Isolated IncidentIn "An Isolated Incident," Morris Fabbri takes a closer look at the bold, controversial decision three decades ago by the government of Cuba to quarantine people with HIV to control an outbreak on the island.
Imagine that you are in charge of a country. One day, an advisor informs you that there’s a disease sweeping the globe. Thousands of people have died; millions more may perish. Despite the efforts of researchers around the world, no one really knows what causes the disease, and there is no cure. What’s your next move?
In “An Isolated Incident,” Morris Fabbri takes a closer look at the bold, controversial decision three decades ago by the government of Cuba to quarantine people with HIV to control an outbreak on the island. For his summer capstone project, Morris analyzed forty hour-long interviews of Cubans connected to the HIV epidemic, bringing them to life through podcasts that show how history, culture, and epidemiology are experienced by people from different backgrounds.
Episode One: Intro – Isolated Incident
Cuba is the only country in the world to respond to the threat of AIDS with quarantine. Cuba also has one of the lowest rates of HIV in the Americas. To what extent are these two facts related?
This introduction to the Cuban epidemic provides an overview of the historic, geographic and cultural factors that informed Cuba’s decision to isolate. Disease responses are always messy: Cuba saw in isolation a way to contain and study a fatal disease while caring for victims. Cuba could also broadcast its low AIDS rate as validation of its systems of health and government. The sanatoria were also only part of a comprehensive AIDS program; this episode traces how Cuba’s bold action set the stage for sustained epidemiological success. By studying the Cuban epidemic and parsing out how Cuba made AIDS a manageable epidemic, nations around the world can shape their plans for the next plague.
Episode Two: Pretty Prisons
In 1988, WHO Global AIDS Program Director called Cuba’s AIDS sanatoria “Pretty Prisons.” From 1986-1993, Cubans with HIV were hospitalized in sanatoria around the country. Sanatorium residents were separated from their friends, jobs, and their families. But these sanatoria were also places of comfort, education, and refuge from homophobic bigotry and from the harsh reality of economic crisis.
In the early 1990s, hundreds of young, rebellious Cuban men and women went as far as to infect themselves with HIV to gain access to the luxuries of sanatorium life. In this episode, interviews reveal how the sanatoria evolved over time, shaping residents’ perceptions of themselves and of the possibility of returning to life on the outside. If the sanatoria offered a haven for sexual diversity and a shield from discrimination, they also led residents to become complacent, reluctant to reintegrate into everyday life.
Does it matter that the sanatoria provided free medical and psychological care to residents who were denied their freedom? The answer to this question gets tricky when we consider that freedom allows disease to spread. Although the sanatoria have faded from use, their legacy lingers over any discussion of HIV in Cuba.
Episode Three: La Cara de SIDA (The Face of AIDS)
In this conclusion to the series, participants’ voices add color to a description of the contemporary landscape of HIV prevention in Cuba. Cuba earns international plaudits for its intersectoral, community-engaged response that maintains low HIV prevalence despite serious resource constraints.
AIDS prevention is only one of the Cuban government’s many priorities, and some prevention programs conflict with other national interests. Old ethical questions about the responsibilities of the state and the individual within an epidemic have transformed as AIDS has become a chronic, manageable condition. These questions still linger, tinged by the influence of international organizations, and the answers given by Cuba’s citizens and its government carry implications that extend far beyond the Caribbean.
An Interview With Professor Karrie Stewart
Kearsley “Karrie” Stewart, Ph.D., is Professor of the Practice at Duke University with joint appointments in the Duke Global Health Institute and Cultural Anthropology.
In the Press
Cuba quarantined people with HIV. It was controversial, but it worked. – Tampa Bay Times
Governments may need to take swift, decisive action to prevent disease epidemic – Des Moines Register
About Morris Fabbri:
Morris graduated from the University of Michigan in 2016, where he received a B.A. in Philosophy, Political Science, and Economics. He chose to come to Duke for this master’s program because he was not convinced he could effectively address societal inequalities and inadequacies as a doctor. He hopes to use his time at Duke to better understand how interactions between scientists and policymakers affect society and to figure out where within the web of conflicting ideas and interests he can fit in and do the most good.