A Directed by David France Review by Jon Kissel |  |
The stakes for the heroic activists in David France’s documentary How to Survive a Plague are life and death. Composed of archival footage from the 80’s and 90’s, France withholds who’s going to be alive when the film ends. Some of the more prominent leaders of Act Up, bright and vivacious in the past, don’t see their quest through to the end. The story of the LGBT men and women and their allies who spent years advocating for their community in the hunt for a treatment for HIV and AIDS is one of passion and protest and theatricality, but it’s primarily a story of people becoming capital-C Citizens, of motivated individuals, their brains and their hearts working as one, marshalling all the knowledge available on a subject and bludgeoning the unwieldy apparatuses of government and big business into tragically-belated action. This is a civics success story, but one built on the 8.2 million bodies who died before a reliable and safe treatment for AIDS could be put into practice. How to Survive a Plague contains the best and the worst of America, a bravura journalistic masterpiece that retains its anger 22 years from when its historical timeline ends.
France’s film begins in year six of the AIDs epidemic, a time when there are exactly zero treatment options for patients. Not even the classic American solution of money is a balm to wealthy sufferers; there’s nothing for them to buy. Ignored by the government and hated by much of the country, the gay community of New York starts Act Up as an aggressive public policy group. What’s arrest or assault by the police when you and your friends will potentially be dead in a year? Their confrontational style is paired with a thirst to understand what is happening to their bodies and the cutting-edge state of the pharmacology, so Act Up meetings become dominated by lectures from scientists and health care workers. A member of Act Up might find themselves at a kiss-in at a Catholic hospital by day and surrounded by a stack of immunology journals by night. Cloaked in technical knowledge and wreathed in righteous fury, Act Up members become hugely effective avatars of change, or they would if the forces arrayed against them weren’t so insulated and callous.
How to Survive a Plague has no lack for antagonists, none more repulsive than Senator Jesse Helms. A proud bigot, Helms lustily condemns millions to death from the Senate floor, castigating AIDS sufferers as perverts who reaped what they sowed. France easily and reliably produces a jolt of bile anytime he cuts to Helms spouting hatred, but he’s only the most forthright villain. Funeral homes refuse to take in the bodies of people who died from AIDS. Police and security forces relish the chance to bash protestors. The first treatment, AZT, is finally approved, but it’s coincidentally a harsh and caustic drug that also happens to be the most expensive ever at the now-quaint sum of $10,000 a year. Catholic bishops band together to condemn condom use, prompting a protest complete with an actor playing Jesus, who in turn loses his senses to AIDS. This verbal and physical cruelty continues while the death toll continues to mount. Each passing year is demarcated by a revised number of the dead, growing by hundreds of thousands of lives snatched away in their primes.
Malevolence alone isn’t enough to slow Act Up’s progress towards treatment. Apathy and incompetence play their parts as well. Presidents Reagan and HW Bush are portrayed as utterly indifferent, providing no leadership or urgency on agencies tasked with finding (NIH) or evaluating (FDA) potential cures. Medicines approved for treatment in other developed countries are blocked in this one. Act Up’s dogged expertise tops that of the scientists employed at the agencies, to the point where they are giving shocked NIH officials treatment plans based on literary research they did at someone’s apartment. The FDA relents in shortening its approval process, but they shorten it too much, resulting in drugs that are either ineffective or prohibitively dangerous. Every victory is reframed as a setback. What good is more funding if it’s spent on a research path that’s sure to fail? Why hire more scientists and staff if they’re going to duplicate each other’s work thanks to poor communication and oversight?
What stays constant is Act Up’s dogged pursuit of some kind of sustained victory. Many of the principals are sick themselves, but despite diminishing strength and increasing skin lesions, they continue to press their case in news studios and on the streets. Some abruptly leave the film following their death. France doesn’t dwell on these losses, as this is a dense film, but their absence is felt by the viewer and by the growing weight on the survivors’ shoulders. The cantankerous Larry Kramer, one of the founders of Act Up, is shown losing his temper at his own people, condemning their infighting over strategy while that annual death toll keeps rising into the millions. It’s impossible to imagine the strength necessary to keep coming in and doing this work day after day in rooms that used to contain so many more people. The crushing work of science drags on, alternating between tentative hope and the finality of dead ends, while activists gradually become resigned to the likelihood that they’ll die before success is found.
