those newly diagnosed and mandated (under the threat of detention), and treatment adherence monitored via house calls made by doctors and nurses who live in the community. These same clinicians are the gatekeepers for upward referrals to more specialized care, and they convene quarterly with community leaders to discuss health issues within the community. Despite the fact that taxi drivers and hotel clerks make more money then do government-paid clinicians and health researchers (Cuba boasts that they are one of the few developing countries that can provide a comprehensive supply of generic HIV medicines to their people), medicine remains a highly respected profession.

Cuba’s public health system and its health care delivery model underscores the reality that despite limited resources much can be accomplished in improving health outcomes via strong (indeed, often coercive) political will. But, the central question remains: At what costs, and who gets to decide? As the HIV/AIDS community can attest, Cuba’s authoritarian approach to protecting public health tramples the human rights of people living with HIV.

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