In the mid-1980s, Dr. Anita Rachlis was an infectious diseases physician at Sunnybrook when she noticed an increase in patients being admitted to the hospital with undiagnosed weight loss, herpes zoster, diarrhea and pneumonia.
“Those presentations were not common in people with normal immune systems, and I remember thinking it was odd that many of the patients were so young,” she says. It wasn’t long before the full picture emerged: it was the early days of the HIV/AIDS epidemic, and internal medicine wards were filling up with very sick patients whose HIV infection had progressed to AIDS.
Sensing a need for more specialized care, Dr. Rachlis advocated for an outpatient clinic dedicated to treating people living with HIV. The clinic opened at Sunnybrook in 1989. Originally comprised of just one nurse and 275 patients, the clinic quickly grew to 10 staff members and over 1,000 patients. A pioneer in her field, she was one of the few health care providers willing to take on the management of people living with HIV at the time.
Nearly three decades later the clinic is still operating, with an important change: in recognition of her dedication to HIV for 30 years, it’s being renamed The Anita Rachlis Clinic.
As Dr. Rachlis prepares to retire at the end of 2017 after 40 years at Sunnybrook, she reflects on her career and her work in HIV.
What was it like working an infectious diseases physician in the early days of the HIV/AIDS epidemic?
Caring for this patient population was, and still is, complex. Initially, some patients required daily infusions and more support from a variety of healthcare professionals, including dietitians and physiotherapists. Antiretroviral medications (ARVs) weren’t available until the late 1980s, making it even more challenging to treat patients. The turning point didn’t come until 1996, when new, much more effective drugs (specifically, the protease inhibitors) became available.
What’s the biggest change you’ve noticed in your 30 years of working with HIV patients?
Originally, the majority of the patients we saw were inpatients, and since there were no effective treatment options, many of them died. When the newer drugs became available in 1996, that changed almost overnight. People were surviving and all of the sudden, we were mostly seeing outpatients. Today, it’s not very common for us to see patients who’ve been admitted to the hospital.
What’s your proudest achievement?
Getting people living with HIV involved in teaching the next generation of medical students. With a group of medical students and residents I got a Canadian Institutes of Health Research (CIHR) grant to evaluate the role of people living with HIV as patient instructors, in order to reduce stigma and improve interest around HIV care among medical students. The results of the study led to HIV testing and pre- and post-test counselling being incorporated into the undergraduate medical preclerkship curriculum.
What’s the most important thing you learned while working in the HIV field?
I learned about the importance of advocacy, and how your voice can make a difference. It’s so important to involve patients, and to do things together. Things get done when there’s involvement of the community that’s being impacted.
For example, more treatments for HIV became available over time, but they were very expensive ($20,000 a year per patient). We lobbied the government for universal access to these drugs in Ontario. One of my patients made a videotape of himself reading a letter I’d written about the importance of universal access, just one day before he passed away from complications from AIDS.
Although that didn’t happen in Ontario, patients are able to access the therapies they need, either through the Ontario Drug Benefit program, the Trillium program or with the help from the pharmaceutical industry.
That level of activism, and of working together to get things done, was quite unique to the area of HIV. I’m proud to have been a part of it.
What’s surprised you the most?
The pace of change has been so dramatic. While HIV is still a disease of isolation, stigma and discrimination, patients are now able to live long, full lives – I’ve been seeing some patients for over 20 years. Mothers with HIV are now able to give birth to uninfected children, which they probably never realized would be possible. Of course, having an incredibly dedicated clinic team over these past few decades has made this work possible, and I’m appreciative of their commitment to HIV.