And then, one day, the dawn breaks. Combination therapy and proteases and drug cocktails break through and dramatically reduce the viral load, reducing AIDS from a death sentence to a chronic, but manageable, illness. France finally shows present-day footage of activists we’ve previously only seen in the past, letting the viewer know that they made it. However, there’s no burst of music, no jubilation. Instead, there’s a long moment of silence as he switches between their rueful faces. They talk about how they were sure this was going to happen in the 80’s, that there was no way things would drag on for ten years before the tide could be slowed. Millions died in the meantime. Celebration is impossible.
How to Survive a Plague is an ur-documentary in that it finds real human drama amongst a wide swath of history, real people doing meaningful work. It shows the effort of democracy, of citizens demanding to be paid attention to and asserting that their lives have meaning. Forces of judgment and recalcitrance are well-entrenched, but are finally beaten down by truth and righteousness, albeit at great cost. Perfectly bittersweet and deeply powerful, How to Survive a Plague is a must-watch, vital viewing about recent history that must be remembered. A
How to Survive a Plague has no lack for antagonists, none more repulsive than Senator Jesse Helms. A proud bigot, Helms lustily condemns millions to death from the Senate floor, castigating AIDS sufferers as perverts who reaped what they sowed. France easily and reliably produces a jolt of bile anytime he cuts to Helms spouting hatred, but he’s only the most forthright villain. Funeral homes refuse to take in the bodies of people who died from AIDS. Police and security forces relish the chance to bash protestors. The first treatment, AZT, is finally approved, but it’s coincidentally a harsh and caustic drug that also happens to be the most expensive ever at the now-quaint sum of $10,000 a year. Catholic bishops band together to condemn condom use, prompting a protest complete with an actor playing Jesus, who in turn loses his senses to AIDS. This verbal and physical cruelty continues while the death toll continues to mount. Each passing year is demarcated by a revised number of the dead, growing by hundreds of thousands of lives snatched away in their primes.
Malevolence alone isn’t enough to slow Act Up’s progress towards treatment. Apathy and incompetence play their parts as well. Presidents Reagan and HW Bush are portrayed as utterly indifferent, providing no leadership or urgency on agencies tasked with finding (NIH) or evaluating (FDA) potential cures. Medicines approved for treatment in other developed countries are blocked in this one. Act Up’s dogged expertise tops that of the scientists employed at the agencies, to the point where they are giving shocked NIH officials treatment plans based on literary research they did at someone’s apartment. The FDA relents in shortening its approval process, but they shorten it too much, resulting in drugs that are either ineffective or prohibitively dangerous. Every victory is reframed as a setback. What good is more funding if it’s spent on a research path that’s sure to fail? Why hire more scientists and staff if they’re going to duplicate each other’s work thanks to poor communication and oversight?
What stays constant is Act Up’s dogged pursuit of some kind of sustained victory. Many of the principals are sick themselves, but despite diminishing strength and increasing skin lesions, they continue to press their case in news studios and on the streets. Some abruptly leave the film following their death. France doesn’t dwell on these losses, as this is a dense film, but their absence is felt by the viewer and by the growing weight on the survivors’ shoulders. The cantankerous Larry Kramer, one of the founders of Act Up, is shown losing his temper at his own people, condemning their infighting over strategy while that annual death toll keeps rising into the millions. It’s impossible to imagine the strength necessary to keep coming in and doing this work day after day in rooms that used to contain so many more people. The crushing work of science drags on, alternating between tentative hope and the finality of dead ends, while activists gradually become resigned to the likelihood that they’ll die before success is found.
And then, one day, the dawn breaks. Combination therapy and proteases and drug cocktails break through and dramatically reduce the viral load, reducing AIDS from a death sentence to a chronic, but manageable, illness. France finally shows present-day footage of activists we’ve previously only seen in the past, letting the viewer know that they made it. However, there’s no burst of music, no jubilation. Instead, there’s a long moment of silence as he switches between their rueful faces. They talk about how they were sure this was going to happen in the 80’s, that there was no way things would drag on for ten years before the tide could be slowed. Millions died in the meantime. Celebration is impossible.
How to Survive a Plague is an ur-documentary in that it finds real human drama amongst a wide swath of history, real people doing meaningful work. It shows the effort of democracy, of citizens demanding to be paid attention to and asserting that their lives have meaning. Forces of judgment and recalcitrance are well-entrenched, but are finally beaten down by truth and righteousness, albeit at great cost. Perfectly bittersweet and deeply powerful, How to Survive a Plague is a must-watch, vital viewing about recent history that must be remembered. A
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