Reading Time: 4 minutes

“Grief is a sword, or it is nothing.”

This quote from American author Paul Monette opening David France’s book also prefigures the engine driving it. How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS delivers on the storytelling promise of its title, while being propelled by the sadness and rage of one who lost friends and fellow activists during the early years of the epidemic.

David France’s book, published late last year, opens in 1981, the year The New York Times published a small article about a “rare cancer seen in 41 homosexuals.” It closes in 1996, with the discovery of protease inhibitors, the drug class that would turn HIV into a virus that people would die with, rather than inevitably die from.

In between these years is one hell of a narrative, passionately and knowingly chronicled by France. Living in 2017, one can be ignorant of the far more overt homophobia of the 1980s and 1990s. How to Survive a Plague reminds readers of the time when gay sex was illegal in most of America, of a president who would not even use the words HIV or AIDS until four years of the epidemic had passed.

This was a period when over 50% of gay men in New York City and San Francisco were HIV-positive, and over 50% of physicians refused to treat AIDS patients. Laws passed by the U.S. Congress reinforced hiring discrimination against gays, while North Carolina Senator Jesse Helms was viewed by many of his political colleagues as the conscience of Congress for repeatedly labeling gay sex as an abomination and opposing federal AIDS funding.

David France had a ground-level view of this crisis, as a gay man living in NYC, the American city that suffered the highest number of AIDS-related deaths, and where the most visible and effective activism arose. France describes the horror of losing friends and partners to opportunistic infections like Pneumocystis pneumonia or Kaposi’s sarcoma (the purple tumors that started on the skin but more dangerously spread to the lungs).

He proceeds to recount how he became an activist journalist during these years, giving an insider’s perspective of the rise of GMHC (Gay Men’s Health Crisis) and ACT UP (AIDS Coalition to Unleash Power). Taking cues from the nonviolent disobedience of the feminist and black civil rights movements, ACT UP successfully brought the plight of people with AIDS into American living rooms, before gaining a hearing and ultimately seats of power at the NIH and pharmaceutical companies.

France tells his story chronologically, giving readers an empathic toehold by attaching his narrative to the lives of multiple figures in the epidemic. We vicariously observe and feel along with people like Peter Staley, a Wall Street whiz kid turned ACT UP spokesperson; Joe Sonnabend, an infectious disease specialist treating an overwhelming number of dying gay men; and Larry Kramer, the man who did the most to bring AIDS into the national spotlight, despite repeatedly alienating fellow activists with his abrasive statements and prickly temperament.

As I completed reading How to Survive a Plague, I discovered that David France’s 2012 film of the same name is available for instant viewing. If you crave depth, read the book; if you want the version that delivers a faster, stronger gut punch, see the documentary.

Having begun my medical career in the late 80s, the documentary’s opening images of gaunt figures helplessly supine in hospital beds stirred up painful memories of the men I treated with AIDS-related wasting syndrome. Witnessing a once-hilarious performance artist—in one scene dressed as Jesus and advising condom use for the second coming—morph into a confused patient brought to mind the men I almost helplessly treated with AIDS dementia.

I see why How to Survive a Plague carries a 99% fresh rating at Rotten Tomatoes. France knows how to tell a great story both in book and documentary form. His film version skillfully combines video footage from the period with present-day recollections of gay survivors and key scientists.

France’s documentary authentically shows the personal and societal tragedy of AIDS, compounded by the genocidal sluggishness of the Reagan and Bush administrations. But it is also a stirring testament to the power of citizen activism. Like his book, France’s film chronicles Staley’s civil disobedience. But more heavily than the book, it zooms in on the efforts of Bob Rafsky, famously confronting presidential candidate Bill Clinton and extracting a promise from him to do more for people with AIDS. Later, the film shows Rafsky even more vehemently and eloquently eulogizing outside of Bush’s campaign headquarters.

In the early days of the Trump presidency, I find parallels between the Reagan era and ours, between the work of ACT UP and the protesters against Trump’s policies and conduct. (And I suspect David France would not object to the latter, since as I mentioned previously, AIDS activism used a playbook modified from earlier civil rights movements).

For instance, one sees the importance of who holds political power. In a reverse analogy of the retrograde shift in quality from Obama to Trump, the change from Reagan/Bush to Clinton inarguably helped the fight against AIDS. However, even Clinton needed pressure from folks like Rafsky (and obviously, Clinton was far from perfect, as “don’t ask, don’t tell” amply illustrates).

Additionally, both now and then, the simulation of action can mask callous inertia and villainous perversity. As Trump spews forth grotesquely unqualified candidates for his cabinet, so Reagan created his farcical Commission on the HIV Epidemic. As France puts it, the commission comprised “a roster of figures whose lack of experience was matched by their reckless beliefs,” with useless props like the Amway president (what is it with Republican presidents and Amway?) and New York Cardinal John O’Connor, who was vocally anti-gay and anti-condom.

More importantly, present-day activists can find inspiration in GMHC and ACT UP. Though it took far too long, AIDS agitators saw substantive, life-saving results from their efforts. Thanks to them, drug studies and approvals were hastened, and the NIH and the FDA opened their doors to community participation. So we can gain hope that our voices against a fascist bigot will effect change in immigration, health care, and foreign policy. A single voice, powered by passion and knowledge, amplified by a movement, can still today alter the world.

4.5 out of 5 stars

(Parents’ guide: France’s documentary is unrated, but contains some strong language, a few violent scenes of police/demonstrator clashes, and upsetting scenes of illness-related dying and death.)

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