HIV /AIDS in Cuba – low prevalence but driven by MSM

UNAIDS  reports  an  exceptionally   low prevalence   of  HIV   in  Cuba. 

Cuba  has  been collecting  data  on  HIV  since  1983.

The  abstract  of   reference  #(80)  cited   in  the  UNAIDS  document ”  Epidemic  Update / 2010  GLOBAL  REPORT”  is  below.

The  whole  article  may  be  seen  at  : http://www.biomedcentral.com/1471-2334/7/130 

The HIV/AIDS epidemic in Cuba: description and tentative explanation of its low HIV prevalence

Héctor de Arazoza^1* , Jose Joanes² , Rachid Lounes³ , Camille Legeai⁷ , Stéphan Clémençon⁴ , Jorge Pérez⁵ and Bertran Auvert^6,7,8*

¹  Facultad de Matematica y Computacion, Universidad de La Habana, La Habana, Cuba

²  Ministerio de Salud Publica, La Habana, Cuba

³  Université René Descartes, Laboratoire MAP5, UMR-CNRS 8145, Paris, France

⁴  Modalx – Université Paris X Nanterre; LPMA – UMR CNRS 7599 – Universités Paris 6 and Paris 7, France

⁵  Instituto de Medicina Tropical «Pedro Kouri», La Habana, Cuba

⁶  INSERM U687, 14 rue du Val d’Osne 94415 Saint-Maurice, France

⁷  Hôpital Ambroise Paré, Boulogne-Billancourt, France

⁸  Université de Versailles – Saint-Quentin; UFR médicale Paris-Ile-de-France-Ouest, Garches, France

author email corresponding author email* Contributed equally

BMC Infectious Diseases 2007, 7:130doi:10.1186/1471-2334-7-130

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2334/7/130

Received:	4 April 2007
Accepted:	9 November 2007
Published:	9 November 2007

© 2007 de Arazoza et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The Cuban HIV/AIDS epidemic has the lowest prevalence rate of the Caribbean region. The objective of this paper is to give an overview of the HIV/AIDS epidemic in Cuba and to explore the reasons for this low prevalence.

Methods

Data were obtained from the Cuban HIV/AIDS programme established in 1983. This programme has an extensive adult HIV testing policy, including testing of all pregnant women. HIV and AIDS cases have been recorded since 1986. Persons found to be HIV-positive are interviewed on their sexual behaviour and partners. Tracing and voluntary testing of these partners are organised. Epidemiological description of this epidemic was obtained from analysis of this data set. Using elementary mathematical analyses, we estimated the coverage of the detection system (percentage of HIV-positive adults detected) and the average period between HIV infection and detection. Estimated HIV prevalence rates were corrected to account for the coverage.

Results

HIV prevalence has increased since 1996. In 2005, the prevalence among pregnant women was 1.2 per 10,000 (16/137000). Estimated HIV prevalence among 15- to 49-year-olds was 8.1 per 10,000 (4913/6065000; 95%CI: 7.9 per 10,000 – 8.3 per 10,000). Most (77%) of the HIV-positive adults were men, most (85.1%) of the detected HIV-positive men were reported as having sex with men (MSM), and most of the HIV-positive women reported having had sex with MSM. The average period between HIV infection and detection was estimated to be 2.1 years (IQR = 1.7 – 2.2 years). We estimated that, for the year 2005, 79.6% (IQR: 77.3 – 81.4%) of the HIV-positive persons were detected.

Conclusion

MSM drive the HIV epidemic in Cuba. The extensive HIV testing policy may be an important factor in explaining the low HIV prevalence. To reduce the HIV epidemic in Cuba, the epidemic among MSM should be addressed. To understand this epidemic further, data on sexual behaviour should be collected. Now that antiretroviral therapy is more widely available, the Cuban policy, based on intensive HIV testing and tracing of partners, may be considered as a possible policy to control HIV/AIDS epidemics in other countries.