Patients on long-term HIV therapy often experience lipodystrophy, which can include facial wasting (lipoatrophy) and fat deposits in the back or belly (hyperadiposity). "It is the scarlet letter of AIDS," said Robert, 46, who requested anonymity. In November, Robert became one of the first Canadian lipoatrophy patients in a pilot project to undergo injections of the synthetic gel Bio-Alcamid to help fill out his sunken cheeks.

Nine months ago, Health Canada began approving Bio-Alcamid injections on a case-by-case basis; a final decision on full approval is expected in two to three months. Since October, more than 125 Canadian patients have undergone the treatment. In March, Toronto's Maple Leaf Clinic had to choose patients by lottery after some 200 wanted to enroll in a trial with 30 treatment slots. The product is not yet available in the United States.

Though Bio-Alcamid's long-term effects are unknown, in a 2002 Italian study of 2,000 participants, only 12 people had to have the filler removed after they developed infection. In Europe, the gel was approved in 2000 and is used in chins, buttocks, noses, and other soft tissue affected by the disease.

"Some people with lipoatrophy have contemplated suicide," said plastic surgeon Frank Beninger, who was involved in the pilot project. "[Bio-Alcamid] has been a phenomenal treatment that has greatly changed these people's lives."

Robert, who once found his appearance so upsetting that he learned to shave without looking at a mirror, said it took a few months for swelling to subside. He's had touch-ups since and believes procedure is worth it.

Others, however, say the product is not for them. "There should be more emphasis on telling patients it is alright to look this way, as opposed to this push to change it," said Randy Yates, 43, who has lipoatrophy. "I am not ashamed to have AIDS. I have fought it and earned my scars, which are just part of who I am."

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