A new focus on healthcare in South Africa's most densely populated inner-city suburb, is to help regenerate a community hard hit by HIV/AIDS, poverty and crime.

Hillbrow used to be the most trendy and cosmopolitan area in Johannesburg; today it is thought to be one of the most tightly packed places on the continent.

Immigrants and migrants from the rest of the country and the continent head for Hillbrow's crowded anonymity and informal economy as a first stop on the way to finding employment and accommodation - over half its inhabitants are believed to be refugees, whether legal or illegal. One doctor working in the area described Hillbrow as the "hub of desperation for people looking for the African dream in Johannesburg".

The result is a highly transient, fragmented, poverty-stricken population, speaking a multitude of languages and living in an area renowned for its many sex workers and high levels of drugs and crime. Social and physical ills caused by poverty and overcrowding, including sexually transmitted infections and tuberculosis, are rife and healthcare workers say about 30 percent of the adult population is HIV-positive.

High hopes for health

Now, after seven years of negotiations, a multimillion-dollar joint venture between non-governmental organisations (NGO), various levels of government, local communities and academia is steadily turning a disintegrating swathe of the suburb into the Hillbrow Health Precinct (HHP).

The first stage was formally launched in late September 2007 with the opening of a Wellness Centre offering healthcare, but also housing a variety of NGOs providing a wide range of related services, such as counselling, nutritional support, and assistance in developing income-generation projects.

The University of the Witwatersrand's Reproductive Health and HIV Research Unit (RHRU) is co-ordinating the project and will also provide funding support. The existing Hillbrow hospital and Esselen Street clinic are to be revamped and incorporated into the new precinct.

According to RHRU executive director Prof Helen Rees, what makes the Hillbrow Health Precinct unusual is that it has both a developmental and health focus, combining inner-city regeneration with a comprehensive programme for poverty alleviation, primary healthcare, and HIV/AIDS.

"Health services are usually seen as something that is just given to the community; it's a neutral thing. This is a world first, because it is taking conventional health services but expanding them into the interface with inner-city regeneration and poverty alleviation," she told IRIN/PlusNews.

Given the needs of Hillbrow's population, a major focus is the prevention and treatment of HIV/AIDS. According to Dr Shanil Naidoo, who manages antiretroviral (ARV) treatment sites in the Hillbrow area, the local primary healthcare centre now treats over 2,600 patients with the life-prolonging medication, making it the largest such programme in the country.

Naidoo describes the health precinct as a "hypermarket for HIV services" reaching beyond the immediate area; roughly 25 percent of people using existing healthcare services in Hillbrow don't live in the suburb, but these numbers are expected to expand, as are prevention programmes.

Providing all services in one safe area will make it more likely that people will return for follow-up visits and adhere to treatment.

The transient population of Hillbrow adds to the challenge of providing healthcare services. It is particularly difficult for immigrants to access healthcare, sometimes because they are unable to communicate in a local language, sometimes for fear of persecution if they are in the country illegally.

Dr Francois Venter, another RHRU doctor working on the health precinct project, said many immigrants, especially from North African countries, have not been exposed to education about HIV/AIDS to the same extent as South Africans, making them particularly vulnerable when placed in such a high-risk environment as Hillbrow.

Migrant South Africans provide their own challenges, like the tradition of going home for the Christmas festive period, when the number of patients defaulting on antiretroviral therapy increases as people either forget to take their medication or do not take it while staying with their families for fear of discovery that they are HIV positive and the stigma that often results.