HAVANA, Nov 30 - When Cuba discovered its first AIDS case in 1986 among soldiers returning from Angola and Mozambique, alarm bells went off in the island's Communist leadership.
The virus was largely unknown and 300,000 Cuban soldiers who fought in Africa over a decade could have been exposed.
Authorities scrambled to test all military personnel that had been in Africa, and quickly found dozens of cases.
HIV-positive Cubans, at first mainly heterosexuals but later increasingly homosexuals, were treated in sanatoria where they were obliged to stay, a policy that drew international criticism.
Cuba stopped quarantining in 1993 and allows people with HIV to stay at home after a course to teach them how to look after themselves and not spread the virus.
Universal free access to locally made generic antiretroviral drugs has kept AIDS cases and deaths very low, said the UNAIDS program.
Almost 20 years later, Cuba has one of the lowest rates of HIV infection in the world, a prevalence of less than 0.1 percent of its sexually active population.
That's six times less than the United States and a big exception in the Caribbean, the second most-affected region in the world after sub-Saharan Africa, according to UNAIDS.
Cuba, a country of 11 million people, now focuses heavily on prevention and will mark World AIDS on Thursday by sending out volunteers to distribute free condoms on the streets of central Havana to encourage safe sex.
Since 1986, only 6,782 Cubans have tested positive for HIV and 2,784 have developed AIDS, with 1,314 deaths, according to the Health Ministry.
"The quarantine was very effective in stopping the first wave of the epidemic that came from Africa, given the amount of people we had over there," said Cuba's top AIDS expert Dr. Jorge Perez, a director at Havana's Pedro Kouri Tropical Medicine Institute.
"Of course, it was painful for the people interned," he said.
PETS AND LOVERS
Cuba still requires mandatory HIV testing for pregnant women, blood donors, army recruits, prison inmates and all adults with sexually transmitted diseases.
But at the Los Cocos sanatorium in a mango and coconut grove on the outskirts of Havana, the 300 resident HIV patients are there because they want to be.
They live in bungalows with room-mates or their partners. Pets are allowed, there is a basketball court and the food is better than in the average Cuban household.
Besides 24-hour medical care, Los Cocos gives gay patients a refuge from Cuba's homophobic society.
"I've been here eight years and decided to stay. I have everything I need: food, medicine, housing and the doctor right there," said Josue, 36, who lives with his gay lover.
Another resident is Maria Julia Fernandez, an anti-AIDS health worker and widow of the first AIDS case detected in Cuba, Reynaldo Morales. He was a soldier who returned from Angola in 1986 and died at 45 after 11 years at Los Cocos.
Fernandez has lived with HIV for almost two decades without developing AIDS and does not take antiretrovirals.
When Cuba adopted its outpatient program for people with HIV in 1993, only 15 percent of the patients left the sanatoriums.
"We were surprised. We thought the sanatoriums would empty," said Los Cocos director Rigoberto Lopez.
Mass testing allows Cuba to detect 80 percent of HIV cases in their first year of infection, public health official say. The virtual absence of intravenous drug use in Cuba has helped too.
Cuba's big advantage in the fight against AIDS is that its biotech industry produces six antiretroviral drugs -- ZDV, DDI, D4T, 3TC, DDC and IDV, Lopez said.
"The manufacture of generic drugs brought an extraordinary turnaround in the lives of people who live with HIV, giving them a better quality life, clinically and psychologically," he said.
Deaths have dropped from 25-30 to 4 or 5 a year at Los Cocos.
Cuba currently treats 1,900 AIDS cases with generic drugs that cost the state $350 per person a year, and will soon start producing protein inhibitors to replace imports, Perez said.
Perez expressed concern about a steady increase in HIV-positive cases among men who have sex with men, saying: "We have done a lot in controlling the impact of AIDS, but we cannot sit back contented."