We’ll Always Have Cuba
A round-table discussion with four members of the Black AIDS Institute Cuban delegation
by Larry Buhl
Photographed Exclusively for A&U by Sean Black
[dropcap]L[/dropcap]ess than six months after the beginning of the normalization between Cuba and the U.S., a delegation of fifteen gay men (mostly) of color spent fifteen days in Cuba collecting and sharing information on innovations in HIV/AIDS treatment and prevention, sexual and gender identity, and the differences in responses to the AIDS crisis between a for-profit system and a government-controlled healthcare system.
The men of the delegation had diverse backgrounds and interests. The majority was black, with one Asian-American, and one white traveler. Two were retired, two worked in education, one in law, one in hospitality and the other nine professionals in various aspects of healthcare research and policy.
I spoke with four of the delegation participants after they returned to the U.S. They were:
• Phill Wilson, founder of Black AIDS Institute
• Wakefield, Director, External Relations, HIV Vaccine Trials Network
• Justin Tandingan, Director of the Asian American & Pacific Islander Initiative at Teach For America
• Christopher Hucks-Ortiz, Evaluation Specialist at John Wesley Community Health Institute in Los Angeles and current Chair of the HIV Prevention Trials Network (HPTN) Black Caucus
Larry Buhl: Phill, what did you hope to achieve by putting together this delegation?
Phill Wilson: At the point Obama began to have a conversation about opening relationship with Cuba we at the Institute said there is an interesting story to tell around race in Cuba. We were in connection with people who had been doing anthropological work around the African-Caribbean and African-Latino and the Afro-Cuban experience. We wanted to see what that looked like. That’s why we decided to sign on for the delegation.
What did you find intriguing regarding race there as it applies to the African American experience?
Wilson: We discovered early on what a major African influence there is in Cuba, and while Cuba has a slave legacy like we have in the U.S. and the Americas, one thing is there isn’t a running away from that history in Cuba. There are a lot of places you go and there is a discourse about how this or that was built by slaves. In the U.S. there is a reluctance to acknowledge how much of our country was built on the back of enslaved people that’s a problem when we talk about race dynamics in America today.
Wakefield: And not only did they acknowledge the role of slavery in their history, but they talked specifically about how it contributed to economic growth and made their history possible. Part of that was to affirm that they were valid and important people in Cuba’s history, which we don’t hear in the U.S. Not only do we run away from talking about it, I’ve never heard that [slavery] is important to America in completing the infrastructure.
Christopher Hucks-Ortiz: What we think about Cubans here in the U.S. is overwhelmingly the voice
and experience of white Cubans, who were from the white class, the ruling class or upper class, who had the resources to pull resources out and leave. We were able to engage with two college students from the University of Havana about their understanding of the history of Cuba and about the race and power differential that black Cubans experienced before the revolution and after the revolution. They said [black Cubans] don’t have everything everyone else has right now, but there seems to be more parity than before the revolution and the revolution helped benefit black Cubans. That is a perspective I hadn’t heard.
Is there a disparity in who’s impacted by HIV/AIDS in Cuba?
Wilson: It’s a little difficult to tease out the demographics of the epidemic in the same way we do in the U.S. What I can say is that the delivery of care and the design of the delivery of care is much more equitable in Cuba than in the U.S. Because they have universal healthcare, no matter who you are, you have access to medication. And you have access to the same medication as anyone else, relative to the services provided by the national healthcare delivery system. But having said that, I’m not so sure that we saw evidence one way or another to suggest people were disproportionally impacted or not on HIV based on race.
Cuba has been long touted as a model for how to treat HIV/AIDS from the beginning, while criticized for some of the harsh tactics like quarantining. Do they believe they’ve handled it right?
Hucks-Ortiz: Cuba was the first country on the globe certified by UNAIDS to eradicate transmission of HIV from mother to developing child. We asked advocates at the meeting at the [U.S.] embassy whether they had mandatory testing; they said no. I couldn’t figure out how they were able to facilitate access to treatment for every woman who’s seropositive if they don’t require every woman who’s pregnant to get a test.
Even though people have access to medical care through their national health service, which I wish we had in the U.S., because it gives everyone a basic access to medical care. But they don’t have the same access to ARV treatment that you would have in the developed western world if you have access to insurance. And there isn’t always enough medication for people who want to stay on treatment. It’s easier in Havana but if you’re living in rural Cuba harder to get access to medications. People who are not as adherent will trade medications with people who are more adherent.
