Four Decades of Progress: How HIV care has transformed

When the Human Immunodeficiency Virus (HIV) was first discovered in 1983, the diagnosis was devastating. There were no effective treatments and the care was palliative.  

“In the 80s, it was basically a death sentence,” recalls Dr. Lise Bondy, Infectious Disease Care Program physician at St. Joseph’s Health Care London (St. Joseph’s). “There was no hope of long-term survival.”

Today, that landscape has changed dramatically.  

The evolution began in the mid-1990's with the introduction of highly active antiretroviral therapy (HAART)—the first treatment capable of restoring the immune system and turning HIV into a manageable chronic condition. While early medications were complex, highly toxic and required multiple daily pills, they offered something unheard of at the time - the possibility of living.

And progress has continued. In 2007, HIV integrase inhibitors ushered in a new era of simpler, safer, one-pill-per-day regimens with far fewer side effects.  

“People can stay on them indefinitely,” says Bondy. “For someone newly diagnosed today, if we catch it early and they take their medication, they have a normal life expectancy.”

In the last few years, injectable treatments have expanded options even further. These injections—administered monthly or every two months—are especially valuable for people who struggle to take daily pills.  

“Some people don’t want the daily reminder of their diagnosis,” Bondy explains. For others, especially those who are marginalized or live in unstable housing, injections improve adherence and quality of life.  

Kelly Muhsin, clinical manager of Infectious Disease at St. Joseph’s has also witnessed firsthand what these options mean. “For people who have taken pills every day for 30 years, switching to an injection can be liberating. It gives them a choice.”

Thanks to research, progress has reshaped what it means to live with HIV. With effective treatment, individuals whose viral load becomes undetectable cannot transmit the virus. The principle known as U = U (Undetectable = Untransmittable) has transformed relationships, reproductive choices, and public understanding. “You can have sex without barriers, have children, and live a full, healthy life,” says Muhsin. “Medication is the key.”

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(From left: Dr. Lise Bondy and Clinical Manager Kelly Muhsin have seen HIV treatments evolve dramatically over the years, but more work is needed to address ongoing stigma)

But challenges remain.

Rates of new diagnoses have ticked upward since the pandemic, driven by outbreaks among people who inject drugs, immigration-related factors and inequities affecting marginalized populations.  

“The virus is still very much out there,” Muhsin cautions. “Young people aren’t hearing about HIV anymore, but no one is immune.”

Stigma also persists as one of the most significant barriers. Many patients fear telling employers, partners, or family. Bondy notes that despite advances in treatment, new diagnoses are still emotionally overwhelming. “People are still shocked when they are diagnosed today. The stigma hasn’t caught up to the science.”

Canada continues to work toward the global 95-95-95 goals—ensuring that 95% of people living with HIV know their status, 95% of those diagnosed are on treatment, and 95% of those on treatment achieve viral suppression. Canada sits close, around the 90-90-90 mark, but more work is needed to reach underserved groups and expand access to prevention tools like PrEP (Pre-exposure prophylaxis) and at-home HIV self-tests.

Despite ongoing challenges, Bondy remains hopeful. “HIV today is relatively straightforward to treat,” she says. “The medications are effective, low-toxicity and easy to take.”

Muhsin agrees. “HIV is still here—but it is very treatable. The progress has been amazing. Now we need to keep talking about it. There is still no cure, but the research gives us hope.”