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Frerichs, R.R. Control of HIV in an economically devastated country. 

SEA-AIDS Network, May 31, 1999.

R.R. Frerichs Posting

While the HIV epidemic continues in much of the developing world, funds to support prevention and control efforts are not increasing. This point was again brought home on Tuesday, May 25 at the annual assembly of the World Health Organization (WHO). Dr. Gro Harlem Brundtland, as WHO Director General, had asked the 191 member nations for additional resources, but was awarded a regular budget of $843 million for 2000-2001, the same amount as allocated for 1998-1999. While the full expense of the Kosovo crisis is not yet apparent, it seems clear that the Baltic region is absorbing funds from Europe and the United States that might otherwise have gone to improving public health in Asia, Latin America and Africa.

So what can be done about HIV in Asia, if external assistance funding is not increasing, in line with the epidemic?  The answer may partially lie in Cuba, a country that has experienced severe economic and social hardship as a result of the economic boycott of the United States and lost markets due to the break-up of the Soviet Union.  Even though funds have been scarce, the Cubans have been able to contain HIV, maintaining an estimated adult prevalence of 0.02 percent, among the lowest in the world of countries with noticeable infection. According to the Pan American Health Organization (PAHO), the majority of HIV-infected individuals acquired the infection in Cuba; only slightly more than 15 percent became infected abroad. 

Cuba has long had a program of active case finding. This effort has revealed that most cases are detected in contacts of HIV-positive individuals (33.7%), in persons with STDs (15%), and in prisoners (14.1%). Again according to PAHO, the Cuban strategy for addressing this problem includes conducting studies of the groups at highest risk, carrying out epidemiological investigation of 100% of cases, performing analyses of hospital and outpatient admission records, and implementing a comprehensive program of health education for the general population.

Additional details on the Cuban situation are available at the new UNAIDS website ( and at the PAHO website ( Perhaps officials at UNAIDS or WHO who are familiar with the Cuban situation could share with SEA-AIDS the practices in Cuba that have allowed this economically-devastated nation to keep HIV/AIDS under control. With new money being scarce, such insight is now all the more important for countries in Asia struggling with the epidemic.