A multidisciplinary approach to scaling up HIV/AIDS treatment and care: the experience of the Bahamas.

1 Pan American Health Organization, Washington, D.C. 20037, United States of America. Send correspondence to: James Fitzgerald, Pan American Health Organization, 525 23rd Street, N.W., Washington, D.C. 20037, United States of America; telephone: (202) 974-3718; fax: (202) 974-3610; e-mail: [email protected] 2 Bahamas, Ministry of Health, Nassau, New Providence, Bahamas. The Bahamas has a total population of 314 000 (1). It is estimated that there are now 5 600 to 8 700 adults and children living with HIV/AIDS in the country (2). Approximately 2 500 women in the age range of 15 to 49 years are infected with HIV. The Ministry of Health (MOH) of the Bahamas and the surveillance system of the nearby Turks and Caicos Islands report that approximately 25% of all HIV infections among persons in those two jurisdictions are found in the Haitian immigrant population. Various estimates suggest that the Haitian population in the Bahamas represents 25% of the country’s total population (3). Historically, the majority of Haitians found in the Bahamas have fled Haiti for economic reasons. To address the HIV/AIDS epidemic, the Bahamas has developed effective HIV/AIDS prevention, care, and treatment policies that have been applied since 1985.3 The Bahamas National AIDS Program has developed strategies and interventions in the areas of prevention and education, comprehensive care (clinical and social interventions), support services, and surveillance and research (clinical and behavioral) (4). The National AIDS Program coordinates the national response, and services are provided throughout the public health care system as well as in the private sector. Strong private and public partnerships have been built, as evidenced by the intersectoral HIV/AIDS Resource Committee, which is composed of government agencies and nongovernmental organizations (NGOs). The Committee plays an important role in coordinating the response to HIV/AIDS across sectors, and it provides support as required to the National AIDS Program of the Bahamas. The Samaritan Ministry, a religious organization dedicated to providing social care and support to persons living with HIV/AIDS, is an active member of the Committee, as is the AIDS Foundation of the Bahamas. The Bahamas has been providing comprehensive care for HIV-positive individuals and perinatally exposed infants in two specialized clinics since 1985. Services, including antiretrovirals (ARVs) and other drugs for those unable to pay, are provided free of charge. The services can be broadly classified into clinical care and clinical support services. The support services at the clinic include laboratory, ra