It was 1982. A ballet dancer returning from a trip to New York entered the office of a Montreal doctor. Worried, the young artist said: “I think I have American disease. » The destiny of Réjean Thomas had suddenly taken a new direction.
Exactly 40 years ago, in 1984, Réjean Thomas created with his colleagues Sylvie Ratelle, Alain Campbell and Michel Marchand a center for sexually transmitted diseases. Located in the Gay Village which then consisted of only a handful of bars, the clinic was first called the Annex before becoming the Actuel.
“We were told that it wouldn’t work,” Réjean Thomas tells me. The first day, the waiting room chairs had not arrived. As soon as it opened, the room was full of men and women standing around waiting. »
Some patients arrived traumatized. “I remember a man who told me that his doctor had opened the Bible to the page of Sodom and Gomorrah to lecture him. » In addition to herpes, gonorrhea and chlamydia, a new reality is hitting the Actuel team. “The first AIDS screening tests arrived at the end of 1984,” says Réjean Thomas. We didn’t know what to do with it. »
The first AIDS patients that Réjean Thomas meets have been infected for several years. “They had a life expectancy of six months to two years. Added to this were the problems of homophobia and serophobia in the hospital environment. We had to create a network of doctors, infectious disease specialists, hematologists and pulmonologists who were more open. »
We forget that discrimination against people with AIDS was enormous in the 1980s and 1990s. “Remember, it was the disease of the four Hs: homosexuals, Haitians, hemophiliacs and heroin addicts. »
During these 40 years, Réjean Thomas announced bad news to hundreds of people. No doubt a heaviness is sometimes felt on his shoulders? I point out to him that he tells me about his journey with a smile. “You know, for every patient I gave bad news to, I could have cried. Each case is a cinema story. I think of this African woman who came to Quebec in the hope of bringing her daughter. She thought she had finally found happiness and the sky fell on her. I told her she had AIDS. »
There is also the incredible story of this 72-year-old woman who came to see him one day. “She had a small envelope in her hands. She gave it to me saying she was referred by her doctor. I opened it and it said “HIV positive”. She didn’t know it. Her husband had died of unknown causes. She died of breast cancer at age 92. She became a kind of grandmother to me. »
Increase in cases
In quick succession, two reports have recently emerged of an increase in HIV cases in our country. First that of the Montreal Regional Public Health Directorate published in December 2023 which shows that the number of cases jumped by 120% in the metropolis in 2022. Then, last February, a study by the Canadian Research Foundation on AIDS (CANFAR) which indicates that 1,833 new cases were declared in the country, an increase of almost 25% compared to the previous year.
The media hardly talk about it anymore. Gone are the days when Janette Bertrand devoted entire broadcasts to this. Do you know when the last major STI prevention campaign was? To Marie-Soleil Tougas.
Rejean Thomas
The culprit is the trivialization that now surrounds this disease. “We repeat a lot that we no longer die of AIDS. But be careful, it remains a chronic and serious illness. Two weeks ago, I met a young patient, 25 years old. He was taking PrEP [prophylaxie préexposition] and he stopped taking it. He has just started triple therapy. He lives with his parents who don’t know he is homosexual. It’s 2024.”
If you want to shake Réjean Thomas off his hinges, talk to him about the training that young doctors receive today on STIs and HIV. “They don’t know anything about the history of AIDS. As for young people, they get their sex education from porn films. I told a 19 year old that he had HIV and he didn’t know what I was talking about. For some, it’s an uncle’s disease. This young person had requested PrEP from his doctor in Saint-Sauveur who told him to go to Montreal for it. He became contaminated in the meantime. »
Despite progress, there is still no vaccine against AIDS. There is preventive treatment and still no curative treatment. “Patients, what they want is to be cured. When I tell them they have HIV, I tell them there will be stigma associated with it. This is still the case. »
And hope?
Is Réjean Thomas dreaming of a treatment or a vaccine? Is he hopeful that this will ever happen? “The hope I have is that the research continues. When triple therapy arrived, I was afraid that the research would stop. The most interesting current study is taking a monoclonal antibody injection every six months. For the moment, this treatment exists every two months. And it comes as a preventative measure, in PrEP. »
Screening still remains the crux of the matter. So, when Réjean Thomas heard that the federal government was putting an end to the self-testing program, he stepped up to the plate.
To eradicate AIDS, 95% of people who are HIV positive would need to know it. And after that, 95% of people would have to be on treatment and 95% would be undetectable. We have all the tools necessary to achieve this.
Rejean Thomas
It was a great opportunity to discuss with this experienced doctor the umpteenth shift we are trying to make in our health system. “The system has never been as bad as it is now. Bureaucracy is driving us crazy. Waiting lists make me desperate. I saw a 73 year old patient today. He has an anal fissure, he is incontinent. His surgeon told him he would see him in two years. Didn’t we foresee the aging of the population? Oh come on ! I have never seen so much distress in my office. Crystal meth takes its toll. The situation is desperate. »
On May 9, Réjean Thomas received the Outreach and Commitment Award from the Federation of General Practitioners of Quebec (FMOQ). After all these years, I had forgotten that he is first and foremost a family doctor. “L’Actuel is one of the rare clinics where the care of people living with HIV is provided by general practitioners. I’m very proud of that. »
That said, Réjean Thomas loudly claims the title of community health doctor. For someone who always wanted to be a doctor, this is what guided him. “I come from an underprivileged background. But my mother always told me that just because we’re poor doesn’t mean we’re not intelligent. »
However, his grandmother almost made him deviate from his goal. “She told me one day that she would like me to become a priest and that if I accepted, she was going to leave me her inheritance. The problem was that she didn’t have a penny,” he says, laughing.
For some time now, many people have been worried about whether Réjean Thomas will soon retire. I believe they can stop harboring this fear. “I started my career doing deliveries in Rimouski. I became an AIDS specialist in Montreal. And there, my patients decided that they would not die. So, I am once again becoming a family doctor who also deals with cholesterol and hypertension. Isn’t that wonderful? »
Réjean Thomas never talks about his private life. I dare a more personal question. When you dedicate your life to medicine as he has for 40 years, can you find a balance with the sentimental aspect? He takes a breath. “It’s clear that this fight has sidelined a whole part of my life. But it does not matter. I have the best job in the world. »
It was at that moment that I understood why Réjean Thomas manages to talk about his daily life with a smile from ear to ear.
Questionnaire without filter
Coffee and me: The first thing I do when I wake up is make myself an espresso. I always have black coffee on my desk even though I don’t always drink it. It’s psychological. No milk or sugar, except occasionally, in the evening, a macchiato at the restaurant.
People I would like to bring to the table, dead or alive: Nelson Mandela, Simone de Beauvoir, Barack Obama, Sigmund Freud, Plato, Nelly Arcan, Oscar Wilde, my mother and Janette.
The last book I read: Never wipe away tears without gloves, by Jonas Gardell. This is a book that all medical students should read as well as people affected by HIV/AIDS. Very moving, but so true.
Réjean Thomas in six dates
- 1955: birth in Tracadie-Sheila, New Brunswick
- 1979: doctor in Rimouski
- 1984: creation of the l’Actuel clinic
- 1994: candidate in provincial elections for the Parti Québécois
- 2005: knighted in the National Order of Quebec
- 2009: becomes a member of the Order of Canada