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Mission Statement
Cumulative Number of Reported HIV Infections by Sex -
st
December 31 2005
The HIV/AIDS Centre is dedicated to coordinated,
comprehensive, compassionate community based,
family-centered care for persons living with
HIV/AIDS, as well as their families and significant
others. This includes inpatient, clinical, follow-up
care at hospitals, community health poly-clinics and
outreach programs using a multi-disciplinary
approach.

Vision Statement
The HIV/AIDS Centre will continue to distinguish
itself as a model for success in the Region and be
recognized for providing holistic quality, innovative
prevention education, and skilled clinical Of the 5,243 cases of AIDS, 3,612 (68.99%) have
management through-out the Commonwealth of The died. Of the total 10,479 infections, 7,661are in
Bahamas. young adults between the ages of 55 and 44 years.
The ratio of males to females infected with HIV is
Objective 1.1:1.

The objective of the National Programme is to


Cumulative Number of Reported HIV Infections with Current Status -
reduce the incidence and impact of HIV/AIDS and st
December 31 2005
other STIs by providing a strategic, holistic
approach to HIV prevention education; clinical
management, care, support, treatment; HIV/AIDS
training; HIV/AIDS Research; Focus on Youth
initiative; HIV Laboratory Services and CARICOM
Youth Ambassador for Positive Living initiative.

1. Background Information

The focus of the HIV/AIDS Centre is to prevent and


control the spread of STIs/HIV/AIDS in The
Commonwealth of The Bahamas and to extend and
improve the quality of life for all persons in The The number of new persons testing HIV positive
Bahamas living with HIV disease. decreased from 404 in 2000 to 256 in 2004. As a
result of a Mass Media Campaign encouraging
In The Bahamas, the National AIDS programme persons to know their HIV status additional people
has monitored the epidemic since the first case was have come in for HIV testing, this was reflected in
confirmed in 1985. As of December 31, 2005 there the increase by 47 new reported HIV cases totaling
had been a cumulative total of 10,479 HIV 303 new reported HIV infections for 2005.
infections, 5,243 cases of AIDS and 5,236 persons
Adolescents and young people account for the
who are non-AIDS HIV infections.
fastest growing group of new HIV infections.

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The prevalence of HIV in antenatal patients is 2%. 4. Bahamian Infectious Diseases and STI experts
The overall HIV prevalence rate for The Bahamas is documented the connection with genital ulcer
3%. disease, HIV infection and cocaine use, causing
Prevalence of HIV in Antenatal Women, Blood Donors and STI Clients risky behaviours, which resulted in the spread of
Prevalence
Bahamas, 1994-2004 of HIV in Antenatal women, Blood Donors, HIV.
and STI Clients – 1994 - 2004

8 Antenatal Women Blood Donors STI Clients 2. Collaboration Between Health Agencies,
7.5
7
7.2
Units, and Departments In the Response to
6.5
6 5.4
the HIV/AIDS Epidemic
5.5 5.2
5 4.7 4.4 4.8
4.5
4
4.2 3.8 4
4.1
From the first reported case in The Bahamas, the
3.6 3.6
3.3
3.5 3.3 3.1
3
3.3
2.7
3.1 3.1
3.6
2.9
problem was seen as a Sexually Transmitted Infection.
3
2.5 This fostered the already excellent working
2
1.5 relationship
1 0.5
0.5
0.4 0.4 0.4 0.4 0.4 0.5 0.4 0.4
0.2 0.2 between the
0 Infectious
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Diseases Wards
Year and Clinics of
the Princess
The leading cause of death in the age group 15 to 29
Margaret
is AIDS.
Hospital, the Princess Margaret Hospital
Comprehensive
1.2 Crack Cocaine Epidemic/Genital Ulcer (S.T.I.) Clinic, the Pharmacy Services, X-Ray,
Epidemic and HIV Epidemic Laboratory Services, Private Physicians, the
Department of Public Health, Social Services, other
1. The crack cocaine epidemic in the early 1980’s support services and private allied agencies.
led to an increase in sex for drugs and sex with
drugs. The use of cocaine caused impaired
judgment, resulting in persons having sex with 3. Surveillance
multiple partners (approximately 30 % of persons
with AIDS used cocaine). Epidemiological surveillance of HIV/AIDS in the
Bahamas, spans over a twenty year period
2. Following on the crack
cocaine epidemic, the 3.1 Statistics are generated in the following ways:
STI (Sexually
Transmitted Infections) Voluntary counseling and testing (VCT) with pre-test
Clinic documented an Genital Ulcer and post-test counseling, to the following clients:
alarming increase in persons with genital ulcer 1. Antenatal clinic attendees in New Providence and
diseases like syphilis, herpes, chancroid, and Family Islands.
lymphogranuloma venereum (LGV).
2. STI clinic clients and contacts.
3. The four-fold increase seen in HIV infection at that 3. Prisoners during medical assessment on entry to
time was an indication that the three epidemics Her Majesty Prison (also VDRL and Mantoux
(crack cocaine, genital ulcer disease and HIV) testing).
together caused the Bahamas numbers to increase 4. Contacts of HIV positive clients.
disproportionately.
5. Referrals from Substance Abuse Agencies

