Santana S, Faas L, Wald K
G.H. Sergievsky Center, Columbia University School of Public Health, New York, NY 10032.
Int J Health Serv. 1991;21(3):511-37. doi: 10.2190/PPF0-X27G-LF4X-XEYC.
This article describes Cuba's effort to develop a comprehensive program for control of its human immunodeficiency virus (HIV) epidemic. The program consists of multiple interventions, including blood donor screening, a ban on imported blood and blood products, widespread semicompulsory screening of defined and general populations, research and clinical trials on treatment and diagnostic methods, and health education in the press, radio, television, workplace, and schools. The most controversial of the program's measures has been the treatment of HIV antibody-positive persons (both asymptomatic and clinically ill) through what Cubans term a "sanatorial regimen," consisting of admission into an institutional setting where both preventive and curative treatment is offered, and where residents have limited contact with their families, neighborhoods, friends, and the rest of society. The Cuban HIV control program merits studying because of the comprehensiveness of the measures in a poor country; the special experience of screening large, mostly healthy populations; its potential contribution to understanding the natural history of the disease due to the early identification and follow-up of HIV antibody-positive individuals; and the cultural, political, and socioeconomic conditions that give rise to a different epidemiologic profile of the disease and to an apparent societal consensus on the controversial issue of institutional semiconfinement.
本文介绍了古巴为制定一项全面控制人类免疫缺陷病毒（HIV）疫情的计划所做的努力。该计划包括多项干预措施，如对献血者进行筛查、禁止进口血液和血液制品、对特定人群和普通人群广泛开展半强制性筛查、对治疗和诊断方法进行研究及临床试验，以及通过报刊、广播、电视、工作场所和学校开展健康教育。该计划中最具争议的措施是对HIV抗体阳性者（包括无症状者和临床患者）采用古巴人所说的“疗养院疗法”进行治疗，即让他们入住一个提供预防和治疗的机构，在那里居民与家人、邻里、朋友及社会其他人员的接触受到限制。古巴的HIV控制计划值得研究，原因在于一个贫穷国家所采取措施的全面性；对大量主要为健康人群进行筛查的特殊经验；由于对HIV抗体阳性个体的早期识别和跟踪，其对了解该疾病自然史的潜在贡献；以及导致该疾病呈现不同流行病学特征并在有争议的机构半隔离问题上达成明显社会共识的文化、政治和社会经济状况。
