The National Anti--Drug Plan of the Commonwealth of The Bahamas 2004 – 2009
"The development of integrated national drug plans (master plans) is a relatively new strategy in the anti-drug campaign. Their genesis harks back to the adoption of the 1988 United Nations Convention against Narcotics and Psychotropic Substances. The United States of America, for example, established its Office of National Drug Control Policy (ONDCP) in 1988 and subsequently introduced its national drug strategy. In the United Kingdom, a ten-year strategy for fighting drug abuse, 'Tackling Drugs to Build a Better Britain', was launched in 1998. Canada’s Drug Strategy coordinated by the Office of Canada’s Drug Strategy (OCDS) was updated in 1992 and renewed again in 1998. Though Australia had a rudimentary national strategy since 1985, it was not until 1997 that the Government agreed to the National Illicit Drug Strategy, 'Tough on Drugs.' In 1997, Member States of the Organization of American States adopted The Anti Drug Strategy in the Hemisphere, as a platform for greater efforts to control drugs in the twenty-first century.” A Plan of Action for The Implementation of the Hemispheric Strategy was adopted a year later. Since 1998, Latin American and Caribbean countries began in earnest their efforts to adopt National Drug Plans with varying degrees of fidelity to the Hemispheric Strategy. While incorporating the uniqueness of the drug reality in The Bahamas, the architecture of the National Anti Drug Plan is consistent with the structure and organization of the Hemispheric Strategy. Indeed, the NADP is organized along the thematic lines established by the Hemispheric Strategy: Institutional Building, including Legal Framework, Demand Reduction, Supply Reduction, Other Control Measures and Global Commitment."

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Reports, Guidelines, and Projects

