Cuba quarantined people with AIDS and HIV from 1986 to 1994 to limit the spread of the disease. It may have contained the disease but there were anecdotal reports of some young people intentionally infecting themselves with HIV so they could be assured of meals during the country's economic collapse after the fall of the Soviet Union in 1991. That scenario born out of desperation was the subject of the 2011 film "Boleto al Paraíso" ("Ticket to Paradise").
While the numbers were kept relatively low in those early dark days of AIDS, now Cuba's HIV rate of people living with the disease is about the same as the U.S., with an overall infection rate of .36% in the U.S. versus .39% in Cuba. Those figures from Cuba are based on UNAIDS' numbers from 2022. The U.S. numbers are from 2021 as cited at HIV.gov. But many have questioned the accuracy of Cuba's health statistics and allege they paint a far too rosy picture of its health care system. The country has long boasted of a socialized health care system with an abundance of doctors, but critics say those doctors often don't have the medical equipment and basic supplies to adequately serve patients.
The independent online publication the Havana Times reported in December that according to state-run media, at the beginning of December 2023 there were 1,600 new HIV cases reported for the year, more than the recent average of 1,500 annual new cases, with another month to go. The publication noted that HIV testing stopped during the COVID pandemic lockdowns, helping to fuel new infections.
Last month the Bay Area Reporter talked to two gay HIV-positive Cuban men in their 30s. Both said that there is, at times, a lack of availability of AIDS drugs, as there are shortages of just about every essential item provided by the country's socialist economic system. PrEP is for sale to anyone on the black market but free only if someone is already partnered with an HIV-positive person.
A 33-year-old Cuban native and sex worker who requested anonymity told the B.A.R. that he was first diagnosed with HIV 10 years ago. It was the result of oral sex with someone he was dating during a time he had gingivitis with bleeding gums.
Although it was common practice at the time in the U.S. and other countries to immediately put an HIV-positive person on medication, the man was told he had to wait until his viral load increased or had developed symptoms before he could begin treatment. He started taking HIV drugs three years after he was diagnosed. Then he said that he was given ineffective medicines with side effects before being switched to his current medication that has allowed him to have an undetectable viral load without drug side effects. He said that the pharmacies sometimes run out of medication, forcing him to go without HIV drugs for a time.
"I go to the pharmacy, to the drugstore, they don't have it. So I must wait. Like maybe a week, maybe 15 days, to take it before they have it again," he said, speaking in English.
Doctors have long cautioned that skipping HIV doses can lead to drug resistance in some people and cause a viral rebound in others.
He said that in his sex work, clients want sex without protection.
"When a tourist contacts me, they always ask if we can have unsafe sex. I always ask them if they are on PrEP. They say yes, that's all," he said, adding that his clients never ask if he is HIV-positive. He says that even though a customer may say they are on PrEP, he tells them the price is higher for unprotected sex.
"You say for a meeting, $50 or euros," he explained. "But if they want to have unprotected sex then it is $100."
He said the majority of his clients are from Russia or Western Europe, followed by Americans.
The man said that despite the drug shortages, he has remained undetectable so he is confident he is not going to spread HIV to an uninfected person.
He noted that Cuba provides PrEP drugs but only for people who are coupled in a long-term relationship with someone who is positive. He said PrEP is for sale on the black market for about $2 for a month's supply. Since the average Cuban makes just $20-$30 a month, that is a significant price, he explained.
Prostitution is illegal in Cuba and, to cut down on sex work, hotel guests are not allowed to bring people home. That rule can easily be gotten around via an Airbnb residence or other rentals where guests are not monitored. He said that he uses the gay hookup site PlanetRomeo to get clients.
He said that despite the prevalence of HIV in Cuba, HIV-positive people face prejudice, and it is not something that is talked about openly.
"Almost eight of 10 that you can see in the gay community are positive but they don't say it because of the stigma," he told the B.A.R.
He said he appreciates the work that former president Raul Castro's daughter, Mariela Castro, has done in support of LGBTQ rights, though he sees the pro-gay sex education bureaucracy she runs, CENESEX, as mostly a propaganda tool designed to improve Cuba's image on the world stage.
He is single and would like to live in the U.S. one day. When asked his overall impression of the United States, he responded, "I want to go there."
"I want to be oppressed by capitalism," he added with a laugh. "At least they have free will. We don't have that."
The second HIV-positive man with whom the B.A.R. spoke said he was diagnosed just two years ago after suffering from a rash and feeling physically sick and depressed.
"So, I went to the doctor and he recommended to me an HIV test," said the man, who also requested anonymity and spoke in English. "I got the HIV test. It was positive. And I was like, 'I can't believe it.' And then I repeated the test. It came back positive again."
Immediately after his positive test he was sent to a psychologist in the next office. He told her of his depression and suicidal thoughts.
"Before (the HIV diagnosis), I knew there was something wrong with me. But I didn't know what it was," he said.
Unlike the man who was diagnosed 10 years ago, he was prescribed HIV drugs immediately. But like the other man, he feels prejudice even within his own community.
"I noticed a lot of stigma," he explained. "That's why I don't share it with people. Because then they won't see me just as me. They will see me as the guy who has AIDS, you know, even when it's not AIDS anymore, but they don't see a difference between HIV or AIDS. This gay community doesn't have much culture in this country about sexual transmission diseases, even when there are a lot of sexual conditions like this going on. People just still don't have sex with protection. And they do all these crazy things."
He was not sure from whom he got HIV but believes it was because he didn't have safe sex.
"That happened to me because I didn't use protection. Of course, in a one-night stand, it got out of hand. It was so hot. Everything was so ... then you got it," he said. "I don't even know who and (medical professionals) don't ask you anymore. They don't even ask you anymore. Who could be, who could possibly be? I think it was my ex I think but that was six years ago, but I was always so healthy. I think that maybe my body resisted. And eventually, after the depression, my immune system went down and this illness came up. I don't know."
He is doing well with his HIV treatment. A year ago, he married his partner of six years. His husband has remained HIV-negative.
The Cuban sex-education bureaucracy, CENESEX, did not respond to multiple emailed requests for comment. A B.A.R. reporter stopped by the CENESEX offices in January but was referred to another office nearby that appeared to be set up to support people with HIV. That office directed questions to Cuba's central press office, but the person who was designated to handle questions was not available when a reporter arrived at the office.
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