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"Fangs" is a screen reader emulator which transforms any page to an approximation of what a screen reader would read out, including details of page structure, links, alt text, etc.
Although it cannot (yet) truly replace a true screen reader for testing, it gives a valuable insight into how a visually-impaired visitor would access your site.
It's an early beta (version 0.51) at the moment, but it installed successfully and works well. Note: it requires Firefox 1.0, and will not work on any earlier releases. Highly recommended!