CAMAGÜEY.- Although they are mentioned more at the beginning of December, when World HIV Response Day is celebrated, in Cuba there is a Care Program for patients living with HIV-AIDS that has been working continuously and has been operating since 1986. Dr. Yadira Betancourt Camargo, specialist in Internal Medicine, and Dr. Miguel Obediente Tan, Comprehensive General Physician, assume responsibility for said program in the province. Adelante spoke with her.
—How did the program come about and what function does it have?
— The program emerged many years ago, since the beginning of the epidemic in 1986. When the first cases appeared, the need arose to create a program that would be responsible for the care and attention of these patients. Over the years, Cuba joined the United Nations Program (PENU), one of the programs that currently supports our country with a view to eradicating the epidemic by the year 2030.
“We work with the premises of the three 95s: that more than 95% of people know their serological status, that more than 95% of diagnosed patients have antiretroviral therapy and finally, that more than 95% of these patients have a burden suppressed virus, that is, the virus is minimal in your body. Through these premises it is possible to avoid the transmission of HIV.”
—How does the patient care system work?
—Each patient care goes from the provincial program to each of the municipalities, passing through each area and basic health team, that is, the family doctor offices. Everyone is involved in the care of these patients, from the closest staff to the provincial levels and across the country.
“This year's campaign had the motto 'let the communities lead', because this is the support network for people living with HIV and who belong to the program. There are several types of networks: the DHCH network (Men who have sex with other men), the DPVV (patients living with HIV), the network of young people living with HIV, the network of people over 50 years of age and the trans network.
“All networks contribute to the process, because there is no better approach to a patient with HIV or pending a diagnosis than that offered by a person with the same condition. In the case of the DPVV network, the experience that those who work in the network, very close to us, can transmit to you, with respect to knowing your illness, treatments and medications, as well as its evolution, helps a lot. Above all, to help them eliminate all the stigma and discrimination that exists regarding people who have another sexual orientation and people living with HIV.
—What is the treatment like, for example, when there is a pregnancy involved?
— There is a treatment and management protocol from pregnancy planning. We have two different cases: HIV-positive women and wives of HIV-positive patients. In the first case, they are women who constitute a preconception risk due to their serological status. Both they and their partners must have an undetectable viral load for at least one year prior to conception. This, plus appropriate treatment, ensures that the baby is not born with HIV. Transpelvic birth, which until a few years ago was contraindicated, is now accepted worldwide and today this option is given to our pregnant women. Professionals explain to them, of course, all the conditions that must be met for this delivery route.
“In the case of a serodiscordant couple where the woman is negative and the man is positive, there is also a management and care protocol where antiretroviral therapy is given to the patient. She is being treated with pre-exposure prophylaxis to ensure that this woman, if she has not been infected so far, does not do so during pregnancy and does not transmit the virus to her child. Camagüey, since the epidemic arrived here, has added 170 children of mothers with HIV, all healthy; some today are men and women.
—How is the center linked to the family to achieve better care?
—The treatment is comprehensive but there is something very important to keep in mind: the patient has every right to decide with whom they will share their serological status. There are patients who rely on their family while others do not want them to know. What all patients do receive from us, as well as from all health personnel, is unconditional support. We are in charge of supporting all the people who are hospitalized, many who already live with AIDS and are in the process of monitoring and controlling it.
“We manage to maintain a direct relationship with them and with the family we urge them to get involved, so we are always open to anyone who wants to know and learn more about the management, how they should behave with their family members and support them better.
“Help not only comes from health personnel, precisely for this reason this year's motto, because HIV support networks play a fundamental role in accepting the disease to learn to live with it and above all for a better adherence to treatment. A patient who takes their medication correctly and takes all precautions to avoid transmitting the disease is essential in this process.”
—How to combat the prejudices that still exist about HIV?
—Prejudices still exist both in the general population and in our own health sector. We have had cases of patients who have been denied entry into social life simply because they are a patient living with HIV. They are taboos that still exist in society, not in all sectors, but there are still cases where they are denied a service or a job.
“For this reason, the program also has a legal guidance service that is located in our center located on Martí Street #64, every Friday. Anyone can come there if they feel discriminated against due to their serological status, their sexual orientation or any difficulty, for example, with medical care. They are explained everything they need to know to protect and defend their rights.
“There are many cases and in daily work we have many patients so it is very joyful to see how they recover and manage to leave the hospital. We are still hit by late diagnoses that do not allow the patient's life to be saved. Once the disease is identified, retroviral therapy is immediately started, so all staff feel relief when they perceive an improvement in the patient.”
Today HIV is not considered a fatal disease, but rather a controllable chronic disease, such as diabetes mellitus or hypertension. It is essential to call on the entire population not to be afraid to know their serological status. To do this, says the Doctor, all health areas in our province have first-generation rapid kits. The sooner the serological condition is known, the sooner treatment begins and the greater the chances of a favorable development of the disease.
Translated by Linet Acuña Quilez