Leaders of the University of Belize's Faculty of Nursing and Allied Health had a vision. Their country has the third highest HIV prevalence in the region, after Haiti and Guyana, yet it lacked an effective system for training providers in counseling and testing. As faculty members, they dreamed of establishing a national training center that would provide the latest resources and trainings for both students and providers.

A small country of 300,000 people, English-speaking Belize is nestled between Spanish-speaking Mexico and Guatemala. There is no public medical school, and the University of Belize is the only institution graduating nurses, nurse aides, lab technicians, pharmacists and social workers. The lack of in-country capacity forced Belizeans to look abroad for training opportunities for health providers.

The Capacity Project is helping universities in Belize, Costa Rica, El Salvador, Guatemala, Nicaragua and Panama to improve HIV-related pre-service education. The University of Belize faculty, under the leadership of Dr. Shirlene Smith-Augustine and Gabriel Carrillo, worked with Project staff on this initiative and began helping to build capacity to develop the training center they envisioned. The goal was for the university to offer training and refresher courses on counseling and testing to providers from public and private health services and to strengthen the integration of HIV into the curriculum.

Focusing on voluntary counseling and testing (VCT)-the entry point to HIV services- the Project trained 46 Ministry of Health providers and, most importantly, six core trainers who will carry this work forward. Now qualified to instruct others on VCT, these six full-time faculty members are currently training other faculty, staff and providers at hospitals and facilities throughout the country. At the same time, they are using the new tools and skills to provide better instruction for their students.

"The core trainers are from nursing, pharmacy and social work,"Carrillo explains, "and we were open to having anyone that interfaces with clients and is expected to provide HIV services to be included in future trainings." The Project's program officer and clinical trainer Udaya Thomas adds, "It was extremely beneficial to have mixed cadres training together so that they learn from each other as well as understand the barriers and expectations that they have in their roles in the community."

Lecturer in pharmacy Yusuf Abubakar is one of the core trainers. "Starting with counseling is necessary," he asserts, "because you have people doing [so-called] 'counseling' but there is no uniformity and the client doesn't understand what the results mean. The form [Jhpiego's VCT protocol] provides uniformity" that should result in "better service for the client and the community."

The protocol helps to maintain confidentiality, as pharmacy professor and core trainer Lydia Thurton points out. "The VCT protocol changes the whole practice of VCT services by changing attitudes and professionalism," she remarks, "realizing that there is no need to get into the client’s personal details." The trainers note that they have the opportunity to change some attitudes, dispel myths and make HIV services more humane.

Nurse Bernadine Grinage is a provider who had just completed the VCT training before her first day on the job at a local clinic. She was eager to report that she had already used the new protocol, deleted the old forms and entered client data directly into the electronic system. She looked forward to sharing with her colleagues the ease of the process. Supervisor Nurse Margaret Bradley praised the work that Nurse Grinage was able to accomplish in one day, joking that "she can take over the clinic for me and I can finally retire!"

The core trainers will conduct VCT trainings for additional providers in collaboration with the Ministry of Health. In less than a year since the program began, the University of Belize is already seen as a national-level resource by the Ministry and the National AIDS Commission, and the Ministry has embraced the VCT standards and tools for use in all facilities. The country is now home to more trained providers, a core group of trainers, a national training center and standard resources. Adds the Project's Petula Lee, a Jhpiego VCT trainer, "We're improving both the quality and capability of Belize's health care providers."

As the work goes forward, social worker and core trainer Starla Acosta reflects that "the whole Capacity Project is important to strengthen public health education about HIV/AIDS, and the approach is user-friendly. It is a multidimensional approach," she notes, that "helps to streamline the national approach, whether public or private."