Starting with the title, cruel irony abounds in journalist David France’s How To Survive a Plague, a systemic dissection of the NYC-based gay community’s response to the AIDS epidemic and the lessons learned by its principal activists. Let’s get one thing out of the way: There is no magic bullet, no voilà!, no “how-to” whatsoever—but perhaps there would have been, had the disease infected any visible section of hetero-heartland America. If that seems an admission of bias or a line drawn in the sand, stop reading here and just see the movie: today’s rhetoric on the subject doesn’t seem half as bad when you can watch conservatives ranging from Jesse Helms to Ed Koch all insisting, some more abrasively than others, that H.I.V.-AIDS was, while unfortunate, the consequence of some voluntary lifestyle choice. George H.W. Bush, the supposed bastion of old-school Republican reasonableness is shown saying in a 1992 presidential debate, “It’s one of the few diseases where behavior matters. I once called on somebody, ‘change your behavior: if the behavior you’re using is prone to cause AIDS, change the behavior!’”
Plague emphasizes the importance of no-bullshit public awareness, but the real backbone to its story’s success is more complicated. Flannery O’Connor once wrote that “the way to despair is to refuse to have any kind of experience,” and indeed the only workable remedy France’s film proposes is a rigorous education of self. It is a pointedly “American” story: As Larry Kramer has stated in myriad interviews, they were on their own. The push was against institutional neglect, a broad and vicious nemesis with no intricate fixes or a standalone public face, for better-quality research, and for bottom-line wider availability of drugs. The activists’ impulse—which would be almost entrepreneurial, if not for the atmosphere of fear and decimation—threw a cluster of men and women together in the mid-1980s, resulting in the formation of ACT UP (AIDS Coalition to Unleash Power) and its splinter/rival faction, TAG (Treatment Action Group). The story of the groups’ impact goes well beyond Ralph Nader’s most successful consumer-empowerment campaigns of the ’70s, watching a motley crew of activists—gay, straight, young, old, men, women—eventually infiltrate the inner chambers of the National Institute of Health and the F.D.A.
But reaching those pivot points doesn’t make it a “success story”: Epistemologically, ACT UP and TAG’s leaders evolved from assuming that the right drugs were merely being withheld by an indifferent government to discovering that they actually didn’t exist. During one direct action in 1990 at the Daiichi Pharmeceutical headquarters, H.I.V.-positive demonstrator Bob Rafsky bellows to a hapless, bespectacled executive: “See this dark mark on my forehead? That’s Kaposi’s sarcoma. It’s gonna spread, it’s gonna kill me. You coming to my funeral? Because you’re the man fucking responsible; you are my murderer, in your shirt and tie!” Activists Mark Harrington and Peter Staley formed the Treatment & Data committee of ACT UP, self-publishing the best and most up-to-date pamphlets and books on new research and therapy options, while the silver-tongued Rafsky worked as the group’s media coordinator. (His explanation for ditching his high-paid PR job is telling: “The question is, what does a decent society do with people who hurt themselves because they are human?”)
As one talking head after another blandly announces the dispute between activists and drug companies (laden, of course, over the standard footage of zillions of pills being shoved down conveyor belts and meticulously arrayed in plastic delivery trays), the community forms its own networks and black markets. Much of the stuff was available over the counter in other first-world economies. Bookseller and activist Derek Link is seen delivering a shit-eating grin into a friend’s camera and chuckling, “We’re at People With AIDS health group, the largest underground buyer’s club in the United States. We have a whole variety of things for your treatment pleasure. None of which work, by the way.” These VHS images are culled from the group’s own records, from TV interviews, and from home movies, and France is careful not to spotlight any one individual perspective or angle—rather, these are the collective remnants of a struggle. It’s all here: group meetings, infighting, curtailed interviews, marches, demos, speeches at healthcare conventions. Funerals. Hospital visits. Whether fighting the crisis or recounting it 25 years later, participants in France’s film have had to forego any pretense of a life separate or “private” from the epidemic.
Punched in to fit a 16:9 aspect ratio, the images are cushioned by shimmering synthesizers and voiceover recollections. It’s slick, but the effect is less coddling (except in the instance of a Bush/Helms action scored to Louis Armstrong’s “I’ll Be Glad When You’re Dead, You Rascal You”) than level-headed. If the only logical response to seeing dozens of young, healthy men withered down to skeletons with eyeballs is surrendering logic, then France’s light manipulation allows viewers to proceed along acknowledged lines of uncertainty; the narrative hurts, but never allows itself to break down. In the space of five years, Zidovudine (AZT), the drug developed by Burroughs Wellcome and the National Institute of Health, went from being the activists’ great white hope to being found totally ineffective. (It was practically impossible to afford anyway; soon after, the same thing happened with an F.D.A.-pushed drug called ddl.) One of Plague’s passages shows members of TAG—Harrington and Staley foremost—acknowledging their own naïveté in assuming any one drug could solve the problem.
After the failure of “accelerated approval,” three activists—Link, Staley, and David Barr—are seen over red wine and cigarettes, openly discussing the fact that time is running out. Link: “The story doesn’t seem to have this relationship to effective treatment, or a cure, anymore: it seems to have this relationship with death. It ends, it ends with everybody dying. ‘Will the last person alive in Chelsea please turn out the lights?’” By the time the worldwide death count reaches six million, a new “family” of drugs is reluctantly introduced by F.D.A. commissioner David Kessler. At the same time, the credibility of the “elitists” of ACT OUT is in total jeopardy within the activist group’s ever-more-enraged membership. France downshifts from interviewees’ recollections here to an unbroken 20-minute chunk of archival footage, the story playing out in almost real-time at the absolute peak of uncertainty and fear. 1996 is recalled without a single decisive turning point, which is honest: The F.D.A.-approved combination therapy arrived when the movement was at its most broken.
Seventy million infections in a little over three decades. If not an outright cure, the new cocktail worked; the music soars and interviewees begin addressing their own survival, a moment that could feel cheap if not for the prior 15 years’ worth of death and paranoia. Again, France’s own insider status to the movement is perhaps the film’s greatest asset. Among others, Andrew Sullivan maintains that the direct byproduct of these struggles is the LGBT community’s forceful cohesion today, as a movement propelled forward from under the long shadow of its own abandonment. This kind of brutal cause-effect pattern being endemic to changing American mores, France and his crew aren’t really interested in exploring those shockwaves—the narrative encircles the crisis, the community’s response, and loops back around to the long list of activists who died along the way. Late in the film, several new faces appear in the chair, lit against the same black curtain, and you realize they are the same faces you’ve been seeing on VHS for nearly two hours. The effect speaks for itself: I realized immediately that I had been operating under the presumption that none would be alive by the end of the movie.
How to Survive a Plague opens in New York on September 21.