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

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• 作者：Héctor de Arazoza (1)
  Jose Joanes (2)
  Rachid Lounes (3)
  Camille Legeai (7)
  Stéphan Clémen?on (4)
  Jorge Pérez (5)
  Bertran Auvert (6) (7) (8)
  
• 刊名：BMC Infectious Diseases
• 出版年：2007
• 出版时间：December 2007
• 年：2007
• 卷：7
• 期：1
• 全文大小：508KB
• 参考文献：1. Inciardi JA, Syvertsen JL, Surratt HL: HIV/AIDS in the Caribbean Basin. / AIDS Care 2005, 17 Suppl 1:S9-5. CrossRef
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  16. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2334/7/130/prepub
  
• 作者单位：Héctor de Arazoza (1)
  Jose Joanes (2)
  Rachid Lounes (3)
  Camille Legeai (7)
  Stéphan Clémen?on (4)
  Jorge Pérez (5)
  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
  7. H?pital Ambroise Paré, Boulogne-Billancourt, 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
  8. Université de Versailles -Saint-Quentin; UFR médicale Paris-Ile-de-France-Ouest, Garches, France
  

文摘

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.