New York Times "global health correspondent" Donald McNeil Jr. made a rare trip to Cuba and filed a report praising the Communist island's handling of the AIDS epidemic for Tuesday's "A Regime's Tight Grip on AIDS – In Cuba, rigorous testing, education, and free condoms help keep the epidemic in check [1]." Conspiciously absent from that headline, especially for a newspaper that prides itself on defending civil liberties, were the involuntary quarantines of AIDS patients that took place in Cuba until 1993.
McNeil also downplayed concerns about the sanitarium prisons for AIDS patients ("life inside was not brutal"), a policy the Times would no doubt find dangerous and repellent if done in America. He also praised Cuba's "universal health care" and free condoms and credited "socialism" for Cuba's success.
(The same edition of the Science Times was much harder on American health policy, featuring medical writer Tara Parker-Pope talking to a doctor angry about the medical tests selfish Americans demand, a theme well-suited to the Times' call for cost-cutting via universal health care: "Plenty of Blame in a Health System 'Designed to Fail.'")
McNeil opened with the case of Yudelsy García O’Connor, the first Cuban baby known to have been born with H.I.V., the virus that causes AIDS, and downplayed the quaranatine policy.
Ms. García is alive thanks partly to lucky genes, and partly to the intensity with which Cuba has attacked its AIDS epidemic. Whatever debate may linger about the government’s harsh early tactics -- until 1993, everyone who tested positive for H.I.V. was forced into quarantine -- there is no question that they succeeded.
Cuba now has one of the world’s smallest epidemics, a mere 14,038 cases. Its infection rate is 0.1 percent, on par with Finland, Singapore and Kazakhstan. That is one-sixth the rate of the United States, one-twentieth of nearby Haiti.
The population of Cuba is only slightly larger than that of New York City. In the three decades of the global AIDS epidemic, 78,763 New Yorkers have died of AIDS. Only 2,364 Cubans have.
Other elements have contributed to Cuba’s success: It has free universal basic health care; it has stunningly high rates of H.I.V. testing; it saturates its population with free condoms, concentrating on high-risk groups like prostitutes; it gives its teenagers graphic safe-sex education; it rigorously traces the sexual contacts of each person who tests positive.
By contrast, the response in the United States -- which records 50,000 new infections every year -- seems feeble. Millions of poor people never see a doctor. Testing is voluntary, and many patients do not return for their results. Sex education is so politicized that many schools teach nothing about protected sex; condoms are expensive, and distribution of free ones is haphazard.
McNeil credited dictator Fidel Castro in an anecdote that must surely be 100% accurate, coming from a Communist regime with no respect for free speech, showing the dictator waking up to the dangers of AIDS two years before President Ronald Reagan would even mention the disease.
Many medical authorities agree that Cuba had an early and effective response to the epidemic. In his book, “AIDS: Confessions to a Doctor,” published only in Spanish, Dr. Pérez gave his account of the meeting that galvanized Cuba’s response
In 1983, Fidel Castro visited the Pedro Kourí Institute, Cuba’s top tropical disease hospital, to hear a presentation on malaria and dengue fever.
As it ended, he suddenly asked the director, “Gustavo, what are you doing to keep AIDS from entering Cuba?”
Dr. Gustavo Kourí, son of the institute’s founder, was caught off guard, Dr. Pérez said, and stammered: “AIDS, comandante? AIDS? It is a new disease. We don’t even know whether it’s produced by a bacteria, a virus or a fungus. There isn’t much data on it, just what’s been reported in the United States and a few cases in Europe. It will take time to know how big it is.”
Mr. Castro replied: “I think it will be the epidemic of this century. And it’s your responsibility, Gustavo, to stop it becoming a major problem here.”
This was two years before any American president publicly uttered the word “AIDS.” Asked how Mr. Castro could have been so prescient, Dr. Pérez struggled to find the right word, then said: “Castro has luz larga” -- “big lights,” the Cuban slang for automobile high beams. “He reads a lot. He sees far ahead.”
McNeil later admitted that although testing is legally "voluntary," "...pressure is clearly applied. A patient who says no to the nurse gets an appointment with the doctor, then with a social worker and then sometimes with a psychologist. Then a team of H.I.V.-positive educators will make a home visit. So might the local Committee for the Defense of the Revolution. Depending on whom one asks, those committees are the defenders of Cuban democracy, domestic spies or just state-sponsored Nosy Parkers."
McNeil again credited socialism:
There are other subtle pressures, Dr. Castro said. Socialist education teaches Cubans to feel responsible for one another. Also, most Cubans subsist partly on government rations and the sick get extra food, and their lifesaving drugs, from the government.
He let Castro's homophobia slide by in a single sentence:
Until recently, Cuban society and government policies were deeply homophobic; in the revolution’s early days, gay men were sent to labor camps. Fidel Castro now publicly says he regrets that action.
Now there is more acceptance.
McNeil's sidebar on the AIDS sanitariums was benignly headlined "Cuba's Fortress Against a Viral Foe [2]."
But life inside was not brutal. Inmates got food, medical care and their old salaries; theater troupes and art classes formed. Gay men could live together, which was not true in the macho culture outside.
According to McNeil, the restrictions were eased in 1989 and eliminated by 1993.
Thirteen minutes or so into an accompanying Science Times podcast at nytimes.com, McNeil pondered that with 50,000 new HIV infections every year, America should at least consider Cuban-style mandatory AIDS testing: "If we're gonna tackle this we're going to have to increase our testing in the same way that Cuba does. And I'm not sure we can do it entirely through voluntary testing, it's been a huge bust for the last 30 years. So maybe it's time for the United States to look around and see how some other places, like Vancouver, like Cuba, handle their epidemic."
Times science writer Nicholas Wade was not sympathetic to Cuba's quarantine back in 1989 [3]: "In the U.S., quarantine as a solution for AIDS would be both impractical and repugnant."
Surely today's Times doesn't think that just because a policy might have ended up "working," that it is a moral or admirable approach. Unless "The ends justify the means" is now liberal dogma?