1. Voluntary and Testing Services Bernadette Hamilton-Saunders Bahamas

2. Overview of the Bahamas Archipelago nation of approximately 700 islands, of which 40 are populated. The islands cover an area of about 100,000 square miles, located in the Caribbean, southeast of Florida and northeast of Cuba Population: 330,000 persons, 85% black, 12% white, 3% Asian and Hispanic Nassau is the capital located on New Providence

3. As at Dec 2004 Total HIV infected persons alive 6601 Total AIDS cases alive 1529 PLWHA with CD4 <350 2505 PLWHA on HAART 1600 HIV+ Pregnant Women 105 MTCT rate < 2% PLWHA on Rx 1638

4. Administrative Arrangements of VCT

5. VCT Services Provided PMTCT Program – ANC are –pretest counseled, positive referred to the HIV/AIDS Centre for post-test counseling MW – post-test counseled mainly by staff of the HIV/AIDS Centre Inpatient Care – IDW and other hospital wards: staff from the HIV AIDS Centre called in to counseled HIV+ clients Home care services: to promote privacy, decrease stigma targeted towards the individual

6. Use and Demand of VCT Services PMTCT – Pregnant women and their partners All Blood Donors Screened Contact tracing/screening Walk-ins

7. VCT – usually offered by midwives at the ANC, Maternity Ward, Infectious Disease Clinic and Comprehensive Clinic. 100% acceptance among pregnant women and prisoners App 85-90% acceptance among contacts Return rate for results highest among pregnant women and contacts, lowest among prisoners especially after discharge from prison Type of test – Abbott Murex and Abbott Determine rapid test

8. Barriers to VCT Persons prefer not to know their status Level of stigma and discrimination in the society Confidential issues in the community, health care system Waiting time for test results Availability, accessibility of VCT services (limited) Limited amount of trained VCT Counselors

9. Challenges Confronting VCT Services in the Bahamas Acceleration of access to VCT – training of HCP to decrease patient counselor ratio Overcrowded clinics – impacts privacy Lack of stand alone VCT centres Level of social support interventions is compromised due to insufficient personnel to provide these services Lack of computerized system causing delay in receipts of clients results