Regarding spread and treatment of HIV/AIDS, how did you see race and identity affecting this crisis?
Wilson: One of the things Cuba did was build a robust generic manufacturing capacity on the island. That gave them the ability to make their own ARVs and not be dependent on U.S.-patented ARVs. They’re the same compound. One is branded and one isn’t. But there are shortages in a country that has had a U.S. embargo for sixty years. In theory the medications are available to everyone, but they may not be due to shortages.
Wakefield: Testing [for HIV] is routine. You go in for an evaluation you get tested; you talk to your doctor about what you’ve done. There’s not an opt-out and there’s not an additional stigma attached to it. It’s part of your routine healthcare. You get blood drawn, you get your blood pressure checked, you get the HIV test. That’s a very different approach than we have. Here [patients] often don’t want to have that conversation with a doctor and they don’t get tested because of that.
Do the healthcare practitioners have a better understanding of men’s health and gay men’s
sexuality, and do patients have a lack of stigma in answering these questions?
Justin Tandingan: There is quite a bit of stigma around HIV/AIDS and about LGBTQ or coming out as gay or bisexual, and if you’re in a region outside of the city there may be some insensitivity on the part of the doctors. There are differences between the urban center of Havana and the rest of the island.
Hucks-Ortiz: I would agree with that. There was one young man who said that when they find out you’re gay or bi or same-gender-loving there’s an expectation that you’re living with HIV or you’re going to have HIV.
That’s interesting because they report a low rate of HIV.
Wakefield: There have been papers presented by researchers in Cuba and, based the data they are publishing, it does seem as best we can tell that when we compare what they’ve done to keep the virus under control, they have done a better job than we have done. As to where new infections are happening, we weren’t able to drill down too deeply, other than learn that shortages of meds can happen intermittently. The shortage issue would create an environment of resistant virus and that may be happening in Cuba as well.
Did you get any sense of where the trans movement is there?
Tandingan: We were at CENESEX [see cover story] and they have many resources for trans folks, like legal and mental health services. The fact those are available and sanctioned by the state, that was interesting. The trans movement led the way as far as LGBT rights and activism. That was different than what we see in the U.S. as far as what is accessible and what is not. It showed me a model of what is possible and how to make those shifts from a government perspective.
Wilson: Not only are there services available at CENESEX, but there are trans women in position of authority there. It’s a center that’s inclusive of trans people at the highest levels. In our conversation with Mariela Castro, when asked about her reasons for taking leadership in this arena, her reasons were tied to the fact that basic to the manifesto of the revolution was the freedom of everybody, and that had to be inclusive of LGBT people as well.
What were the people you spoke with eager to learn about regarding HIV/AIDS?
Wakefield: I did not experience much interest in what we in the U.S. were doing around this arena. They know they produce more doctors per capita than anywhere in the world. They know they have an excellent system for training people around this work. I don’t recall at any point anyone suggesting what we were doing could be useful for them.
Wilson: As I have traveled around the world, particularly developing countries, there is a hunger for tips and strategies and guidance on how we do things in America, and that they had lots to learn from us. That is not the attitude in Cuba; at least in this space [HIV/AIDS] they have a lot to learn from us.
Tandingan: There was a language barrier to get at some of the specifics about what might be applicable to Cuba. In our delegation, in conversations, it was difficult to get to an understanding of what was going on without a translator with us. That level of conversation is nuanced in many ways and that is lost in translation.
Was there any concern about increased sex tourism from the U.S. and how that might impact the HIV/AIDS crisis?
Hucks-Ortiz: There was a gentleman on the delegation and he asked if they saw a correlation of sex tourism and the spread of HIV in the population. I did not get the sense that, if there was, that it was information we could have accessed easily. There are people who go there for sex tourism. We know it happens. But I didn’t see it like in other countries in the Caribbean.
What surprised you the most about Cuba?
Wilson: How warm and welcoming the Cuban people were. We did not run into any animus whatsoever. The second surprise is how robust the gay scene is in Havana and even in other places. It may not have a robust [LGBT] infrastructure as we know it, but even the presence of a gay scene that existed even in the more rural communities [was a surprise].
