> One of the many interesting aspects of how the US dealt with the AIDS epidemic is what we didn’t do – in particular, quarantine. Probably you need a decent test before quarantine is practical, but we had ELISA by 1985 and a better Western Blot test by 1987.
> There was popular support for a quarantine.
> But the public health experts generally opined that such a quarantine would not work.
> Of course, they were wrong. Cuba instituted a rigorous quarantine. They mandated antiviral treatment for pregnant women and mandated C-sections for those that were HIV-positive. People positive for any venereal disease were tested for HIV as well. HIV-infected people must provide the names of all sexual partners for the past sic months.
> Compulsory quarantining was relaxed in 1994, but all those testing positive have to go to a sanatorium for 8 weeks of thorough education on the disease. People who leave after 8 weeks and engage in unsafe sex undergo permanent quarantine.
> Cuba did pretty well: the per-capita death toll was 35 times lower than in the US.
> Cuba had some advantages: the epidemic hit them at least five years later than it did the US (first observed Cuban case in 1986, first noticed cases in the US in 1981). That meant they were readier when they encountered the virus. You’d think that because of the epidemic’s late start in Cuba, there would have been a shorter interval without the effective protease inhibitors (which arrived in 1995 in the US) – but they don’t seem to have arrived in Cuba until 2001, so the interval was about the same.
> If we had adopted the same strategy as Cuba, it would not have been as effective, largely because of that time lag. However, it surely would have prevented at least half of the ~600,000 AIDS deaths in the US. Probably well over half.
> In 1986, 1 year after documenting its first case of AIDS, Cuba instituted the world's only mandatory quarantine policy for people with human immunodeficiency virus (HIV) infection. The Cuban Ministry of Health began widespread HIV testing, focused on but not limited to members of groups considered to be at high risk due to their travel or sexual histories. In 1986 alone, the ministry invested $3 million in testing equipment.1 By 1993, 12 million tests had been conducted in a country with 11 million citizens.2 Cubans with HIV infection were confined in newly constructed sanatoriums across the island and were questioned by health workers about past sexual partners for contact tracing and testing. Critics of Cuba's quarantine policy charged that it violated human rights,3 while supporters applauded Cuba's commitment to HIV control.4 In 1994, the quarantine was officially lifted. However, by 2003, half of all HIV-positive Cubans still lived in the sanatoriums.5
> Cuba's early response to HIV was unique in the world, but so were the circumstances of its quarantine. First, as an island and a Communist country, Cuba was geographically, politically, and socially isolated from North American and Western European countries that reported high HIV infection rates. Second, Cuba's Communist political culture did not recognize individual rights as an impediment to its public health measures.6 Third, compared with other resource-poor nations, Cuba had a well-developed health care system that assigned a primary care physician to all citizens and conducted routine surveillance for infectious disease, and in which universal HIV testing and contact tracing was theoretically feasible.5,7 In addition, the Cuban government prioritized HIV care and by the 1990s devoted $15 million to $20 million annually to providing antiretroviral drug therapy, intensive medical care, high-quality food, and housing to quarantined patients.8
