“They were coming in with all these signs and symptoms of different infections we couldn’t pinpoint,” she said. “All these guys, they were getting so sick.

“They were dying before we even knew what HIV/AIDS was.”

Keystone was among the first family doctors in Toronto who banded together to care for patients with HIV and AIDS, placing them at the centre of an epidemic that ravaged the city’s gay community long before effective treatments existed.

Starting in 1987 and through much of the 1990s, the Toronto HIV Primary Care Physicians Group looked after their gay patients, along with injection drug users, those infected through blood transfusions and others with the virus, including women and pregnant mothers.

The group’s founding members say they combined front-line clinical care with physician advocacy to fight for patients at a time when every HIV diagnosis carried fear, stigma and often death. Many of their patients had been turned away by others in the medical community.

This week, 14 doctors from the original Toronto HIV Primary Care Physicians Group met for dinner at a downtown restaurant. The reunion marked 39 years since the Group was launched.

Dr. Jeff Bloom, who joined the Group in 1988, organized the event, tracking down members who had retired years earlier or who had lost touch. He said all but four attended.

In between courses, Bloom stood to thank his colleagues, asking them to reflect on their hard work and dedication during the epidemic. Together, they raised a toast to the patients they lost and their physician friends who had died.

“Share your stories,” said Bloom, who recounted his own “trying days” as a family doctor, when he witnessed one patient a month die of the disease.

As the inaugural medical director of Casey House, which opened in 1988 as Canada’s first standalone treatment facility for people living with HIV/AIDS, Bloom said learning how to deliver comforting palliative care to patients who had felt abandoned by society was a new challenge in their collective fight.

“Thank you for coming tonight,” said Bloom, who retired this year and concluded his stint as Family Physician-in-Chief at the University Health Network in 2019. “We have lived a life-changing experience together that for some of us encompassed the darkest and brightest moments of our medical careers.”

Soon after starting his family practice in 1979, Dr. Alex Klein became known as a “gay-friendly” physician.

It wasn’t long before he started to see patients with a range of severe and unexplainable conditions, including fungal infections and debilitating weight loss.

“At that point, the disease had no name,” Klein said. “It was called GRID — gay-related immune deficiency — for a while and ultimately the name was changed to AIDS.”

Scientists identified Acquired Immune Deficiency Syndrome in 1981. Two years later, researchers announced they had pinpointed the human immunodeficiency virus, or HIV, as the cause of AIDS.

“Once there was a definition, and once people understood what was going on, many of my colleagues literally abandoned their gay patients,” said Klein, adding there was a lot of fear in the medical community about the infectious disease that no one yet knew how was transmitted. Bigotry and homophobia were likely also a factor, he said.

By the mid-1980s, Klein was witnessing several patients die every month with little meaningful treatment to offer, even in their final days. He said there was “shell shock” to see so many young people suffering.

It helped, Klein said, that his practice also included emergency work at downtown hospitals, along with some obstetrical patients, many of whom stuck with him during the AIDS epidemic. Klein said delivering a healthy baby on the same day that he signed another patient’s death certificate kept him sane.

The monthly meetings and support from the Toronto HIV Primary Care Physicians Group were also a comfort. As were regular evening walks with Dr. Philip Berger, a founding member of the group who cared for a large practice of HIV patients in the city.

The pair used those neighbourhood strolls to work out their frustrations and to brainstorm potential solutions for their colleagues and the HIV community. One of their goals, Klein said, was to convince more specialist physicians to see and treat HIV patients. 

“We kept basically browbeating our colleagues, saying: ‘Hey, you’re doctors, you took an oath to treat the sick.’”

In his remarks at the group’s reunion dinner, Berger, who has retired from medicine and was the former chief of family and community medicine at St. Michael’s Hospital, described the AIDS epidemic as a “full-on siege of the gay community, which was in the throes of a killing epidemic.”

He listed key moments connected to the group’s advocacy efforts, which included handing out clean needles to injection drug users in the late 1980s.

Berger pointed to a 1988 Toronto Star article, which quoted a police superintendent stating that “Any physician who gives out clean needles (to addicts) could face charges.” That threat, Berger said, was never carried out, and soon after Toronto Public Health opened its first needle exchange program.

“We saw it all,” Berger told his colleagues, “and we fought back.”

Maggie Atkinson isn’t a physician, but her primary care colleagues considered her a key member of their HIV Group.

A former lawyer, Atkinson was an HIV patient. Even as she endured debilitating symptoms, and after she developed AIDS in 1993, Atkinson was a leading patient advocate and activist.

She joined the group in the early 1990s as chair of AIDS Action Now. During the group’s monthly meetings, Atkinson said the doctors would ask for help to improve access to care and treatment, such as advocating for free infant formula for women with HIV so they wouldn’t pass the virus on to their babies.

“That was the kind of issue that I would take back to AIDS Action Now, and then we would contact the government and tell them: ‘You’ve got to change this, or we’re going to protest.’”

At the reunion dinner, Atkinson addressed the group of doctors, telling them: “You brought clinical knowledge, we brought lived experience and activist urgency. Together we helped move care forward.”

Dr. Colin Kovacs, a gay family physician with a large HIV patient practice in the city, listened quietly to his colleagues speak at the reunion dinner. He joined the group in 1993 and has since spent much of his career as a clinician-scientist.

The group disbanded in the late 1990s when highly active antiretrovirals became widely available.

While he agreed with his colleagues’ descriptions of an epidemic that led to collective suffering in the gay community, Kovacs said that he also witnessed intimate moments of kindness and generosity, often against insurmountable odds.

“That chaos, it was all there, I’m not minimizing it, but I also saw a disparate and ragtag group of people come together,” Kovacs said. “There were caregiver groups that delivered food and buddy systems to support people, even when there was political, social and, at times, medical indifference or slowness to respond.

“I learned you can still survive, and you can still have dignity and humanity.”

Through much of the 1980s and ‘90s, Keystone had five kids at home while running a full family practice that included house calls when her patients grew too sick to come to the clinic.

She kept Thursdays free for bedside visits, though she would also go on weekends or in the evenings, after her children were in bed. Many patients had her home phone number.

“People would call and I would drop everything and go,” she said. Too many times, Keystone said she was called to a patient’s house to be with them as they died, or to pronounce them dead.

“I was one of the only women in Toronto who carried death certificates in their purse.”

Now 79, Keystone said she doesn’t know how she managed to get through those years. She said she is proud to have helped advocate for free infant formula, and that she cared for “as many HIV-positive women as I could handle.”

That so many of her gay patients had been abandoned by their families remains a heartache, Keystone said. She noted that in many cases, a patient’s support group was their gay friends, who often were also sick.

“I sometimes felt that I not only had to be their physician, I had to be their mother, because oftentimes there was no mother.”

Keystone, who retired from family medicine in 2010, recalled how one of her patients — an older gay man named John — would make regular appointments to see her, mainly because he needed someone to talk to.

“I wasn’t altering his medical care every week, but I guess I was a listener, and sometimes that’s all it takes — just to listen,” she said, adding that she was with him when he died. Those moments are still hard to talk about. 

“There were so many losses to endure.”