Epidemic Crack Cocaine Use Linked with Epidemics of Genital Ulcer Disease and Heterosexual HIV Infection in the Bahamas: Evidence of Impact of Prevention and Control Measures
Background: Epidemic freebase/crack cocaine use began in the Bahamas in 1982, closely followed by epidemics of genital ulcer disease (GUD) and HIV infection. Numbers of new clients receiving ambulatory treatment for cocaine use in Nassau peaked in 1984. Goal: To assess interrelations among epidemics of crack use, GUD, and HIV infection. Study Design: The study was designed for review and comparison of temporal trends in ambulatory and inpatient treatment of cocaine users and in numbers of cases of sexually transmitted disease (STD) and HIV infection in the Bahamas. A retrospective case– control study of cocaine use and STDs was performed at the Comprehensive Dermatovenereology Clinic in Nassau. Results: Ambulatory visits and inpatient admissions for cocaine use peaked in 1984 and 1987, respectively. GUD cases increased 12-fold in the Bahamas from 1983 to the period of 1985–1987 and then declined. At the Comprehensive Dermatovenereology Clinic, gonorrhea cases outnumbered bacterial GUD cases approximately 10:1 in 1982 and 1983, but the latter increased to outnumber gonorrhea cases in 1985 and 1987–1988. Annual HIV seroprevalences at new-problem visits rose from less than 0.3% in 1986 to 12.9% by 1994 and then leveled off. Cocaine use among patients seen with STD from 1985 through 1990 was significantly associated with GUD (odds ratio [OR], 3.3; 95% CI, 2.1–5.1), secondary syphilis (OR 5.5; 95% CI, 2.4 –12.6), and HIV infection (OR, 8.1; 95% CI, 4.3–15.2). Conclusions: In temporally linked successive epidemics of cocaine use, GUD, and HIV infection, case-control analyses confirmed the association of cocaine use with GUD and with HIV infection. Declining GUD and HIV seroprevalence stabilization followed declines in cocaine use and implementation of syndromic management of GUD, as well as intensified partner-notification efforts. [author abstract] [click on ‘Article as PDF’ for access] [Sexually Transmitted Diseases, May 2002, Vol. 29, Iss. 5, pp.259-264]
Haitian Migrants in The Bahamas 2005
"Haitian nationals settle in The Bahamas to obtain work. Typically, they arrive illegally and then attempt to regularise their status by acquiring permits, legally or illegally. Once a permit is acquired, that person can obtain employment in sectors which are not allowed by the permit. Having paid a $1,000 to get to The Bahamas, migrants may take over a year to find work and then may be surcharged to obtain documents. Employers may hire persons who are in breach of the law and later assist them to regularise their status by assisting them in acquiring documents. One attraction to employers of hiring Haitian nationals is that they will work for wages which are unacceptable to Bahamians. It is these people who provide the employment engine which encourages the migration from Haiti to The Bahamas. Once Haitian nationals are employed here, it is to be expected that they will want their families to reside with them. Due to the language barrier it is not surprising that Haitian households have elected to live in the same neighbourhoods, typically where rents are low. Due to their low household incomes, typically close to the poverty line, Haitian nationals have no choice but to use the subsidised government services. The use of these services, notably health and education, results in Haitian nationals being seen concentrated in selected areas such as in the one major public hospital and their local public health clinics. These foci can give the impression that 'Haitians are taking over'. Outside of the education and health systems, Haitian nationals make little use of the social services and remain isolated from other residents. While many live peacefully, sending back limited amounts of money to relations in Haiti, other members of the Haitian community are allegedly abused by the authorities, through extortion and physical ill-treatment. Some may suffer verbal abuse, just because of their ethnicity. Vigilance at the major ports of entry should reduce the use of The Bahamas as a stop-over for Haitian nationals en route to North America. It is clear that until all levels of enforcement are improved and a system set up which will allow only those with valid work permits to enter the country, The Bahamas will continue to be a prime place in which Haitian nationals will seek work; and society, although utilizing their cheap labour, will continue to complain about their presence." [The College of The Bahamas for the International Organisation for Migration, September 2005]
Health in the Americas 2007: Bahamas
As a health agency, the Pan American Health Organization’s core discipline is epidemiology, which enables the measurement, definition, and comparison of health problems and conditions and their distribution from the perspectives of population, geography, and time. This publication on the Bahamas addresses the issue of health as a human right, taking into account both the individual and community contexts, and examines various critical determinants of health, including those of a biological, social, cultural, economic, and political nature. That examination reveals the existence of gaps, disparities, and inequities that persist in the Bahamas, especially those related to access to basic services, health, nutrition, housing, and adequate living conditions as well as to the lack of opportunities for human development—all of which contribute to the greater vulnerability to diseases and health risks of some population groups. [Adapted from the preface of Health in the Americas 2007]
Nutrition Country Profiles – The Bahamas
"Overweight and obesity have a greater effect on the nutritional status of the population in The Bahamas than underweight and nutritional deficiencies. Based on the 1994-95 Ministry of Health/CFNI report, among children 4-9 years old, 6.6% were underweight, 12.9% were stunted (a greater proportion of boys than girls) and 5.7% were wasting. In contrast, 14.9% of these children were overweight (the prevalence being the same for boys and girls). … At the sub-national level, relatively high prevalence levels of undernutrition were found on Acklins (15.4%) and Crooked Islands (11.9%) among children > 5 years. The highest prevalence of undernutrition (< 3th percentile) was found on the Family Islands (12.3%) among children <5 years; the national prevalence was 7%. In the other regions covered, the prevalence of undernutrition was acceptably low among this age group. The 1988-89 national survey revealed that the prevalence of overweight (>95th percentile) among the 5-14 year old children, was 6.7%. However, the prevalence among females in New Providence was 16.0%. Among these 5-14 year olds, a relatively low prevalence was seen on Acklins (1.3%), while that seen on Crooked Island (15.8%) was relatively high. The prevalence of overweight (> 97th percentile) among children <5 years, was lowest on the Family Islands (6.4%) and highest on the Crooked Island (16.2%). The female adolescents appear to be at greater risk for overweight and obesity compared with males. Approximately 20% of the females 15-16 years had a BMI of 24.8 or higher, while 16.2% of the males in the same age group had a BMI of 24.3 or higher. Among females 10-14 years, 17.9% had a BMI of 23.4 or higher, while among males at the same age 5.3% had