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BIOLOGY, Health Care

The Elimination of Mother to Child Transmission of HIV in Cuba

Geographic Area: Cuba

Health Condition: In the 1980s when every Sub-Saharan African country was concerned about HIV/AIDS, Cubans also introduced a rigorous system to test the possibility of HIV in the citizens but only a few affected people were found. However, a 1.2 percent prevalence of HIV was reported among pregnant women in 2005 constituting 16 women out of every 137000 women. The total prevalence among people of age 15 to 49 years old was 8.1 percent. Most of the affected, 77 percent, adults were men. Regardless of the percentage, it affects women and their children (de Arazoza et al., 2007; Pérez-Stable, 1991). Since 2005, 26 mothers had transmitted the disease to their children.

Global Importance of the Health Condition: Around 36.7 million people were HIV positive in 2016 out of which 2.1 million were children under the age of 15. Most of these people live in Sub-Saharan Africa and they have been infected with the disease by their mothers. In 2007, vertical transmission was 12 percent prevalent (de Arazoza et al., 2007).

Intervention or Program: National AIDS commission was founded in 1983 to control the disease. The program focused on testing and tracing, quarantine, sanatoria and daycare, treatment, health promotion, and education, and intersectoral work has controlled the condition. It has effectively succeeded in minimizing the epidemic. The program focused on vulnerable groups such as pregnant women, and blood donors. The program aimed at minimizing the transmission of the disease to children. Treatment such as ZDV and ARVT was recommended for people with AIDS. Later other drugs were produced in the country such as 3TC, D4T, DDC, DDI, and IDV to control HIV in the country. In 2001 every patient with HIV was covered (González et al., 2006; Pérez-Stable, 1991).

Cost-Effective: The early programs of nationwide screening cost the U.S $3 million for Cuba. As Cuba was economically not stable, it became difficult for Cuba to spend on the project. Also, some of the medicine came from other countries which were challenging for the country but when the country invented its medicine such as AZT, D4T, DDI, DDC, and 3TC, the cost was managed (de Arazoza et al., 2007). Although it was expensive initially the partnerships and donors helped to control the disease.

Impact: The program was effective in controlling HIV in general. In 2015 Cuba became the first country to eliminate the mother-to-child transmission of HIV and WHO validated it in 2015. In Cuba, 12 children with HIV positive were born in the last 30 years making it a success story (Castro, Khawja, & González-Nunez, 2007).

The Disease

Around 35 percent of women infect their children with HIV as they are HIV-positive mothers. If the mothers are infected the likelihood of the children getting the disease increases. The mothers transfer the disease during pregnancy, delivery, and breastfeeding. Consequently, all the children born to HIV-positive mothers are vulnerable to HIV unless proper preventive measures are taken (Coovadia et al., 2007). People in African countries are affected by the disease most of the time.

Mother to Child Transmission of HIV is HIV transferred to the children from the mother during pregnancy, delivery, or during breastfeeding. It is a chronic disease that does not have a cure but it can be controlled using medication. The children get infected by their mothers. It can occur in Utero via the placenta or due to infection of amniotic membranes (Kourtis & Bulterys, 2010). It also happens during the delivery as various secretions come in direct contact with the placenta or contact with blood or other secretions while delivery. It can also be transmitted during breastfeeding as the infant takes in the infected milk from the mother. HIV infection in children is diagnosed early in life within a few days after birth. For instance, in the non-breastfeeding population one-third of the infection is detected within 2 days, two-thirds are detected after the first week, and by six weeks. Therefore, some argue that one-third of HIV occurs during pregnancy and the two-part occur during labor pain or breastfeeding. In addition, the symptoms of the disease vary from person to person. But if the disease is kept untreated it can cause death to the children as AIDs affects the immunity of the children leaving them vulnerable to diseases (Kourtis & Bulterys, 2010).

Etiology:

The disease is caused by a virus that affects immunity. As negativity is attached to the condition, people face stigmatization and discrimination and lack of preparation can cause death (Castro et al., 2007).

Recommendations

The disease was controlled using national programs that not only focused on prevention and control, but also educated and trained people to minimize the conditions. The government uses various techniques of treatment and preventive measures. They involved communities and screened the population to ensure that there is no one with the infection (Pérez-Stable, 1991). The rigorous approaches to combat the disease can be replicated in other countries to ensure the prevention of the disease.

Implementations:

The government of Cuba was involved in taking all the possible measures to implement the program to control the disease despite the financial struggles of the country. It focused on creating its own medication to control the disease and achieve the target of assisting everyone with the disease. They reached every affected person and helped them control their infection by raising awareness about the conditions and preventive measures. Also, the government distributed condoms and other tools to assist the citizens. The government with donors and other stakeholders emphasized controlling the condition before it had become a major issue in the country.

Evaluation:

The program was successful in controlling HIV infection among babies. Less than five babies were born HIV positive in 2013 making it the first country to control Mother Child Transmission of the disease.

Lessons Learned:

The governments must not wait for the outbreak of the disease to respond. They can focus on prevention if there are risks of getting the problem. Also, governments must take rigorous steps to prioritize the health and well-being of their citizen as Cuba did to control HIV.

References

Castro, A., Khawja, Y., & González-Nunez, I. (2007). Sexuality, reproduction, and HIV in women: the impact of antiretroviral therapy in elective pregnancies in Cuba. LWW.

Coovadia, H. M., Rollins, N. C., Bland, R. M., Little, K., Coutsoudis, A., Bennish, M. L., & Newell, M.-L. (2007). Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. The Lancet, 369(9567), 1107–1116.

de Arazoza, H., Joanes, J., Lounes, R., Legeai, C., Clémençon, S., Pérez, J., & Auvert, B. (2007). The HIV/AIDS epidemic in Cuba: description and tentative explanation of its low HIV prevalence. BMC Infectious Diseases, 7, 130. https://doi.org/10.1186/1471-2334-7-130

González, I., Díaz, M., Pérez, J., Mengana, H., Gutiérrez, I., & Gorry, C. (2006). National Program for Detecting & Treating Mother-to-Child Transmission of HIV. MeDICC Review, 6(1), 2–5.

Kourtis, A. P., & Bulterys, M. (2010). Mother-to-child transmission of HIV: pathogenesis, mechanisms and pathways. Clinics in Perinatology, 37(4), 721–737.

Pérez-Stable, E. J. (1991). Cuba’s response to the HIV epidemic. American Journal of Public Health, 81(5), 563–567.

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