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	Workers Vanguard No. 1010	12 October 2012

Defend Gains of Cuban Revolution!

Cuba: Socialized Medicine and the Fight Against AIDS

During the 19th International AIDS Conference held in Washington, D.C., in July, Secretary of State Hillary Clinton announced that the U.S. government was committed to achieving “an AIDS-free generation.” With the numbers of those living with AIDS in the U.S. and internationally continuing to climb, Clinton remarked: “If we want to save lives, we need to go where the virus is and get there as quickly as possible.” She doesn’t have far to travel. In the conference’s host city, the rate of HIV infection has increased 22 percent in the last six years. Some 3 percent of the population of D.C. is infected—a rate higher than Ethiopia’s and almost on a par with Nigeria’s. More than 4 percent of the black population of the U.S. capital is living with HIV, largely stemming from high rates of injection drug use, homelessness and incarceration.

Data released during the conference by the Centers for Disease Control speaks volumes to the U.S. government’s criminal lack of care for those infected. Only a quarter of the 1.1 million people living with the disease in the U.S. are receiving treatment to keep their viral load suppressed. An estimated one in five of people with HIV are not even aware of their infection.

While the profit-gouging pharmaceutical companies that funded the conference gave a platform to multibillionaire “philanthropist” Bill Gates, they were certainly not about to feature representatives from a nearby country with one of the smallest epidemics and most effective HIV/AIDS treatment programs in the world: Cuba. To hear how Cuba has been successful in this regard, one had to attend a fringe event organized by Democratic Congresswoman Barbara Lee, which was addressed by Cuba’s leading AIDS doctor, Jorge Pérez.

A New York Times (7 May) article by Donald G. McNeil Jr. titled “A Regime’s Tight Grip on AIDS” detailed Cuba’s extensive HIV/AIDS prevention and treatment programs based on its system of free universal health care, contrasting this to the woeful state of care in the U.S. One effect, McNeil notes, is that Cuba’s infection rate, 0.1 percent, is one-sixth that of the U.S. and one-twentieth of Haiti. Despite poor natural resources and a 50-year, suffocating U.S. embargo, Cuba has managed to produce the antiretroviral drugs it needs and provides a free and expansive treatment program including HIV testing, condom distribution and sex education.

Cuba’s renowned health care system is a result of the overthrow of capitalist rule in the period following the 1959 defeat of the U.S.-backed Batista dictatorship at the hands of Fidel Castro’s petty-bourgeois guerrilla forces. Facing fierce U.S. hostility, the new regime signed trade agreements with the Soviet Union and went on to expropriate U.S.-owned properties. By October 1960, all of banking and 80 percent of industry had been nationalized. This marked the liquidation of the capitalists as a class and the creation of a workers state, although one that was deformed from its inception by the rule of a bureaucratic caste led by Fidel and now Raúl Castro. Politically suppressing the working class and opposing the perspective of international proletarian revolution, the bureaucracy acts as an obstacle to further advance toward socialism—an egalitarian society based on material abundance.

While Cuba remains underdeveloped and beset by material scarcity, the overthrow of capitalist rule has resulted in massive social gains. The collectivization of the means of production and the establishment of central economic planning and a state monopoly over foreign trade provided jobs, housing and education for everyone. Soviet aid—both military and economic—was indispensable for this development. Cuba has one of the highest literacy rates in the world and a renowned health care system that sends tens of thousands of doctors around the world to help mostly poor patients in need. Infant mortality in Cuba is lower than in the U.S. and Canada. Abortion is a free, readily available health service. In the 1970s, the country’s network of free public universities, including medical schools, was extended to all of its 14 provinces. Such advances are unattainable in underdeveloped countries in the grip of imperialist domination.

Cuba’s Treatment Programs

In 1983, two years before the first case of HIV appeared in Cuba and when very little was known about the disease, the country had already set up the National Commission on AIDS to educate the population. When it was understood that HIV could be transmitted through blood, all blood products were destroyed, at considerable financial cost. HIV-testing of all blood became national policy in 1986. This prevented the deaths of people receiving blood transfusions at a time when thousands of hemophiliacs and others in countries like the U.S. died from contaminated blood.

The HIV virus arrived in Cuba with the return of the heroic soldiers who had fought to defend Angola’s newly secured independence from Portugal against reactionary local forces backed by U.S. imperialism and apartheid South Africa. For 15 years beginning in 1975, several thousand Cuban troops served in Angola, driving out South African military forces and thereby also securing the independence of Namibia. This material support was packaged with the Cuban Stalinists’ political support to the bourgeois nationalist MPLA, which to this day rules Angola as corrupt stooges for the imperialist oil companies.