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Cumulative Number of Non-Aids, HIV Infections AIDS Cases Alive, By Age, Group and Sex - December 31st 2005
st
By Age, Group, & Sex - December 31 2005
1200

1000

800
Number

600

400

200

0
<01 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ Unk
Male 73 49 21 11 76 293 440 491 357 253 188 91 60 85 105
Females 79 50 26 22 185 429 529 433 312 196 95 73 50 45 119
Total 152 99 47 33 261 722 969 924 669 449 283 164 110 130 224

New Cases of AIDS, By Sex and Year - December 31st 2005 Current Status of Reported AIDS Cases - December 31st 2005

300

250

200

150

100

50

0
198
198 199 199 199 199 199 199 199 199 199 199 200 200 200 200 200 200
5-
9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
198

Male 173 91 97 142 163 173 204 239 219 224 207 192 181 162 208 204 135 147

Females 101 79 68 78 99 122 111 145 153 158 112 128 132 125 127 143 99 101

Percent Distribution of HIV Infections Current Non-AIDS HIV Infections, By Sex and
(AIDS Cases and Non-Cases) Reported Annually, st
Reported Year - December 31 2005
st
By Bahamian Status - December 31 2005
500

450

400

350

300
Number

250

200

150

100

50

0
1986-
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
1988
Male 432 307 243 270 297 285 341 250 210 225 171 170 200 185 162 126 127 141
Female 278 188 207 238 280 280 315 248 219 192 185 172 205 201 168 162 129 162
* Data as at December 31st, 2005

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3.2 Partner Notification & Contact Tracing 4. HIV/Tuberculosis
Due to improved clinical management and the DOTS
A major factor therapy, co-infection of TB and HIV continues to
responsible for the decline.
accuracy of
HIV/AIDS statistics 5. Bahamas National HIV/AIDS Response:
is the outstanding In 1985 the National Standing Committee on HIV/AIDS
skill of the Public was formed, with the CMO as its Chairperson, and the
Health nurses in Infectious Diseases Specialist as Director of the
counseling, partner National AIDS Programme. From 1985, AIDS has
notification, contact been a notifiable disease.
tracing and maintaining Staff at the Coconut Grove
client confidentiality. The following strategies were identified:
This has resulted in increased numbers of persons
being named as contacts and being counselled tested 1. Prevention of sexual transmission.
and followed up. 2. Prevention of transmission through blood/blood
products.
3. Prevention of perinatal transmission.
3.3 What Statistics/Research tells us: Focus 4. Epidemiological Surveillance and research.
Should Be on HIV Prevention For Teenagers & 5. Reduction of the impact of HIV infection on
Young Adults. This Is Supported By:
individuals, groups and society.
• Antenatal Statistics showing 2% of pregnant 6. Development of treatment protocols for
women are infected with HIV. HIV/AIDS.
• STI/HIV infections in young girls - this is the fastest 7. Accelerated access to ARV’s.
growing group of persons testing positive.
Subcommittees on Epidemiological Surveillance,
• The number of teenagers having babies
Public Education, Blood Banking, Treatment and
(unprotected sex) each year is high, approximately
Research were introduced.
700 - 800.

5.1 The AIDS Secretariat was developed in 1988 to


3.4 Trends Noted coordinate HIV/AIDS prevention education related
activities. The purpose of the Secretariat was to serve
• A decrease overall in new person testing HIV
as the coordinating centre for the dissemination of
positive
information on HIV/AIDS and Sexually Transmitted
• A decrease in vertical transmission from 30% to Infections education. All information
10% and now to less than 1% in 2005. available/provided by the HIV/AIDS Centre is extended
• 2% of antenatal clinic clients are HIV positive. to the Family Islands.
• A decrease noted in death rate. This role was expanded in 2003 under the HIV/AIDS
Centre to include all arms of HIV/AIDS activities under
• Increase in HIV infected persons on ARV
one umbrella.
medication
• Challenges with compliance with ARVs.

