A history of care for all: The role of St. Michael’s Hospital in advancing HIV and AIDS care in Canada

Official opening of the HIV clinic at St. Michael’s Hospital in 1989

At Unity Health Toronto, we are in service to and advocate for those who are especially vulnerable to discrimination. This is reflected in the history of our hospitals going back more than 150 years, from our founding by the Sisters of St. Joseph of Toronto and their mission to serve the most marginalized members of society, to our work today, where our staff, physicians and researchers across our network are focused on caring for each and every person in a way that meets their individual needs.

We see this in our work to advance care and research about HIV and AIDS and the communities most impacted by the disease, starting from some key partnerships and programs at St. Michael’s Hospital in the late 1980s and 1990s during the height of the HIV and AIDS crisis.

For World AIDS Day, we are looking back at our history and how that important work continues in our clinical care, research and community partnerships. 

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A history of compassion

In 1988, at the peak of the HIV and AIDS epidemic, Casey House hospice opened as the first free-standing hospice in Ontario, and the first stand-alone HIV and AIDS treatment centre in Canada. At the time, provincial funding models did not yet accommodate free-standing hospices, and Casey House needed an affiliate hospital through which to receive its funding. St. Michael’s Hospital became that affiliate.

“This affiliation between a hospital and a hospice is without precedent in Canada,” states an article in the December 1987 issue of The Bond, a St. Michael’s Hospital newsletter. “[This is] a unique opportunity to meet the needs of AIDS patients in their efforts to cope with this devastating disease.”

The organization grew and evolved, and Casey House is now an independent HIV-specialty hospital providing ground-breaking care for people living with and at risk of HIV.

As the epidemic roared on, the need for clinical care was vital, and in November 1989, St. Michael’s opened an outpatient clinic for patients with HIV and AIDS-related illnesses, led by Dr. Bernadette Garvey. According to Pulse, the St. Michael’s staff newsletter at the time, the clinic was a chance to centralize the services that patients with HIV and AIDS required, meaning patients could seek diagnosis and care, but also therapy, counselling and companionship. The clinic was equipped with outpatient treatment rooms, examination rooms and meeting spaces for individual and family counselling.

Joanne Solarski was a clinic coordinator, and was quoted in the 1989 issue of Pulse: “We will attempt to meet not only [patients] physical but also their psychological, social and spiritual needs.” This mandate to care for the patient in mind, body and spirit, continues to be embedded in the care at St. Michael’s today, and all of the sites of Unity Health Toronto, the health care network that St. Michael’s became a part of when the network formed in 2017.

In 1995, The Wellesley Hospital, a centre located in St. James Town known for its research and treatment of HIV and AIDS and care for the 2SLGBTQ+ community, was set to close its doors. The bulk of its programs were transferred to nearby St. Michael’s Hospital between 1998 and 2001, allowing its important work to continue.

Anthony Mohamed, who eventually became Unity Health’s Senior Specialist in Equity and Community Engagement, was hired in 1995 to act as a liaison between St. Michael’s and queer and trans communities, including some who were initially wary of seeking care at a Catholic institution. He described that time in an interview for Unity Health’s Behind The Mask series, including his work with community advisory panels who helped guide and influence the hospital. His focus at St. Michael’s, like in all of his previous work, was about “balancing social power, promoting health equity and creating safe spaces for on-going dialogue.” And while the transition wasn’t without bumps in the road, he said, it was ultimately successful. 

“Regardless of your faith background, or those without any faith connection, I think most people would agree that showing love to your neighbour is a good thing, especially in a hospital setting,” he said. “Back then, our founders, the Sisters of St. Joseph of Toronto, still had a visible presence in the hospital and I had the privilege of working with them regularly, especially when they were setting up a hospital based drop-in for women experiencing homelessness or being underhoused. The Sisters always expressed love for 2SLGBTQ+ communities. They truly lived our founding values and I miss their guidance and leadership.”

Footage from the St. Michael’s archives shows staff and leaders, including then CEO Jeffrey Lozon, were active in the AIDS Walk Toronto (originally named From All Walks of Life) – a fundraising walk for HIV and AIDS research that looped through Toronto’s downtown core. AIDS Walk Toronto ultimately ended in 2020, but these moments were pivotal for drawing attention to the patients and families affected by the disease.

