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book review

David France takes us back to the ‘Plague’ of AIDS and those who fought the war against it

David France’s heart-wrenching 2012 documentary “How to Survive a Plague’’ catapulted viewers into the trenches of the AIDS crisis of the 1980s and early 1990s.

With stunning immediacy, the film examined the people, the protests, and the internecine rivalries that characterized AIDS activism. In particular, it dramatized the role of the group ACT UP in prodding the American scientific and medical establishment to change the way it investigated and brought drugs to market.

France’s follow-up book of the same name provides a more nuanced take on the same events. Substantial and elegantly written, it is at once a deeply reported (if New York-centric) AIDS history and an intimate memoir that makes clear the author’s stake in the story.


The book naturally invites, and merits, comparison to Randy Shilts’s masterful “And the Band Played On: Politics, People, and the AIDS Epidemic’’ (1987), a panoramic nonfiction narrative of the sluggish public-health response to the epidemic. Shilts died of AIDS in 1994, just two years before its ravages were checked by the introduction of drug-combination therapy.

That discovery is the endpoint of “How to Survive a Plague,’’ a title that manages to be both normative and grimly ironic. France — like Ishmael from “Moby-Dick’’ or, in his own analogy, a concentration camp survivor — has escaped alive to survey the wreckage.

While the San Francisco-based Shilts took readers on a breathtaking global pilgrimage, France concentrates on the efforts of a cohort of New York-based activists, physicians, and philanthropists, many of them his friends.

Among his characters is Larry Kramer, whose controversial pre-AIDS novel “Faggots’’ (1978) bemoaned gay promiscuity and whose 1985 polemical drama “The Normal Heart’’ fictionalized his role in sounding alarms against the plague. The temperamental Kramer — “Jane Austen in Erica Jong’s world” — helped found both the Gay Men’s Health Crisis and ACT UP, an acronym for the AIDS Coalition to Unleash Power.


France also chronicles the contributions of other, lesser known pioneers. Among them are the duo of Michael Callen and Richard Berkowitz, who promoted the idea of “safe sex;” Peter Staley, the closeted bond trader whose money helped seed AIDS activism; Iris Long, the unemployed chemist who contributed her expertise to the cause; and Spencer Cox, integral to the “history-changing . . . drug trial innovations” that nevertheless failed to save him.

France, like many gay men of his generation, was traumatized by the epidemic, watching not just close friends but his own lover, Doug Gould, die of AIDS-related complications.

Silence, ACT UP famously proclaimed, equaled death. But the group was riven by debates over the relative importance of changing the nation’s social and political consciousness and the practical goal of getting “drugs into bodies” as quickly as possible. Beyond even homophobia and political stasis, plenty of obstacles loomed.

France recounts the ugly feuding between US virologist Robert Gallo (the first to discover a retrovirus) and Frenchman Luc Montagnier (whose lab first isolated the AIDS-causing retrovirus, eventually named HIV) over both scientific credit and royalties from a diagnostic test. “Gallo, despite his obsessions and unseemly competitiveness, was the acknowledged genius of AIDS research,” France concludes.

He also details the nexus between researchers and Big Pharma — notably the extent to which Burroughs Wellcome’s expensive and often toxic AIDS drug, AZT, dominated the research agenda. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, emerges as an initially recalcitrant figure, “the most powerful man in the epidemic,” and a late convert to the idea of community input.


ACT UP and a splinter organization, the Treatment Action Group (TAG), used both direct action and reasoned discourse to fight for more widespread drug testing and changes in test protocols, efforts that achieved some success. Their campaigns, France writes, marked “the first time patients had joined in the search for their own salvation.”

As those affected by AIDS awaited a cure, the underground drug market thrived, its products providing mostly false hope. In the end, science, with a strong push from the community, triumphed — too late, however, to save more than 650,000 of the afflicted in the United States and, France writes, as many as 40 million worldwide.


The Inside Story of How Citizens and Science Tamed AIDS

By David France

Knopf, 624 pp., illustrated, $30

Julia M. Klein is the Forward’s contributing book critic. Follow her on Twitter @JuliaMKlein.