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5.2 The HIV/AIDS Centre consists of 6 units: 5.4 Infectious Diseases Ward and Medical
• HIV Prevention Education Unit Follow-up Clinic
• Clinical Management, Care Support and
Treatment Unit From 1985 all HIV/AIDS patients have been admitted
• Medical Research Unit to the Infectious Diseases Wards with 20 male, 15
• Laboratory Diagnosis Unit female and 8 pediatrics beds.
• Regional Training Centre Unit Outpatient’s clinics are as follows:
• Focus on Youth, Youth Ambassadors for
Positive Living • Wednesday: - Medical Follow-up clinic for
Adults, Children and HIV+ pregnant women
The National AIDS Education Programme, which draws • Wednesday: - TB (Mantoux) Clinic
on the expertise of volunteers and persons in non- • Mondays: - Counseling Clinic for newly
government organization, has been successful in diagnosed HIV positive persons
making the public aware of the threat of HIV/AIDS to • Fridays: - TB Clinic for all persons with TB and
persons not only in The Bahamas but also in the region. contacts.
Structured Island outreach workshops are held in the 5.5 Interventions to Reduce the Spread of
island on an ongoing basis. HIV/AIDS in Vulnerable Populations;

5.3 National HIV/AIDS Programme A. Prevention targeted at young people – Specialty


Management programmes for the prevention of HIV/AIDS/STIs
in adolescents. e.g. - the expanded Focus on
From the inception, The Bahamas’ National HIV/AIDS Youth initiative.
Programme Director has been Dr. Perry Gomez,
• Not sexually active / Sexually active
Infectious Diseases Specialist, who was the focal point
for all the committees. He was able to coordinate the • Focus on Youth Programme/ I am special Health
work of these committees, and attract key experts to and Family Life (HFL) School Programme: HIV
assist in various areas of HIV/AIDS interventions. prevention/education intervention for grades 6-8.
• Annual World AIDS School Competition.

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5.5 Interventions to Reduce the Spread of 5.8.1 Children with HIV:
HIV/AIDS (continued)
The Bahamas participated in an open Label Phase
B. Commercial Sex Workers(CSW) and Men Who three study of ABT-378/Ritonavir in HIV-infected
Have Sex Sith Men (MSM): trainers working on children. 18 children are enrolled and are doing
data collection through focus groups (CSW and exceptionally well.
MSM). These areas need addition support.
C. Institutionalized populations. 5.8.2 Reduction in Vertical Transmission
D. Work with the large Creole speaking population. Antiretroviral (ARV) Programme - HIV infected women
make up approximately 2% of the 6000 annual
E. Targeted Intervention for uniformed organizations.
pregnancies in The Bahamas. Most of these (85%)
access antenatal care through the Public Health
5.6 To Sustain Reduction Of Vertical Community Clinics. All women are counseled and
Transmission; Work With HIV Positive offered HIV testing. More than 90% of women agree
Mothers and Their Children. to be tested. Those who are HIV positive are referred
to the weekly HIV/AIDS special clinic at the Princess
1. Provision of ARV to all HIV positive pregnant Margaret Hospital, where they are further counseled,
nd
women by the 2 trimester of pregnancy with and offered ARV’s. The babies are followed up at the
monitoring of adherence. weekly pediatric HIV/AIDS clinic, which runs
2. Prevention of repeat pregnancies concurrently with the antenatal clinic. If they are found
3. Protocols for addressing needs of children of HIV to be HIV positive, the babies are followed up monthly.
positive mothers With the ARV programme in place, the Vertical
4. Orphans and AIDS - a growing concern and Transmission rate has dropped from 30% to less than
problem. 1%.

5.7 Human Rights Issues The Bahamas participated in the


Work is ongoing to: Neviparine Study. The result
showed that Neviparine is an
• enact policies development and legislation.
effective ARV therapy for the
• promote human rights and non-discrimination. reduction of MTCT.
• National Consultation on HIV/AIDS in the 5.8.3 Protocol 247:
workplace. (August 2000)
This was a muliti-center, two-arm randomized, double
blind controlled trial to evaluate the effect of an
5.8 Research Initiatives
increased caloric density infant concentrated formula
Bahamian Infectious Diseases expert and STI experts on growth and nutritional status of HIV-infected infants.
documented the connection with Genital Ulcer Disease,
HIV infection and Cocaine use causing risky behaviour 5.8.4 Penpact 1 (Penta9/Pactg390)
which resulted in the spread of HIV. HIV Clinical
Research Trial participation with children, adults and A phase II/III randomized, open-label study of
pregnant women sponsored by International Research combination anti-retyroviral regimens and treatment-
Agencies is ongoing. Other research projects are as switching strategies in antiretroviral naive children >30
follows: days and <18 years of age.

