Approximately 1,600 people have been diagnosed with the human immunodeficiency virus (HIV) in Cuba so far in 2023, it was recently announced in the state-controlled media. 

This figure is a cause for concern for health authorities and for society on the whole, as there are 100 more new cases (and the year isn’t over yet) compared to the 1,500 annual average in recent years. 

Add to this the fact that there are a number of people who are HIV+ and haven’t been detected, so the transmission chain can continue. 

According to a statement from Jorge Perez Avila, a doctor who has been studying HIV/AIDs for over 30 years, a percentage of people still don’t know they have the virus because tests weren’t being carried out during COVID-19 and lockdown. 

Perez Avila admitted that 90% of cases that would have normally been diagnosed under normal circumstances, couldn’t be detected during the pandemic. 

In January 2023, local media warned about rising HIV cases. In Holguin, 116 new cases were detected up until December 1st 2022, 31 more cases than in 2021. The eastern province is one of the six Cuban provinces with the highest numbers of cases detected in Cuba’s history of HIV. 

Another province with rising numbers is Santiago de Cuba, where 307 cases were detected in 2022, a figure that is concerning for health authorities. 

Women account for 19% of those living with HIV, and 30.5% of these women are over 50 years old. Within this last group, two women are over 90 years old.

Approximately 32,000 people live with HIV in Cuba ever since the first case was diagnosed in the 1980s. In 2022, 366 Cubans died and the total number of deaths is 6087, since April 1986 when the first HIV-related death was announced. Nevertheless, the death rate decreased from 3.6 per 100,000 inhabitants in 2021 to 3.3 in 2022. 

Even though there have been breakthrough treatments for people living with the virus – Cuba eliminated mother-child transmission, for example -, condom shortages on the island are still a problem for prevention and treatment. 

There is no prevention without condoms

Health awareness and sexual education campaigns aren’t enough to stop HIV. Condoms are the main form of prevention and there has been a condom crisis in Cuba for over ten years. 

Even though condom shortages are probably the main reason for HIV and other STD cases soaring, there doesn’t seem to be a concrete measure to try and solve this. 

“There is no better prevention than using a condom, and unfortunately, there haven’t been any in our drugstores for years. Are anti-retroviral drugs really cheaper than condoms?” a forum user called Ever asked in the comment section of an article on state-led media platform Cubadebate. 

Nearly every comment on this article complained about the lack of condoms at Cuban drugstores and this doesn’t only increase the risk of getting a STD, but also the number of unintended pregnancies. 

Different media outlets have written about condom shortages in drugstores, which has increased the prevalence of diseases such as syphilis (from 3793 reported cases in 2021 to 7428 in 2022) and gonorrhea (from 1770 in 2021 to 1873 in 2022). 

Statistics from the 2022 Statistical Health Yearbook support Santiago de Cuba’s Head of HIV/AIDs department Niurka Pileta’s statements to the Cuban News Agency. The official said that 894 people were diagnosed with syphilis in 2022 in the province, 91 more than in 2021, and there was a higher number of medical conditions such as genital herpes, urethral discharge, vaginal discharge and lower abdominal pain. 

This is particularly concerning because many of the above illnesses are mostly affecting teenagers and young people aged between 15-24. 

On March 30, 2023, it was announced that the UN Population Fund in Cuba had donated 1,785,600 male condoms “for distribution to health facilities on the island.”

There were over 70 comments on the Facebook post from people expressing thanks for the donation, but they also said that this wouldn’t be enough given condom shortages in the country. Today, you can find condoms on the illicit market for 50 to 100 pesos each (several hours to a day’s pay for many Cubans). Some of those are even the condoms that came from the UN AIDs program. 

“I buy them in packets of 50 or 100 on AliExpress and send them to my family,” a Cuban living in Italy says. “The packet costs from 6-9 euros, they used to sell at Cuban drugstores for 15 cents, but they help,” he noted. 

An article published in July 2023 in Sancti Spiritus’ weekly paper Escambray admitted that condoms hadn’t come into the province since March 2022, when they received only “54,000 condoms from a plan for 2,809,078 units, meaning they only had enough for seven days.” 

Cuba imports condoms or receives them in donations from different foreign NGOs. 

Officials stated in 2022: “there has been a steep drop in condom coverage over the past three years, because contracts that had been signed went on standby because of the COVID-19 pandemic.” However, shortages go back ten years. 

In Santiago de Cuba, pre-exposure prophylaxis (PrEP) are being given out for free as an alternative to the condom shortage. This medicine cuts your risk of contracting the virus during sexual intercourse by 99%. 

Nevertheless, PrEP doesn’t replace condom use.

Beyond condoms and medicine

According to statements from Carilda Peña, the Vice-Minister of Health who oversees the area of Hygiene and Epidemiology, 96.8% of diagnosed cases receive treatment with free anti-retroviral drugs, while over 80% have a one-pill a day treatment. 

In October 2023, news broke that the Pan American Health Organization had given the Ministry of Public Health anti-retroviral drugs from Brazil. The donation contained over 100,000 25 mg tablets of Tenofovir Alafenamide, and it was meant to improve the quality of life of over 100 HIV+ positive people over a six-month period. 

Even though some patients consulted by El Toque say that they have had access to the medicine, with some limitations, different independent media outlets have reported the harsh living conditions for HIV patients who are in Cuban prisons because they are lacking proper medical assistance. 

A report revealed the vulnerable situation of Daysi Rodriguez Alonso, an HIV+ woman who was arrested in Cuba after the July 11, 2021 protests. 

The mother of Brenda Diaz, another prisoner of conscience from 11J (the same protests) in the “Cuba-Panama” prison for HIV/AIDs sufferers, complained about negligent care for her daughter. The lack of medical assistance and poor living conditions in prisons have led to protests, complaints and concern for detainees’ health. 

“Medicines come in one month, the next month you go to the drugstore and they tell you: “this medicine didn’t come in, we’ve got this one,” and so you get that one. It’s madness, because changing medicines should be done by the book,” Marti Maykel Herrera, who is HIV+ told the international Radio and TV Marti. 

In addition to medicines, HIV+ people also need other important conditions to keep some quality of life. 

An online user called Roberto says that in Havana, for example, he hardly gets the food included in his specially perscribed diet. “Only eggs; and beef didn’t arrive this month. They’ve stopped selling milk, root vegetables, cooking oil, canned meat and fish via the ration booklet. Chicken has been missing for many months this year,” he said in an article posted by Cubadebate. 

According to Roberto, he’s lost weight because of the irregular sale of subsidized foods. 

Cuba hopes to reach the 95-95-95 target by 2030. This means that 95% of people with HIV will be diagnosed, 95% of them will have access to treatment and 95% of them will have an undetectable viral load, which is to say, it’s not transmissible. 

However, the objective of the UN/AIDs program seems unreachable in a country where the health crisis – lacking material and human resources – doesn’t look like it will change any time soon.

This article was translated into English from the original in Spanish.