a BMI of 23.0 or higher. The risk appears greater in the older age group for both males and females. … The few studies that reported on adult and elderly nutritional status raise concerns about overweight and obesity, especially in females. Among the adults 15-64 years, 21.3% were obese (significantly more females than males), while another 27.3% were overweight (29.1% males and 25.6% females). Among the elderly, over 65 years, 25.4% of the females and 15.2% of the males were obese. The only micronutrient deficiency known to be a public health problem in The Bahamas is iron deficiency anaemia. This problem is prevalent in children < 5 years, in adolescents of both sexes and in the elderly, especially in females. The problem is most serious in pregnant women, with 19% of them found to be anaemic (using the low cut-off point of 10g/dl) in 1994. Iron deficiency anaemia is also prevalent in adult males ranging from 14% to 20% on different islands, according to a 1988-89 survey. Mixed results are available on school age children, for which the School Health Programme recorded a low prevalence of 4.5% in 1994 (Hb < 12 g/dl)." [FAO, August 2003]
Partnered Care in The Bahamas: A Model of Advanced Healthcare Delivery for Developing Countries
Objective: To assess the delivery of advanced specialized medical care using The Partnered Care Model as a means of providing affordable access to all, irrespective of ability to pay. Design and Methods: A retrospective analysis of all persons presenting to a specialized, private, cardiac unit, The Bahamas Interventional Cardiology Center (BICC), over an 8.5-year period from March 1996 to September 2004 was conducted. The Bahamas Heart Center’s Discounted Service System had been applied since inception to all patients in three groups including insured patients billed at 100% of the fee schedule of The Medical Association of the Bahamas for the procedures performed, private self-pay and government patients billed at 75% and 50% respectively. Their respective distribution and contributions to total revenue was analyzed. A series of financial models were constructed taking into consideration variables that could influence the percentages of revenues collected from each sector and the number of individuals served. Results: One thousand five-hundred and forty-two patients received services in BICC over the 8.5 year period (56% males and 44% females age range: 0.25 – 96 years, with mean age of 55.7 years). One thousand eight-hundred and eighty-eight patient-procedures were performed, with 51% insured generating 69% total revenue, 18% Private producing 16% Revenue, and 31% Government patients generating 15%. Financial models were created to predict revenue behaviour in various scenarios. Conclusion: Partnered Care is a viable alternative for Governments (Ministries of Health) of developing countries to provide costly specialized healthcare to their populations at minimal expense and capital outlay. Partnered Care reduces the otherwise overwhelming burden of healthcare cost to governments, particularly in developing countries, [author abstract] [West Indian Med J, 2006; 55 (1): 30-36]
Personal values and involvement in problem behaviors among Bahamian early adolescents: a cross-sectional study
Background: Few studies, particularly in developing countries, have explored the relationship between adolescents and parental values with adolescent problem behaviors. The objectives of the study are to (1) describe adolescents' personal values, their problem behaviors, and the relationships thereof according to gender and (2) examine the relationship between parental values, adolescent values, and adolescents' problem behaviors among sixth-grade students and one of their parents. Methods: The data used in these analyses were from the baseline assessment of a school-based HIV risk reduction intervention being conducted and evaluated among sixth grade students and one of their parents across 9 elementary schools in The Bahamas. Personal values were measured by the Portrait Values Questionnaire (PVQ). Seven reported problem behaviors were queried from the students, which included physical fight with a friend, drank alcohol, beer, or wine, smoked a cigarette, pushed or carried any drugs, carried a gun, knife, screwdriver or cutlass to use as a weapon, had sex and used marijuana or other illicit drugs over the past 6 months. Multilevel modeling for binary data was performed to estimate the associations between adolescent and parental values and adolescent problem behaviors. Results: Among 785 students, 47% of the students reported at least one problem behavior. More boys (54%) reported having one or more problem behaviors than girls (41%, p < 0.01). Boys compared to girls expressed a higher level of self-enhancement (means score: 36.5 vs. 35.1; p = 0.03), while girls expressed a higher level of self-transcendence (42.3 vs. 40.7; p = 0.03). The results of multilevel modeling indicates that boys with a higher level of self-enhancement and girls with a higher level of openness to change and a lower level of conservation were more likely to report engagement in problem behaviors. Only two parental values (self-transcendence and conservation) were low or modestly correlated with youth' values (openness to change and self-enhancement). Parental-reported values documented limited association on adolescents' reported values and behaviors. Conclusion: In designing interventions for reducing adolescents' problem behaviors, it may be important to understand the values associated with specific problem behaviors. Further exploration regarding lack of association between adolescent and parental values and problem behaviors is needed. [author abstract] [BMC Public Health 2007, 7:135]
The Commonwealth of The Bahamas: Monitoring the Declaration of Commitment on HIV and AIDS (UNGASS) – Country Report 2008
"As of December 31, 2006, The Bahamas had a cumulative total of 10,841 reported HIV infections. Of the 7,036 living individuals, 1,693 are living with an AIDS diagnosis, while 5,343 have HIV infection that has not progressed to AIDS. AIDS has been the leading cause of death in the 15-49 year age group in The Bahamas since 1994. Based on antenatal surveillance, it is estimated that approximately 3% of persons in The Bahamas are infected with HIV. The large majority of persons reported are in the productive years of early adulthood between the ages of 20-39 years of age. The disease occurs primarily among heterosexuals (approximately 87 percent), although under-reporting by men who have sex with men (MSM) remains a challenge. Intravenous drug use is not a common practice in The Bahamas and therefore this is not considered to be a mode of transmission. Since 1994, there has been a decreasing trend in the HIV incidence rate, with the greatest change noted in the 20 - 49 year old group. The number of newly reported HIV infections peaked in 1994, while AIDS cases peaked in 1997 with subsequent declines in both categories. A slight increase in the number of newly reported HIV infections was noted in 2005 and 2006 which was attributed to the increased testing during the 'Know Your Status' campaign launched by the HIV/AIDS Centre." [UNAIDS, 31 January 2008]

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Educational Resources

CDC Travellers' Advice - Temperate South America
Library of Congress, Country Study: Caribbean Islands

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