Cuba: a milestone towards an AIDS-free generation

While a report issued on 25 June by the UNAIDS and Lancet Commission urgently calls for greater investments in HIV prevention to reduce new HIV infections and transmission, Cuba’s sustained efforts to prevent mother-to-child transmission has brought the world positive news – the country has become the first to complete the formal validation process for the elimination of vertical transmission of HIV and congenital syphilis, a process led by PAHO/WHO and UNICEF.
This milestone is a great opportunity to pause and reflect on the whole process, to look back at everything that has been done to achieve this result, and to look forward at everything that remains to be done to achieve an AIDS-free generation.
So how has the situation evolved since 1986, the year in which the first HIV cases were diagnosed in Cuba? In the late 1980s, it was very unusual for HIV-positive women aware of their status to start a pregnancy. The mother-to-child transmission rate was above 40 per cent. Only one HIV test was carried out, during the first trimester of pregnancy. Preventive measures for HIV-positive mothers only included a C-section and the suspension of breastfeeding.
As knowledge improved, so did control and prevention measures. Nowadays, all Cuban pregnant women are tested for HIV three times, once per trimester of pregnancy. HIV-positive pregnant women have access to antiretroviral treatment, and their children receive prophylaxis and are tested for HIV during their first year of life. Thanks to these efforts in preventing, controlling and monitoring HIV, in recent years, pregnancies of HIV-positive women have increased, and the mother-to-child transmission rate of HIV has decreased to 1.85%, below the 2% target.
Yet, a milestone is not the end of the process. We still have a long way to go to achieve an AIDS-free world. In Cuba, as in many countries in the world, our big challenge is to improve people’s knowledge about HIV transmission.
Our work in Cuba focuses on supporting the country’s HIV prevention efforts and raising awareness about HIV among adolescents and young people, as evidence shows a low risk perception and risky sexual behaviours: around one-third of young people start their sexual life without protection, and about half of them consider that they do not have any chance of being infected with HIV[1]. Only 60.9 per cent of women and 58.6 per cent of men aged between 15 and 24 correctly identify two ways to prevent sexual transmission of HIV[2]. It is also necessary to keep fighting discrimination against people living with HIV and AIDS.
As a milestone has been reached, let’s take some time to praise the incredible advances that have taken place in the fight against HIV and AIDS since the 1980s. And then, let’s keep moving forward and working to eliminate the remaining obstacles on the path towards an AIDS-free generation.
Anna Lucia D’Emilio is UNICEF Representative in Cuba.

[1] National Office for Statistics and Information, Cuba.
[2] Multiple Indicator Cluster Survey, Cuba, 2014.


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  1. Cuba is to be congratulated on this major success. But it is unclear why – in the era of effective maternal antiretroviral therapy for HIV-infected mothers, which will reduce their viral load to undetectable within 13 weeks – it is necessary for PAHO to continue to recommend Cesarean Section – a measure which was phased out in the rest of the world about 8 years ago as there was no benefit and many risks. Nor is it clear why PAHO recommend no breastfeeding for HIV-positive mothers in Cuba and other South American and Caribbean countries. The recommendation for formula-feeding would appear to contradict the WHO 2010 HIV and infant feeding guidance which recommends maternal ART and exclusive breastfeeding for the first six months as the feeding method likely to achieve the greatest likelihood of HIV-free survival. See Nor does the Cuban press release mention morbidity/mortality or malnutrition for non-breastfed babies.