Review by Katelyn Smith
David France’s How to Survive a Plague: The Story of How Activists and Scientists Tamed AIDS (2016) documents in detail the grassroots movement of patient advocates fighting for their lives against AIDS in 1980s and 1990s America. The same title as his 2012 documentary, France uses his insider access as a New York City activist from the time to explore and reveal the impacts of individuals and groups that formed to combat the crisis, such as the AIDS Coalition to Unleash Power (ACT UP).
The book follows the chronology of the disease’s progression through America’s population, touching on the worldwide impacts as well. From his time in New York City, the initial epicenter of the disease, France details the political impact of what was initially dubbed a “gay cancer” following the 1970s, a time which France writes “produced the fiercest round of anti-gay legislation the nation had ever known” (14). The book’s four parts cover the naiveté surrounding the initial impact, as many believed AIDS to be an isolated disease; increasing fear and government resistance to support research during the disease’s spread; hurdles and minor victories achieved by activists by the late 1980s; and the eventual divisions among activists amidst increasing deaths. While the book ends soon after the success of antiretroviral drugs against the disease in the mid 1990s, allowing many people infected with HIV to live normal lives, France avoids an overly positive ending, instead claiming there were “heavy burdens of survival” (514). Indeed, the book’s realistic ending mirrors the prologue, which follows a 2013 memorial service for Spencer Cox, credited with initiating drug trials which led to FDA approved treatments for AIDS.
France intersperses positive scientific developments and political influence with personal stories of friends and fellow activists succumbing to the physical and psychological effects of the disease. While generally sobering, France does briefly mention that daily life continued for most of the 1980s, and it was not until the later part of the decade and the increase of the seemingly unstoppable flow of deaths that many activists began to reach their breaking point.
France stresses the impact of AIDS activism in America’s history of medicine, documenting the success and influence of these patient advocates, self-proclaimed experts, on governmental bodies such as the FDA. Formed by attendees of ACT UP, the Treatment + Data Committee informed themselves of all available medical literature on AIDS and through the efforts of members like Iris Long, a trained chemist, eventually helped impact the direction and regulation of scientific research.
Though activist protests were characterized by “carnival-like theatrics and symbolism,” members of ACT UP were eventually called upon to present testimony at international scientific conferences on AIDS and consulted by government officials such as Anthony Fauci, appointed director of the National Institute of Allergy and Infectious Diseases in 1984, on how to pursue AIDS research (413). By the end of the 1980s, scientists, government officials, and even drug companies seemed to recognize that they were on the ‘same team’ as AIDS activists. France reflects, “global pharmaceutical companies succumbed to their demands, at first out of fear of guerrilla protests and later out of respect for their minds” (6). Partly because activists were willing to compromise some of their original zest for speedy delivery of “drugs into bodies,” the initial chant of ACT UP, the group successfully worked within established hierarchies to impact AIDS treatment.
Part of the book’s success stems from France’s careful balance of personal anecdotes, prose descriptions of archived film records, and records of the many protests, kiss ins, and meetings held by activists. Further, attempting to remain impartial, France expertly presents the many characters of the story: scientists, activists, and public figures, as both heroic and flawed. Larry Kramer, perhaps the most recognized AIDS activist and founding member of ACT UP, is described as both a galvanizing leading figure of the movement but also as a radical sometimes at odds with advancement attempts within medical communities.
France’s book is set apart from other AIDS histories, including Steven Epstein’s Impure Science: AIDS, Activism, and the Politics of Knowledge (1998) because of his personal, passionate engagement with the AIDS activism story, drawing in the reader to the tragic loss of many lives and setting the sober tone which characterized the interactions between politics and science at the time. While not a light read, the book is a definitive and engaging narrative of AIDS activism, an appreciated and in-depth account that moves beyond the scope of France’s award-winning documentary.