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World AIDS Day: Five minutes with Dr. Philip Berger

Toronto, December 1, 2014

By Emily Holton

Dr. Philip Berger
Dr. Philip Berger, medical director of the Inner City Health Program. (Photo by Yuri Markarov)

In honour of World AIDS Day, we caught up with Dr. Philip Berger, medical director of the Inner City Health Program at St. Michael’s. He has been treating people with HIV in Toronto for over 30 years and worked at a front-line AIDS clinic in Lesotho.

“I’ve been a physician for HIV-infected patients since the epidemic began in Toronto. I started out with my own community practice, then I was at the Wellesley, then St. Michael’s.

The first 15 years of treating HIV/AIDS patients were defined by despair, hopelessness and fear. Five or six people who were part of my medical practice died every month. I carried around death certificates in my briefcase, for house calls. Most patients wanted to die at home, with their families and the people they loved.

Then in 1996 we saw a dramatic, profound, unimaginable change. Highly active antiretroviral therapy changed everything. We watched Kaposi's sarcoma lesions regress and disappear with drug treatment. It was incredible.

Some medications were available before, but nothing this dramatic. And now people with HIV/AIDS in high income countries can expect to live a normal life span.

We need to be aware of how lucky we are in Canada to have this powerful treatment available to almost everyone who needs it. In poorer parts of the world, people have vastly diminished access to routine care and treatment because of the absence of a health care infrastructure.

Ten years ago today, I was in Lesotho with the Ontario Hospital Association, trying to help provide HIV/AIDS care with very few treatment options available. I went as a St. Michael’s physician, with the full support of the organization. We saw a lot of deaths every day. Eighteen-month-old kids with no possibility of treatment, people dying in the waiting rooms – just slipping off a bench and dying, spread eagle, on the floor. There’s nothing like that here, never has been.

In the mid-1980s, St. Michael’s was the only downtown hospital that agreed to sponsor the AIDS hospice Casey House. We still are their partner. Today, we’ve trained dozens of primary care physicians in HIV care, and now they have their own practices in the community.

Today in Canada, HIV/AIDS is a chronic, manageable – and preventable – disease. I haven’t carried death certificates with me in 15 years.”

Read Dr. Berger’s moving 2011 Toronto Star editorial, Three Decades of AIDS.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.