Twenty years ago, when AIDS was a fearsome disease, Peter Jepson-Young spoke directly to British Columbians on the CBC's evening news. "I am going to introduce you to someone who has AIDS," he said. "I'm a doctor, but I'm also a patient … a patient with AIDS."
It was a profound act of courage in an era when being gay was not openly talked about, let alone having HIV-AIDS. Discrimination was rampant - some government officials said people with HIV-AIDS should be banished to a remote island. His parents feared for his safety, and the doctor himself kept his last name hidden, even while inviting the spotlight on television.
The illness had robbed him of his sight but in a series of more than 100 short, televised segments, The Dr. Peter Diaries, he used his physician's knowledge to educate Canadians about HIV-AIDS. Young, handsome and gay, likeable and funny, Dr. Peter explained the illness and his struggles until two weeks before his death in 1992 - before the emergence of life-extending drug regimens. He touched hearts across Canada and changed the way the country understood the disease.
Twenty years later, what has changed? A lot - and not that much. Today, there are many faces of AIDS - women, children, youths, older adults, injection drug users, sex-trade workers and the unchanging face, gay men. A disproportionate number are aboriginal.
Because of medical advances, HIV-AIDS has become a chronic manageable condition, albeit one with significant challenges. Many injection drug users are not benefiting from this progress because health-care services are not adequately designed to respond to the complex issues in their lives. Research has recently shown that HIV treatment is a prevention measure - successfully engaging injection drug users in HIV treatment will turn back the tide of new cases in this country. Innovative ways of accomplishing that task should be welcomed.
Most of us would not tolerate receiving our health care on the street. Yet, street nurses in Canada's towns and cities have become necessary because indoor locations have been disallowed by local authorities and, in the case of Insite, Vancouver's supervised injection site, challenged all the way to the Supreme Court of Canada.
In July, The Lancet called this aversion to true HIV care for people who use drugs "aggressive, state-sponsored hostility." The leading medical journal called for "enlightened, scientifically driven attitudes and more equitable societal responses."
In the months before his death, Dr. Peter set up a foundation with a mission to provide care for people living with HIV-AIDS. Today, the Dr. Peter Centre, in Vancouver's downtown West End neighbourhood, is a quiet icon for what an integrated care model can achieve.
The Dr. Peter Centre has a 24-hour, skilled nursing-care residence and day-health program. There are a broad range of health services: Counselling. Art, music and recreation therapy. Nutritious meals. And nursing care, including medication support, provision of clean needles, methadone management and supervised injection service.
Recognized locally and globally for its innovative approaches to care, the centre also helps individuals who face the additional challenges of serious mental illness, trauma, addictions, poverty and homelessness. It is a therapeutic space of acceptance, facilitating greater engagement in health care for some of our most unwell and disadvantaged citizens.
Twenty years ago, Dr. Peter spoke to Canadians about living with HIV-AIDS, the most controversial health issue of that time. Canadians responded with understanding and compassion. We need government and community leadership on one of today's most controversial health issues - health-care services for people living with HIV-AIDS, serious mental illness and addictions. Like Dr. Peter's Diaries, action is an act of courage.
Maxine Davis is executive director of the Dr. Peter AIDS Foundation.