{"id":36504,"date":"2016-04-13T14:33:35","date_gmt":"2016-04-13T13:33:35","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=36504"},"modified":"2016-04-13T14:33:52","modified_gmt":"2016-04-13T13:33:52","slug":"jeanne-lenzer-the-backstory-how-i-got-the-cuba-hiv-story-wrong","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/04\/13\/jeanne-lenzer-the-backstory-how-i-got-the-cuba-hiv-story-wrong\/","title":{"rendered":"Jeanne Lenzer: The Backstory\u2014How I got the Cuba HIV story wrong"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/02\/12\/jeanne-lenzer-the-backstory-when-is-patient-consent-needed\/jeanne_lenzer\/\" rel=\"attachment wp-att-36185\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-36185\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/jeanne_lenzer.jpg\" alt=\"jeanne_lenzer\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/jeanne_lenzer.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2016\/02\/jeanne_lenzer-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a><a href=\"http:\/\/www.bmj.com\/content\/352\/bmj.i1619\">I recently reported on<\/a> the World Health Organization\u2019s announcement that Cuba was the first country in the world to halt mother-to-child transmission of HIV, an accomplishment praised by WHO\u2019s director-general, Margaret Chan, as \u201cone of the greatest public health achievements possible.\u201d<\/p>\n<p>As I sat in the semi-circle of doctors who treat pregnant women in Matanzas, Cuba, I asked a question that had long concerned me: Did children who were exposed to antiretroviral drugs <em>in utero<\/em> and\/or during infancy have a higher rate of congenital or developmental problems than other children?<!--more--><\/p>\n<p>I waited as one of the doctors who served as a translator, relayed my question and then translated the answer back for me.<\/p>\n<p>The answer was brief, \u201cThere are so few children exposed to antiretroviral drugs that we really can\u2019t say.\u201d<br \/>\nI couldn\u2019t imagine that.<\/p>\n<p>I asked again.<\/p>\n<p>Again, my translator translated. And again, I got the same answer.<\/p>\n<p>I wondered whether there was a problem with the translation. So, I rephrased the question, and this time the doctors looked at each other, shrugged, and started talking all at once\u2014and they all said the same thing: It was impossible to draw any conclusion since, yes, some of the children were now 25 years old, but there were so few that they couldn\u2019t comment.<\/p>\n<p>I grew a bit testy: Were they avoiding discussion of negative outcomes? After all, they\u2019d been doing this for 25 years\u2014they were more effective than any nation on earth, including the US at halting vertical transmission of HIV. They had to have made <em>some<\/em> observations.<\/p>\n<p>I tried one last time to get an answer. This time, however, I changed the question and I asked for exact numbers.<\/p>\n<p>It turned out that in Matanzas, one of 15 provinces in Cuba, with about 600,000 inhabitants, there are roughly 6,000 to 7,000 pregnancies a year, yet only seven pregnant women in the past five years were HIV positive.<\/p>\n<p>How did they stop HIV transmission? I gave the details <a href=\"http:\/\/www.bmj.com\/content\/352\/bmj.i1619\">in my article<\/a> for <em>The BMJ<\/em>, but in a nutshell, Cuba relies on public health measures to prevent HIV and uses drugs only as a last resort. In order to prevent not just HIV, but syphilis, viral hepatitis and other sexually transmitted diseases, Cuban doctors vigorously promote the use of barrier contraception. Since most HIV transmission is interrupted through the use of condoms, very few mothers test positive. Or as one of the Cuban doctors said, \u201c\u2026success is based on what you do <em>before<\/em> they are pregnant.\u201d<\/p>\n<p>Cuba\u2019s low-tech, inexpensive, common sense approach is in stark contrast with the US where drugs are the go-to answer for everything. Since the body of my work as an investigative journalist has centered on the intersection of money and medicine, and how profiteering distorts science and promotes a pill for every ill, I was surprised that I fell into the \u201chigh-tech\u201d trap and assumed that Cuba\u2019s success was achieved through the widespread use of antiretroviral drugs.<\/p>\n<p>I was wrong.<\/p>\n<p><em><strong>Jeanne Lenzer<\/strong> is a medical investigative journalist who sadly has to leave fascinating tidbits about various stories on the cutting room floor. The Backstory is an attempt to archive some of those bits and to provide a bit of insight for the public about the \u201cbehind-the-scenes\u201d aspect of investigative journalism.<\/em><\/p>\n<p><em><strong>Competing interests:<\/strong> None declared.\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>I recently reported on the World Health Organization\u2019s announcement that Cuba was the first country in the world to halt mother-to-child transmission of HIV, an accomplishment praised by WHO\u2019s director-general, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/04\/13\/jeanne-lenzer-the-backstory-how-i-got-the-cuba-hiv-story-wrong\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1357],"tags":[],"class_list":["post-36504","post","type-post","status-publish","format-standard","hentry","category-us-health-care"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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