Hucks-Ortiz: I don’t think I had any negative interactions. Everyone was concerned: “Are you enjoying our country? Are you having a good time?”
Tandingan: There is genuineness about the way Cubans build relationships. You need one another to survive there. You’re on an island. There’s an ability to know people for long periods of time. People want to be in each other’s business but also support each other. They wanted to share what they had with us and I appreciated it. As a Filipino-American and it was a unique experience to feel just as welcome as others on the trip. It helped that I spoke a little more Spanish. The problem is, it’s hard to communicate on-line and when you are it’s very slow. I wonder how that will change the community when everyone gets connected.
Hucks-Ortiz: This was a really powerful experience for me. I’m willing to bet other men on the trip had similar experiences. I learned about Cuban people but about experiencing myself in a different way. It’s intangible but important. You know that saying, “We’ll always have Paris”? I say, “We’ll always have Cuba,” no matter what else happens. This moment was special.
For more information about the Black AIDS Institute, log on to: www.blackaids.org.
Larry Buhl interviewed the staff at MSMGF about their work for the March 2016 issue.
[dropcap]T[/dropcap]raveling to another country, particularly one you’ve never been to before, can be exciting and even a little scary. The Black AIDS Institute was proud to join with A&U magazine to sponsor the first U.S. Gay and HIV/AIDS delegation to Cuba since President Obama started normalizing relationships between the U.S. and Cuba last year. This delegation of fourteen cross-generational, primarily Gay men of color from various sectors was both historic and monumental.
The U.S. ratcheted up sanctions on Cuba in 1960. Diplomatic relations between the two countries broke off in 1961. With tensions increasing after Cuba signed a trade agreement with the Soviet Union, President John F. Kennedy made the embargo official in 1962.
We arrived on Christmas Day 2015, not knowing what to expect, but still full of expectations and preconceived notions about a country that has legally been cut off from the U.S. for nearly sixty years. Cuba is a beautiful country, but the thing that grabs you and won’t let you go is how beautiful, friendly and resilient the people are.
Cuba is a lovely, exhilarating and complicated place. In many ways Cuba is two countries. There is the country with the classic cars from the forties and fifties, and the crumbling Art Deco architecture. There’s also the country where enterprise and entrepreneurship is everywhere, as well as a thriving Gay scene. Everyone we met was excited about building new relationships with the United States while at the same time extremely proud and committed to Cuba. Cuba has a long and storied slave and racial history, but unlike the U.S., Cuba does not appear to be running away or in denial of its history. By facing its past head-on and acknowledging the critical role Black people played in building the country, literally and culturally, Cuba is working to create a Cuba for all Cubans.
In this issue, we try to give you a glimpse of both the old and new Cuba. We present a round table of some members of our delegation, sharing their insights about Cuba’s fight for LGBT equality, efforts to support individuals living with and at risk for HIV, and embrace of the history and lived realities of Cubans who are part of the Black diaspora. Delegation member Christopher Hucks-Ortiz also weighs in about new opportunities for information exchange between the U.S. and Cuba. At the U.S. Embassy, we met with advocates, among them Belkis Fonseca Medina and Jesús Manuel Rodrigues Valle, both of whom share their insights about working to secure equality for people living with HIV/AIDS in this issue. And check out our review of VIVA, a new film about Cuba, in The Culture of AIDS.
We want to thank our friends at AirBNB for helping with the accommodations, Orly Cowly and the crew at ENLISTA for providing us with ground and logistical support (you have not traveled to Cuba until you’ve traveled with ENLISTA), the folks at CENESEX, Dr. Mariela Castro Espín, this month’s cover story, for spending time with us and for her tireless efforts on behalf of LGBT equality and HIV/AIDS education in Cuba, and the amazing Sean Black for chronicling our trip photographically.
As hard as we have tried, no publication can provide an adequate description of all of Cuba in its beauty, majesty, and ambiguities. My advice is to go and to go soon. The Black AIDS Institute is working on another delegation to Cuba following the 2016 US conference on AIDS. For more information, please contact us at [email protected]. We look forward from hearing from you. Until then, please take care of yourself and your blessings.
For more information about the work of the Black AIDS Institute, log on to: www.blackaids.org.
Yours in the Struggle,