Cuba’s victory

Cuba marked its place in history on Tuesday when the World Health Organisation (WHO) was able to validate that it had eliminated mother-to-child transmission of not just the Human Immuno-deficiency Virus (HIV), but also syphilis, both of which are sexually transmitted infections that are also vertically transmitted from mother to foetus and can have debilitating effects on babies.

Cuba is the first country in the world to have done this and its accomplishment has been hailed as “one of the greatest public health achievements possible,” said WHO Director-General Dr Margaret Chan. She further stated, “This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation.” In order to earn the validation, Cuba had to meet rigid impact indicators for at least one straight year. However, Cuba would have known it was on track since 2013 when only two babies were born with HIV, and only 5 babies were born with congenital syphilis.

Although prevention of mother-to-child transmission (PMTCT) of HIV had always been on the radar of international bodies it was in 2010 that it upped the ante and WHO, through its regional arm the Pan American Health Organisation (PAHO), implemented an initiative in the Americas.

The next year, WHO in collaboration with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and other partners launched a global plan to eliminate new HIV infections among children by 2015 and keep their mothers alive. While the international bodies would have been offering support to all of the countries involved in the initiative, national governments, through their ministries of health would have been expected to “ensure early access to prenatal care, HIV and syphilis testing for both pregnant women and their partners, treatment for women who test positive and their babies, caesarean deliveries and substitution of breastfeeding.”

In order for these services to be successfully delivered, there needed to be “an equitable, accessible and universal health system.” It was foreseen that maternal and child health programmes would be integrated with those for HIV and other sexually transmitted infections.

Cuba’s health sector can be regarded as the epitome of equitable, accessible and universal care, hence its success. There is much that other countries, and not just those in this hemisphere, can learn from Cuba.

Guyana’s pursuit of the elimination of PMTCT has not lived up to the hype it had received, notably by former health minister in the previous administration, Dr Leslie Ramsammy. One can recall that in 2008 Dr Ramsammy had famously rejected a UNICEF report done in collaboration with UNAIDS and WHO, which stated that the only countries in the region that were on track to reach the goal of “offering the appropriate services to 80 per cent of HIV+ pregnant women to ensure PMTCT” were Barbados, Jamaica and Cuba.

While Dr Ramsammy had claimed that Guyana was being slighted for reasons unknown, the fact was that then and up until 2011 when he was removed from the Health Ministry and placed to head up Agriculture, comprehensive PMTCT services were only being offered at ten health centres and three public hospitals. Given the spread of the local population across the country, it would not have taken a rocket scientist to know that there was no way Guyana could have been included with Barbados, Jamaica and Cuba as being able to offer appropriate services to 80 per cent of HIV+ pregnant women. It must also be mentioned here, though it is well known, that local community hospitals are frequently referring cases to the Georgetown Public Hospital (GPH) because of a deficiency of equipment, medicine and medical personnel. As a result, the GPH is constantly overrun and lacking bed space.

In addition, the data gathering capacity of the Health Ministry has not been the best. Figures were released in piecemeal fashion, rather than annually as is done elsewhere in the world. And this was not just in the instance of PMTCT but as regards all health issues across the board. One would hope that this changes now as the gathering and analyzing of data is important to practising evidence-based public health.

What other countries, and Guyana in particular, can learn from Cuba is that equitable access to healthcare can make a world of difference. As PAHO Director Dr Carissa F Etienne noted, “Cuba’s success demonstrates that universal access and universal health coverage are feasible and indeed are the key to success, even against challenges as daunting as HIV.”

Cuba’s victory is inspiring and it has now become the best practice for other countries to aspire to. No doubt that country will continue to build on its current success and may well be celebrating other achievements in the future. UNAIDS Executive Director Michel Sidibé called it a celebration not just for Cuba, but “for children and families everywhere. It shows that ending the AIDS epidemic is possible and we expect Cuba to be the first of many countries coming forward to seek validation that they have ended their epidemics among children.”

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