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5.8.5 Tipranavir 1182.33 7. Care Initiatives
A randomized, open label, active controlled trial to Support for PLWHAs.
evaluate the antiviral efficacy and safety of treatment Clinical management and treatment of HIV/AIDS
with 500 mg Tipranavir plus 100 mg or 200 mg Ritonavir enhanced at the community level:
p.o. BID in combination with standard background
Indicator: At least 30% of reported persons living with
regimen in comparison to 400 mg Lopinavir plus 100 mg
HIV infection receive appropriated clinical
Ritonavir p.o. BID in combination with standard
management at Community Health Poly Clinics by end
background regimen in antiretroviral therapy naïve
2006.
patients for 48 with extension up to 156 weeks

8. Continuing HIV/AIDS Education for health


5.8.6 ATN 024 care providers maintained:
A multicenter, stratified, block-randomized, open-label Indicator: Approximately 50% of relevant health care
trial to study the initial and persistent immune response providers receive CME certification in HIV/AIDS
to safety of three hepatitis B vaccination schemas in education and treatment by December 2006.
HIV-infected adolescents 12 to <25 years of age.
9. Family Island Initiatives:
Education in island communities is on-going
5.9 HIV/Tuberculosis
with the Community nurse in charge of the major
The Bahamas was one of the first Caribbean countries clinics, which serve as the focal point, and the School
to document the relationship between HIV infection and Family Life Educators assisting. A range
Tuberculosis and the Multi-Drug Resistance problem of prevention, support and care activities take place in
with Tuberculosis. different Islands, settlements and communities.
Prevention efforts are maximized during cultural
activities such as regattas, with involvement of Local
6. Special Population Groups Empowered/
Government teams.
Educated for HIV prevention, Reduction In
Stigma Discrimination & Serving As Partners
in care Efforts Include: 10. HIV/AIDS Centre Resource Committee
• Religious Based Instructions - Churches; their role A very active and vibrant multi-Sectoral team of
in prevention, care and support especially home persons from the community, meets monthly. It
care. consists of Public Health Nurses, playwright/ author,
cosmetologist, educators, youth and drug prevention
• Work with Unions, Human Resource Managers. officers, Infectious Diseases and STI consultants,
• Women’s groups - UNIFEM Project, Zonta, Links representatives from a large utility corporation,
Inc, Bureau of Women’s Affairs. Bahamas Family Planning Unions, Ministry of
Education and Youth, Community Policing, the AIDS
• Media: Their ongoing role in HIV prevention Foundation, the Religious Community, Service Clubs
education. and PAHO/WHO, Legal Department, Banks, Chamber
of Commerce and other Non-Government
Organizations.

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11. Areas In Which Current HIV/AIDS
The HIV/AIDS Resource Centre provides:
Prevention Work Needs To Be
1. Information dissemination assistance with school Accelerated
and youth groups.
2. Networking (Red Cross, Girl Guides, Boys Scouts, • Work with PLWHAs
Governor General Awards Group, Sporting Events,
• Work with large and growing Creole speaking
Street Vendors, Narcotics Anonymous,
community
Cosmetology, Professionals, Churches, Schools,
• Work with target audience MSM, bisexuals
Bahamas Family Planning Association, Samaritan
Ministries. • Work with sexually active young people in and
3. Presentations out of school
4. Walk-in Counseling • Work with parents
5. PLWHA expansion of CRN + organization • Work with CSW and with persons who are not
generally “considered” CSWs but who regularly
As well as Workshops for the following: have sex for car payments, loan payments etc.
• Repeat pregnancy prevention for HIV positive
persons who have had on child.
• Teachers • Guidance
• Structured, sustained work with smaller
• Church Leaders Counselors
Evangelical, Pentecostal and Independent
• Media: Staff • Workplace Churches.
• Social Workers • Work with addicted population especially
• Political
alcoholics
Constituents • Parents
• Work utilizing sports community
• Volunteers • Unions • Work with men patronizing bars, using
• Uniform Officers • Corporations bartenders and bar room setting
• Health Fairs • Sporting Groups • Website development
• Youth • Family Island
Regattas 12. National Non-Government Involvement:
• Officers/groups
• Family Island • Crisis Centre
12.1 The Samaritan Ministry Programme began
• Community • Home Coming
in 1988 and is unique to the region. It has had a
Outreach • Health Care positive impact on the care and support offered to
• Communities’ Workers those persons with HIV and those living with AIDS.
• Bank Staff Samaritan Ministers are specially trained lay
• Tourism Industry
counselors who work one on one with HIV/AIDS
• Decision Makers • Insurance Staff
clients and families. Members of The Samaritan
• Family Life • Hotel Workers Ministry are part of the AIDS Secretariat Resource
Committee.

