The stately old Victorian sits on a corner lot at the end of a quiet, downtown Toronto street. It is a place I know well, having donated four hours of my time each week since 2006. When I started, it was an AIDS hospice. Years before, during the darkest days of the epidemic it was not uncommon for several patients to die there each week. Tracy, a nurse and friend, once told me of the time she lost three patients during the first half of her shift.

No longer called a hospice, today it is one of the first HIV specialist hospitals in Canada. The name change is more than cosmetic; consider that in 1988 the discharge rate was 0%. If you left, you left dead. Today, the percentage of patients discharged is 93%. Demographics have also shifted; from a majority of thirty something, white, gay men to a growing number of women, racial minorities, recent immigrants, IV drug users, those with histories of rape and sexual abuse, and clients with housing and mental health issues that have contributed to their becoming positive. Recently, we started accepting youth, provided they are a minimum fourteen at the time of admission.

It’s a wildly diverse group, and sometimes that gets complicated. But it’s the mood that has changed since I started a decade ago; there is hope now, as medications can sustain health with a normal life expectancy. Provided, and this is a big one, those medications are taken, and a strict schedule adhered to. That seems agonizingly simple to our privileged experiences, where a roof over our heads, food in our stomachs, and our bodily autonomy is never in question. For a large number of the people treated here, well, their mileage often differs.

Coming in for my shift today, I am greeted with a big smile from a man I will call Nan. A gay man from West Africa, he recently immigrated here after spending seven years in prison for his sexual orientation. He was told of his HIV diagnosis on the first day of his sentence, as testing is mandatory. Treatment however, was not. Today, his immune system has paid the price and is in dire condition. Nan has a CD4 count of only 19. Considering that a normal count for these vitally important immune cells is 500 to 1100, he arrived here with little time to to spare. The good news? Fatal immune conditions can repair themselves when treated, and Nan stands an excellent chance of bringing those numbers to normal within the year. But only if he receives treatment, and follows his medication schedule by the book.

Clearly excited for the program today, Nan asks me what‘s on the menu. I tell him mac and 3 cheese. He laughs, telling me when I say the words it sounds like something is popping. I assure him he will like it, though his guarded smile tells me he’s less than convinced.

Today is Tuesday, the day that every other week myself and a volunteer will facilitate a group cooking program at the hospital. Though fun, it t is not easy work, can be frequently stress inducing, and achieving the group cohesion needed to create a meal can sometimes be a challenge. A wealthy gay men, sneering over the absence of his favorite brand of hot mustard, chopping carrots and potatoes with a shy, young homeless woman, distracted and anxious on day number three of her first real attempt to stay clean, is never an ideal situation. A clash should be expected. And yet … spending a few hours here every week over several years, I’ve become intimately familiar with those hard to define things that can never be explained in an orientation booklet. Some of the best support I have been witness to has come from the one you’d least expect. Surprising potential exists between those unique constellations of identity and experience, when HIV is the sole commonality.

By the time we actually sit down to eat, any friction in the group is well past and people have started to come out of their shell. There is conversation amid laughter, and when the meal (also including cornbread, salad, and mocha/vanilla pie) is finally finished, no one is hungry.

In terms of socialization alone, simple programs such as this one serve a crucial function for people with HIV. Because looking at the numbers, we know that three out of four HIV positive people in an urban center are socially isolated, with no one they can turn to for support in a medical or emotional crisis. The rural experience is much worse.

Yes there are medications, and yes we have come far, but HIV is still not a picnic for anyone. The heavily muscled hunk who pops a pill a day to “get on with life” is an allusion, even for the most privileged. For those on the margins, those with complex and overlapping health issues, it really is 1983 all over again. In Toronto, there is the benefit of a 13 bed specialty hospital. Everyone else however, is still on their own.

Now … on to the grub.

Best Ever Mac & 3 Cheese

What You Will Need For Four Large Servings

Vegetable oil
Salt
4 cups macaroni or cavatappi
3 cups milk
4 tablespoons unsalted butter
4 tablespoons flour
8 ounces grated Gruyere cheese
6 ounces grated extra-sharp Cheddar
4 ounces blue cheese (more crumbly than creamy)
8 ounces thick-sliced bacon
1/2 teaspoon freshly ground black pepper
Large pinch nutmeg
4 tablespoons Dijon mustard
4 slices white sandwich bread, crusts removed
4 tablespoons freshly chopped basil leaves

Instructions

• Preheat the oven to 400 degrees F.
• Place a baking rack on a sheet pan and arrange the bacon in 1 layer on the baking rack. Bake for 15 to 20 minutes, until the bacon is crisp. Remove pan from the oven. Transfer the bacon to paper towels and crumble when it is cool.
• Drizzle oil into a large pot of boiling salted water. Add the macaroni and cook according to the directions on the package, 6 to 8 minutes. Drain well.
• Heat the milk in a small saucepan, don’t boil. Melt the butter in a medium pot and add the flour. Cook over low heat for 2 minutes, stirring with a whisk. While whisking, add the hot milk and cook for a minute or 2, until thickened and smooth.
• Take off the heat, add the Gruyere, Cheddar, blue cheese, mustard, 1 teaspoon salt, pepper, and nutmeg. Add the cooked macaroni and crumbled bacon and stir well. Pour into 4 individual size gratin dishes, or 2 cake pans.
• Place the bread slices in a food processor fitted with a steel blade and pulse until you have coarse crumbs. Add the basil and pulse to combine. Sprinkle the bread crumb mixture over the top of the pasta.
• Bake for 35 to 40 minutes, or until the sauce is bubbly and the macaroni is browned on the top.

Serve with crusty bread and enjoy.