Cuba Knows Condom Use Not Enough

Cuba Knows Condom Use Not Enough
By Ivet González

HAVANA, May 9 2013 (IPS) - "But I always used a condom!" was the
sentence that played over and over in Jaime Roche's mind when the young
Cuban man tested positive for HIV in October.

"I couldn't believe it. I'm an advocate of using condoms, even for oral
sex," the health worker, who preferred not to give his real name, told
IPS. "This happened to me by accident: the condom broke during a casual
encounter," Roche said.

"Maybe I would have been protected if I hadn't been with another person
outside my stable relationship. That might be the ideal thing for total
security," said Roche, who is also a social activist. "My partner of 10
years is still with me. For now, I apparently haven't infected him,
although he has to get tested again."

Young people, especially men who have sex with men (MSM), make up the
majority of new HIV and AIDS cases detected in Cuba every year, even
though young people use condoms more when engaging in sexual relations,
according to recent studies.

A 2011 survey on prevention indicators for HIV infection conducted by
the National Office of Statistics and Information (ONEI) found that 59.6
percent of MSM, 62.9 percent of other men, and 65.9 percent of women
under the age of 20 practiced safe sex in their first sexual encounter –
a rising indicator.

As of late last year, a little over 13,000 of Cuba's 11.2 million people
were HIV-positive. Of those individuals, 29.6 percent were 15 to 29
years old in 2011, when the ONEI conducted its most recent survey of
people living with HIV/AIDS.

Meanwhile, the 15-19 year age group accounted for the largest number of
new cases detected in 2012, unlike in previous years, said Dr. Jaqueline
Sánchez, coordinator of the Line for Adolescents and Young People of the
state-run National Centre for the Prevention of STDs
(sexually-transmitted diseases) and HIV/AIDS.

For that reason, Sánchez said in a conversation with IPS, more needs to
be known about this group, and comprehensive work needs to be done to
foment "protective factors" – that is, behaviour, situations,
environments and attitudes that will keep this population group away
from the epidemic and other STDs.

Communication in the family and with one's partner; positive
relationships with parents, teachers and other adults in the community;
social policies for comprehensive services for adolescents; a
participatory environment free of violence and discrimination; and
access to sex education from an early age are all elements that protect
against the spread of HIV.

"Condom use is not enough to stop the epidemic," said Sánchez.

Young people, defined by the experts in Cuba as the 15-30 age group, are
considered to be at high risk for HIV-AIDS all over the world, to the
extent that about five million people in that age group are now living
with the disease, according to the United Nations.

In Latin America, the prevalence of the virus among 15 to 25-year-olds
went down to 20 percent during the 2001-2011 period.

Drug and alcohol use, dropping out of school, unequal opportunities,
unsafe environments, ignorance about sexuality, and under-use of health
services are all risk factors for this age group around the world.

It is also typical during this period of life to change partners and
depend more on one's friends, often ignoring the advice of close adults
and engaging in risky behaviour.

Studies show that today's generations are assuming sexuality more
freely, and that they often view casual and open relationships and even
group sex as something natural.

The prevalence of HIV/AIDS in Cuba since the first case was detected in
1986 has been concentrated among young people aged 20-29. That increases
possibilities for contact with the virus in this group, making it
epidemiologically vulnerable, Sánchez said.
"Young people are the most likely to follow safer sexual behaviour if
they receive guidance from an early age," she said. "But that will
depend in great measure on adults providing them with increasingly
friendly information, knowledge, and services as a normal, healthy part
of growing up."

In a post on the Café 108 webpage of the IPS Bureau in Cuba, biologist
Isbel Díaz said prevention campaigns should "shake people up a bit, even
at the risk of shocking them a little." He added, "We cannot let our
young people be exposed simply because we are worried about looking like
we're exaggerating, or about shocking people when talking about the
disease."

Other health promoters, such as Liana Trelles, who teaches English at
the Saúl Delgado high school in Havana, advocates empathy with teens and
young people. "I started out by observing them, asking them what their
concerns were, and addressing them directly," she told IPS.

Trelles, who is also a psychologist, and other teachers at her school
created spaces for conversing about these issues with students 15 to 18
years old. "I was alarmed when I heard about the 'descarga,' a type of
relationship that may or may not reach sex, and where there is no
commitment or stability," she said.

"Practices of that type also make a group vulnerable," she said, noting
that studies are needed about that behaviour to understand how
widespread it really is. Therefore, she said, she promotes protective
factors, such as "increasing knowledge about condom use and responsible
behaviour."

The HIV/AIDS rate in Cuba is just 0.19 percent of people aged 15 to 49.
But since the start, it has slowly but steadily grown. It mostly affects
men, especially MSM, but since 2004 the figures have risen for women,
especially young women.

http://www.ipsnews.net/2013/05/cuba-knows-condom-use-not-enough/