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12.2 The AIDS Foundation (formed in 1992) 12.6 Bahamas Barbers & Cosmetologists:
This non-governmental organization has as its The Bahamas Barbers and Cosmetologist Association:
objectives to:
A past President is an active member of the Resource
• Assist in the establishment of and funding of Committee.
housing for HIV/AIDS infected persons.
• Assist with the education of the public 12.7 The All Saints Camp

Funding for this important organization is due in large The All Saints Camp located on the Lazaretta Road off
part to the support from a major insurance company and Carmichael Road west is a Non-Government
other business organizations. Some of its activities to Organization. It was established under the Direction of
date include: Rev. Glenroy Nottage. This institution is home to
• sponsored a company of Peer Educators (the Ashe numerous HIV infected persons. The lovely setting of
Group) from Jamaica, who through song and spotless white cottages along paved pathways,
dance provided STI and HIV/AIDS information and overhanging trees, pets like fish, turtles, and parakeets
prevention education to more than 20,000 20,000 are only a few of the amenities to make PLWHA feel
Bahamian youth. and look good.
• sponsored numerous workshops at the national 12.8 Corporate Bahamas
and international level and has co-sponsored
various educational and fund raising activities with 13. International Non-Government
the Imperial Life Insurance Company, for example, Involvement
workshops for youth and the extremely successful
Red Ribbon Ball. • PAHO
• initial provision of funds to purchase AZT for • UNAIDS
pregnant mothers infected with HIV. The • Med-Pharm
programme, which now includes triple therapy, is • Clinton Foundation
funded by the Government.
• Wayne State University
• United States Embassy
12.3 Bahamas Red Cross • Hospital for Sick Children

The Red Cross: Junior volunteers HIV/AIDS training is 14. The number of persons on ARV’s has significantly
ongoing and was recently expanded. increased since October 2002. At the end of
12.4 The Bahamas Family Planning December 2005, 1800 PLWHAs had commenced
Association ARVs.
15. An Anti-Discrimination in the workplace Law was
The Bahamas Family Planning Association: works in recently passed; hopefully this would assist in the
close collaboration with the AIDS Secretariat on a prevention of Stigma and Discrimination of HIV/AIDS
number of projects including training of peer educators, persons in the workplace.
family life educators, students etc.
16. HIV/AIDS Advisory Committee is responsible for
12.5 Unions the overall policy management, development and
implementation of the National HIV/AIDS Programme
The President of the Airport, Airline and Allied Workers it is chaired by the Chief Medical Officer and the
Union is a member of the AIDS Secretariat Resource Director of the National AIDS Programme.
Committee. The Workers Credit Union Executive and
members have had sessions on HIV/AIDS.

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Management & Staff
HIV/AIDS Centre

Mr. Thomas Holbert Ms. Tami Clarke


Dr. M. Perry Gomez
Ms. Claramae Farrington Ms. Tamazina Farrington
Dr. Stanley Read
Mrs. Tanya Kelly Ms. Uvie Johnson
Mrs. Rosa Mae Bain
Mrs. Masie Miller Ms. Lorraine Clarke
Dr. Percival McNeil
Mr. Solomon Sands Ms. Ernestine Deveaux
Ms. Janet Lundy
Ms. Jessica Stubbs Mr. Keith Kemp
Mrs. Sandra Miller
Ms. Mercia Strachan Mrs. Lynette Deveaux
Mr. Terry Johnson
Ms. Marjorie Morley Dr. Sonja Lunn
Mr. Victor Smith
Ms. Vianna Williams Mrs. Bernadette Saunders
Ms. Lorna Anderson
Ms. Sandra Stubbs Mrs. Shanice Rahming
Ms. Shelley Munnings
Mr. Emile Lesbott Ms. Chanelle Diggiss
Mrs. Cynthia Johnson
Ms. Mariette Newry Ms. Pamela White
Rev. Irene Coakley
Mrs. Thelma Cargill Dr. Ismae Whyms
Ms. Marva Jervis
Mrs. Sophia Bethel Ms. Stephanie Braynen
Ms. Indira Martin
Ms. Maria Cartwright Mr. Keith McConnell
Mr. Sidney Albury
Mrs. Esther Johnson Mr. Sean Kennedy
Mr. Lamorn Armbrister

National HIV/AIDS CENTRE


Tel: (242) 328-1540 or
(242) 323-5968
Fax: (242) 322-6610
Email: medicineid@batelnet.bs
2006