HIV/AIDS is no longer a death sentence – in rich countries

Montreal Gazette

In the early 1980s, when the AIDS epidemic that went on to kill millions of people around the world was still a mystery, Christos Tsoukas was one of the few doctors in Montreal to treat people with HIV/AIDS. Colleagues would discreetly disappear to wash their hands if they’d shaken hands with him. You would not find an HIV/AIDS clinic in a hospital. It was always called something else, hinting at rather than naming the disease.

Tsoukas lost 100 patients a year to AIDS. It was heartbreaking work.

“One night, I was called when one of my patients was dying,” Tsoukas said this week in an interview in his office at the Montreal General Hospital.

“He was one of two brothers, both of whom had contracted AIDS through blood products. He died just as I arrived, surrounded by his family. Everyone was carrying a single red rose.

“I sat at the kitchen table, signing the death certificate. On one side of me was a beautiful flower and on the other side, a week-old baby, the child of my patient’s cousin. It brought home to me so strongly that there is a cycle of life. I will never forget that moment.”

By 1995, with the advent of effective anti-HIV drugs, the situation had changed, dramatically. Tsoukas has not had a single AIDS patient die in 15 years. “It’s amazing.” Drugs can prevent an infected partner from transmitting the virus, and drugs mean an infected mother doesn’t pass along the virus to her children.

Years ago, testing positive for HIV was a devastating diagnosis. Today, people won’t even get very sick, said Tsoukas. “We have new challenges,” he said. “We have people who are living into their 80s with AIDS and they have specific and complex problems, cardiovascular illness, diabetes, osteoporosis.”

Longer life spans mean that the number of people with HIV or AIDS remains high in Canada and the rest of the developed world. In Canada, an estimated 65,000 people were living with HIV in 2008, compared with 57,000 at the end of 2005. In 2008, new HIV infections numbered between 2,300 and 4,300, roughly similar to the figures from 2005. In Quebec, a total of 5,199 cases of HIV infection were reported between 2002 and 2008, the majority in Montreal. In Quebec as elsewhere in the developed world, homosexual men continue to be more affected than any other group.

In the developed world, the way is open to stopping the virus from spreading. In the lead-up to the annual World AIDS Day on Dec. 1, a British Columbia AIDS expert, Dr. Julio Montenar, told a U.S. medical conference that the province had achieved an astonishing 96.3-per-cent drop in HIV transmission.

Montenar, head of the British Columbia Centre for Excellence in HIV/AIDS, was reported as saying that the key to success is testing, followed by treatment with highly active antiretroviral therapy.

Unfortunately in Canada, an estimated 27 per cent of people infected with HIV are unaware of their infection. Treatment may be the best protection, but they aren’t getting it.

“Today, unless someone is in a community where AIDS is talked about, that person won’t know about it. Years ago, you would see posters or television campaigns, but not today,” said Tsoukas. He would like to see hospitals make an effort to teach patients about HIV. But on even the most basic level, “You still won’t see clinics called HIV/ AIDS clinics,” he said.

In the developing world, the news was heartening, with the United Nations publishing data showing that hundreds of thousands of lives had been saved by the availability of cheap drugs and new infections were down by as much as 30 per cent to 50 per cent. But the good news was sharply undercut this week by the announcement by the Global Fund to Fight AIDS, Tuberculosis and Malaria, hard hit by the continuing economic crisis, that it would cancel its next round of funding. The fund pays for more than 70 per cent of AIDS medicine.

Even with medicine, the developing world is struggling. Last summer, Tsoukas travelled to Tanzania, to visit an HIV/AIDS clinic founded by an Ottawa doctor, Don Kilby (http: //

“There was a 29-year-old girl with lymphoma,” said Tsoukas, “which is treatable. But she could not afford the bus fare to get to Dar es Salaam to be treated. No one in her family could go with her. You have to have someone, because there are so few nurses.”

The young woman died. “You become very pessimistic,” Tsoukas said, sadly. “The medication is available, but people can’t get to it.”

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