In particular, I’d like to speak about my friend David Polson, who has generously allowed me to talk about him tonight. I have been his HIV physician for more than 20 years and I am honoured to be allowed to call him Polly. It was Polly who has left me in no doubt over the years that the life-saving HIV drugs I had given him have had vile, really appalling side-effects. It was Polly who marched into my office a few years ago and pulled up his shirt to show me a disfiguring side effect called lipodystrophy, or on another occasion to dramatically announce his intention to abandon all HIV medication because of the endless nausea, fatigue, vomiting, tingling of lips, peripheral neuropathy, migraines and other unbearable effects of the drugs. In fact, I would like Polly’s story to be heard by every young person at risk, who has come of age believing that HIV is nothing to worry about any more – they think the pills will be enough. To them I say, yes we have treatments but no magic bullets. I first met Polly in 1989. We use a key blood marker for HIV, called CD4, to determine the strength of a person’s immune system. Polly’s CD had recently dropped dramatically and I gave him the first of his many HIV drugs, in fact the only HIV drug we had then, called AZT. He soldiered on through the side- effects, and for the next twenty years he kept soldiering on through increasingly ugly side-effects as the single drug therapies came along one by one. But he continued to volunteer for clinical trials, which are the essential key for us to understand which treatments work best in which circumstances. These clinical trials over 25 years led directly to the development of combination therapy, one of the miracles of modern medicine now responsible for saving literally millions of lives around the world. It is fair to say that these clinical studies have been the rock on which our successes in HIV and more lately in viral hepatitis have been achieved, and without these studies, and our willing pool of volunteers, we as a community would have seen a great deal more infection, illness and death. Polly himself has thought about this over the years and I think he is representative of the many hundreds of people who have volunteered, when he says that he’s about 50-50: meaning that half of his motive in volunteering is to benefit from the new drugs, and half of it is altruistic, hoping that his participation will help the community and medical science even if it didn’t help him. All the while he was coping with side-effects while doing his job as national training manager for a major hotel group, flying around Australia and managing the strict timetable to take the drugs. Polly is 56 now and has lived with HIV disease for almost half his life. Our drug treatments have kept him alive, kept him at work until recent years and kept him active. The combination therapy of multiple drugs, with much lower side-effects, works well for him as long as he takes his 42 tablets every day. But these 42 tablets tell another story, because they are not all for HIV. Combination therapy is so effective for HIV, and keeps people alive for so much longer, that we find ourselves in a challenging new era of HIV treatment. Long-time HIV patients now present with premature ageing, chronic drug toxicities and other co-morbidities, including heart disease and cancer, at rates higher and earlier than in the general community. In Polly’s case, his HIV treatments have caused heart disease and a very rare brain disease which will increasingly disable him. But Polly is the most positive person you could meet. He’s not complaining. “That’s life,” he says. “There are people worse off than me. Think of all the beautiful people who are long gone.”