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Feature Maternal and Child Health

How Cuba eliminated mother-to-child transmission of HIV and syphilis

BMJ 2016; 352 doi: (Published 21 March 2016) Cite this as: BMJ 2016;352:i1619
  1. Jeanne Lenzer, associate editor, The BMJ
  1. jlenzer{at}

As relations between Cuba and the West have thawed and Barack Obama makes the first visit by a sitting US president to Cuba in 88 years, Jeanne Lenzer explores some lessons the world could learn from the country’s health service

On 30 June 2015, the World Health Organization and the Pan American Health Organization announced that Cuba had become the first nation to virtually eliminate mother-to-child transmission of HIV and syphilis.1 The announcement came after a five day, on-site audit conducted by experts from 10 nations, including the United States, Brazil, and Japan.

WHO defines “effective elimination” of mother-to-child transmission as reduction to such a low level “that it no longer constitutes a public health problem.” Validation was based on transmission rates less than 50 cases per 100 000 live births, and included validation that the services provided were “free of coercion and in accordance with human rights principles.” In 2013, only two babies were born with HIV and three with syphilis in Cuba.

I visited Matanzas Province in northern Cuba to learn how the country had accomplished this goal—something not apparent from the WHO news reports. Margaret Chan, WHO’s director-general, praised Cuba saying, “Eliminating transmission of a virus is one of the greatest public health achievements possible. This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation.” However, there was no mention of the public health …

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