Background:

The HIV epidemic in South Africa is one of the fastest growing epidemics in the world with an estimated 5 million infected South Africans by 2004. HIV and tuberculosis (TB) are recognised as being interdependent with both adversely affecting the immune system. Sexually transmitted infections (STIs), are now acknowledged to be major co-factors in the transmission of HIV . Throughout the country, there is an urgent need to increase expertise and knowledge of health care providers and providers of HIV support services to enable them to respond to patients and community needs. In addition, there is a need to develop centres of excellence which can identify and roll out best practice models into less well resourced areas and which can be used as referral sites to support primary health care (PHC) services.

The crisis of HIV/AIDS is particularly severe in the Johannesburg inner city, creating a major strain on existing health resources and staff. With an estimated 1 million residents making it southern Africa’s most densely populated area, overcrowding, poverty, crime, substance abuse, sex work and unemployment overshadow the lives of the residents of this area, and render them particularly vulnerable to HIV. Appropriate services for people infected and affected by HIV are greatly needed to strengthen the primary health system in the area.

Vision:

The inner city Health Precinct is an innovative project that uses the precinct model of urban regeneration to comprehensively respond to the HIV/AIDS epidemic. This model of urban regeneration, based around an overriding theme, has been successfully implemented throughout the United States, and adapted and used in Johannesburg to develop the Newtown Cultural Precinct and Constitution Hill. The Health Precinct aims to establish an HIV-themed urban regeneration project on the site of the old Hillbrow Hospital. This will include strengthening existing primary care services for all aspects of HIV, establishment of new and novel HIV prevention and treatment services, and the facilitation of non-governmental, academic and private organisations in support roles co-ordinated by an integrated governance system.

The Health Precinct project will allow for easy access to an extremely densely populated area with high HIV infection rate and low levels of support services. HIV-negative individuals are highly vulnerable to infection and urgently need access to appropriate prevention strategies to minimise transmission. HIV positive individuals need clinical and non-clinical care and support. Hillbrow is a major entry point for migrants and refugees from the rest of Africa, giving this project the opportunity to learn from, treat, inform and reduce stigma amongst an extremely diverse and deprived population with an extraordinary range of needs. This microcosm of Africa, contained in a single area, has unique relevance to the needs of an entire continent.

The Health Precinct will provide one of the most comprehensive packages of HIV support services in the world, by gathering a large number of clinical and non-clinical service providers dedicated to HIV/AIDS in one location. The strong emphasis on innovation and service improvement will enable the generation of best practice models that will be disseminated widely in southern Africa, improving knowledge and service provision well beyond the borders of the Health Precinct.

Partnerships:

The Health Precinct is being championed by a team of senior politicians, academics and development professionals. The team consists of the City of Johannesburg, the Gauteng Provincial Department of Health, and the University of the Witwatersrand, including the RHRU. The Johannesburg Development Agency is facilitating the development of the site.