The first Cuban AIDS patients—the majority of whom were heterosexual men—were quarantined in a sanatorium in Havana province in 1986 under an “emergency response” policy of mandatory treatment. By 1989, patients were allowed to go home to be with their families on the weekend as long as they returned. Given that HIV cannot be transmitted by casual contact, quarantining proved to be unnecessary as a public health measure. In 1993, the policy was further amended to make the program fully ambulatory—i.e., HIV-infected persons could choose to move to a sanatorium or live at home. Due to the favorable environment, food and institutional support at the sanatoriums, many patients voluntarily continued to stay there, as others have also chosen to do to this day.

Cuba was thrown into a prolonged economic crisis in the 1990s following the cutoff of aid by the Moscow Stalinist bureaucracy in the late 1980s, shortly before the counterrevolutionary destruction of the Soviet degenerated workers state. The economic crisis exacerbated shortages and remaining social inequality in Cuba, which was now even further isolated than before. Nevertheless, as Dr. Pérez, who ran the main sanatorium for 12 years, noted, “when the country was at its worst economically and people were living on almost nothing, our patients had a 5400-calorie diet” (MEDICC Review, April 2011).

In 1996, Cuba purchased antiretroviral drugs for children with AIDS and their mothers, at a cost of $14,000 per person per year. By the late 1990s, the country had started developing its own generics, and by 2001, the full “cocktail” of antiretroviral drugs was available. Since then, HIV-positive patients have had full access to such medicine. Only 38 children had ever been born with HIV in Cuba, largely due to the quality of prenatal care.

Today anyone diagnosed with HIV is required to attend a multi-week course that includes information about safer sex practices, proper medication, proper diet and nutrition. Participants receive their full salaries for the duration of the course. Furthermore, all teenagers are educated about sex and sexually transmitted diseases. This is a far cry from the U.S., where many youth receive puritanical “abstinence-only” miseducation, putting them at a greater risk of both unwanted pregnancy and acquiring sexually transmitted diseases.

Cuba’s brief quarantine policy served as a rallying cry for anti-Communist charges of “human rights” abuses. The sheer hypocrisy of that campaign was shown by the fact that at the same time, the U.S. was refusing entry to over 200 HIV-positive Haitians fleeing political repression and abject conditions in their home country. Haiti’s subjugation to imperialism, enforced by repeated invasions and occupations, constantly reinforces its deeply entrenched poverty. Today Haiti, where AIDS is the leading cause of adult deaths, has the highest rate of HIV in the Western Hemisphere.

In the early 1990s, the excluded HIV-positive Haitians were incarcerated in the notorious U.S. detention center in Guantánamo Bay, Cuba. On hearing that President-elect Bill Clinton had no plans to break the ban against those with HIV entering the U.S., the prisoners launched a hunger strike, and eleven attempted to escape into Cuba proper. A U.S. federal judge described the “cruel and unusual punishment” at Guantánamo:

“They live in camps surrounded by razor barbed wire.... They are guarded by the military and are not permitted to leave the camp, except under military escort. The Haitian detainees have been subjected to pre-dawn military sweeps as they sleep by as many as 400 soldiers dressed in full riot gear. They are confined like prisoners and are subject to detention in the brig without hearing for camp rule infraction.”

—“Mother Courage and the Costs of War,” Partner To The Poor: A Paul Farmer Reader (2010)

U.S. imperialism’s horrific abuse of HIV-positive Haitians mirrored its malign neglect of AIDS sufferers on the home front. When AIDS was first identified in the early 1980s in the U.S., religious and social bigotry contributed to it being initially branded as a “gay disease.” When it began to spread especially in the ghettos, it was stigmatized as a “poor black disease” as well. Meanwhile, the capitalist rulers were spending only pitiful amounts for treatment and to research the disease.

In 2001, the U.S. dismissed a Cuban offer to staff an ambitious international program to treat HIV in exchange for funding and supplies of drugs, which the island is prevented from importing due to the U.S. embargo. In 2011, the Obama administration blocked $4 million in funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria, destined for Cuba’s National HIV/AIDS Program. The U.S. embargo has also impeded Cuba’s ongoing efforts to develop an HIV/AIDS vaccine.