Advancing care through research and innovation

Today St. Michael’s is part of Unity Health, a network that also includes St. Joseph’s Health Care, a community hospital serving Toronto’s west end, and Providence Healthcare, specializing in seniors care and rehabilitation. One of our goals is to create a health care system that works for everyone – research and innovation are key mechanisms to achieve this.

Dr. Darrell Tan’s research team, the Options Collaboratory in HIV and STI Treatment and Prevention Science (Options Lab), works to maximize the range of medical options for patients affected by these conditions, because the treatment and prevention of HIV and sexually transmitted infections does not have a one-size-fits-all solution.

In 2017, Tan and his team wrote the first and only national guidelines on HIV PrEP and PEP in Canada to show what is evidence-based and effective. Yet, since then, there has been a surge in HIV and AIDS cases in Canada, mainly among communities facing marginalization.

“Many people have the impression that HIV is a problem of the past, but it continues to be a major public health issue all over the world, including in Canada,” says Tan. “Paradoxically, we have worsening HIV incidence in Canada even though we have so many safe and effective medical tools to control the epidemic. It represents an urgent need to re-double our focus and efforts.”

Another St. Michael’s researcher, Dr. Sean Rourke, Director of REACH Nexus and a scientist with MAP Centre for Urban Health Solutions, has studied solutions for HIV and AIDS since the early days of his career in the 1990s. While he marvels at the progress that’s been made, he sees World AIDS Day as an opportunity to draw attention to those still not receiving adequate care: “We want World AIDS Day to be every day – everyone should always have what they need.”

In 2020, Rourke was the principal investigator in a study of HIV self-testing among high-risk populations. The study’s success resulted in the first HIV self-testing kits being approved for sale in Canada, a key milestone in improving diagnosis and care, especially for those who face barriers or stigma in coming forward. In 2021, he launched the I’m Ready program, which has distributed over 190,000 free self-testing kits across Canada in partnership with the community-based counterpart, Community Link. And most recently, Rourke’s Healthbox program – smart vending machines that distribute free health supplies – now operates in 22 communities in Canada, distributing over 1,700 free HIV self-tests.

“Looking back on three decades at St. Michael’s, I’m humbled by what we’ve achieved together,” says Rourke. “Our teams and communities have pushed boundaries, driven evidence into practice, and opened the door to life-changing HIV care for so many. It’s a legacy of work that has made progress and saved lives — and with the prevention and testing tools we now have, we are even more hopeful for what comes next.”

Care for all in need

The same focus of our research on health equity is embedded in the patient care across our sites. One of those sites, the Wellesley-St. James Town Health Centre, is one of five primary care clinics that make up the St. Michael’s Academic Family Health Team. The clinic aims to provide a safe, welcoming environment for its patients, many of whom are likely to have had negative experiences with the health care system. In addition to 2SLGBTQ+, transgender and non-binary flags and gender-neutral washrooms, the clinic also offers a specialized HIV program, staffed by physicians, nurses, nurse practitioners, pharmacists, social workers, income security health promoter workers, dieticians and HIV researchers.

“Since the early 90’s, our clinic has been providing comprehensive team-based HIV primary care. Our focus has been on whole person care, including the management of HIV and AIDS, mental health concerns, addiction, sexually transmitted infection prevention and treatment, comorbidities and focusing on HIV prevention including PrEP and PEP,” says Gordon Arbess, the HIV program’s Medical Director.

The need for this work is ongoing. At our sites and healthcare organizations all across the country, institutional marginalization against 2SLGBTQ+ people continues. Studies show transgender people are less likely to be screened for cancer, for example, and LGBT youth are disproportionately at risk for cancers, cardiovascular diseases, obesity, anxiety, depression, and suicide compared to the general population. This impacts people’s ability to come to us for care, and we know this is also the case at Unity Health.

“A world without HIV is in our grasp, and places like St. Michael’s can help lead the way,” says Dr. Irfan Dhalla, Vice President of Clinical Programs and Equity at Unity Health Toronto. “People are more willing to be tested for HIV, and treated, if they are included in how decisions are made, and how programs are designed. Our commitment is to continue this work, and the legacy of compassionate care, at Unity Health Toronto.”

By Christine Davidson

Photos by St. Michael’s Hospital Archives