Socially retrograde policies have marked the U.S. government’s AIDS programs into the present. The Obama White House has adopted and pursued the President’s Emergency Plan for AIDS Relief (PEPFAR) established by George W. Bush in 2003. Many HIV-infected individuals abroad have received antiretroviral therapy under the program, mainly in sub-Saharan Africa. At the same time, the program funded religious organizations to push reactionary moral codes, e.g., sexual abstinence and monogamy. As one American health specialist in Rwanda commented: “The administration may have managed to generate more, not fewer, AIDS cases by pushing this largely religiously-driven policy” (“PEPFAR’s Shortcomings: What Is to Be Done?” Huffington Post, 31 July). “Faith-based” programs get a third of PEPFAR financing. But the bulk of the lucre goes to the U.S. pharmaceutical giants.

Contradictions of Cuban Stalinism

It is the qualitative superiority of a collectivized economy over the anarchic, profit-driven capitalist system that has allowed Cuba to deal with AIDS on a rational, scientific basis and to achieve great gains in education and other areas. An overturn of the collectivized property forms would be a historic step backwards, not only for Cuba’s working people but for the toilers throughout the world.

Retrogression has certainly defined the former Soviet Union, where capitalist restoration has brought massive economic and social immiseration. The obliteration of the public health system has contributed to a historically unprecedented drop in life expectancy. Tuberculosis, which had been effectively eradicated in the USSR, returned with a vengeance, particularly with increased incarceration in overcrowded, unsanitary prisons. And in its wake came HIV/AIDS. The rise of HIV in Russia is mainly due to growing rates of injecting drug use, which in turn is closely linked to the sharp increase in poverty. A Russian TB doctor quoted in Partner to the Poor put it eloquently in 1998: “I have spent my entire medical career caring for prisoners with tuberculosis. And although we complained about shortages in the eighties, we had no idea how good we had it then. Now it’s a daily struggle for food, drugs, lab supplies, even heat and electricity.”

As we said in regard to the Soviet degenerated workers state, it is the fundamental duty of the proletariat internationally to defend the Cuban deformed workers state against imperialism and domestic counterrevolutionary forces. But we give no political support to Cuba’s Stalinist bureaucracy, which promotes the fallacy that socialism—a society of material abundance—can be achieved in one country (let alone an island). In practice, this has meant opposing the fight for workers revolutions in the rest of the Caribbean and Latin America, to say nothing of the U.S. and other imperialist centers, and instead fostering deadly illusions in “progressive” bourgeois regimes—e.g., Salvador Allende’s Chilean popular front in the early 1970s and today’s Venezuela under Hugo Chávez. To defend and extend the social gains in Cuba requires a struggle for a proletarian political revolution that creates a regime based on workers democracy and committed to the fight for world socialism.

In the Stalinist tradition, the Castroite regime has glorified the role of the nuclear family in Cuba. This has been accompanied by the persecution of gays, particularly in the 1960s and 1970s. The Batista-era criminalization of homosexuality was not repealed until 1979, and the penalization of “flaunting” in public, a measure used by the cops to harass gay men, was not repealed until 1987. Since that time, there has been a certain increase in official tolerance of gays, as seen for example in the treatment of HIV/AIDS. Since the 1990s, men who have sex with men have been the ones most affected by the disease. Health care programs have been adapted to emphasize safer sex and to promote greater acceptance of homosexuality. Nevertheless, the machismo that remains widespread on the island as elsewhere in Latin America reinforces homophobia. And it sure doesn’t help that both under Fidel and Raúl Castro, Catholic popes have been hosted in Cuba, where they have spread their counterrevolutionary religious poison.

Cuba today is increasingly racked by the severe limitations of an isolated workers state facing a relentlessly hostile U.S. imperialism. Cuba’s stagnant economy has never fully recovered from the severe crisis that followed the cutoff of aid from the former Soviet Union. Over the past two years, Havana has moved toward implementing a certain amount of “market reforms”—the standard means by which Stalinist regimes, which exclude the working class from political power, try to correct the imbalances in bureaucratically mismanaged planned economies.

Within the confines of Stalinist rule, neither the advocates of market reforms/decentralization nor those who would return to a more rigidly centralized economy can provide a way out. The way forward lies in the Cuban workers sweeping away the Castroite bureaucracy through a political revolution. Our article “Cuba: Economic Crisis and ‘Market Reforms’” (WV No. 986, 16 September 2011) put things squarely:

“A Cuba ruled by elected workers and peasants councils—open to all parties that defend the revolution—would be a beacon for working people throughout Latin America and beyond. The ultimate answer to Cuba’s economic backwardness and the only road to a future of material abundance, social equality and personal freedom is international proletarian revolution—not least in the U.S. imperialist bastion—leading to rational global economic planning and an egalitarian socialist order. The necessary corollary to this perspective is the forging of a Trotskyist party in Cuba, part of a reborn Fourth International, to lead a proletarian political revolution to victory.”