How to Survive a Plague

American journalist and filmmaker David France’s nonfiction book How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS delves into the history of the AIDS epidemic and the fearless citizen-activists who worked tirelessly to raise awareness about the disease, to advocate for more aggressive medical research, and to bring compassion and attention to the tens of thousands of innocent lives impacted by this illness. Published by Alfred A. Knopf in 2016, How to Survive a Plague is an expansion of France's 2012 documentary film of the same name, further exploring the stories featured in the film, as well as adding substantial additional material that gives readers a more in-depth look at life and death in the era of a modern plague.

Much of the book centers on the efforts of two groups of activists, ACT UP (the AIDS Coalition to Unleash Power) and TAG (the Treatment Action Group). The book opens with a reunion of ACT UP members in 2013, where the ones fortunate enough to have survived the plague assemble at a memorial service in Manhattan, united all those years ago by their shared experience of death; and, now, brought together again by the death of one of their longtime members. Looking around the room, which swells to some 500 people, most of whom are gay men, France reflects on the work they've done and the ways they've literally changed the world. Throughout the narrative, he shares his own story, which begins with his arrival in New York City in 1978—right on the cusp of the AIDS crisis.

The disease first shows up in gay men, and while it would come to impact every facet of the world population—in countries both developed and undeveloped; among the rich, poor, and everyone in between—it is thought, in the beginning, that the disease is a "gay cancer." In those early days, the condition is largely concentrated in cities with sizable gay populations, like New York, San Francisco, and Los Angeles. Occasional news reports from France's first years in the City discuss the emergence of this mysterious illness, but, for the most part, the public at large ignores it. This willful disregard turns out to be just a small taste of the monumental ways doctors, scientists, researchers, society, and even an American President (Ronald Reagan) would all eventually turn a blind eye.



Not all ignore the suffering, however. Dr. Joe Sonnabend is one of the first doctors to start researching this new disease, despite virtually no funding and no public awareness. Gay men are showing up in hospitals across the country with compromised immune systems and infectious diseases. As Dr. Sonnabend tries to figure out what's going on, the gay community—losing their partners and friends with increasing speed and frequency—rallies their own to organize and speak out for treatment, for funding, and for a little acknowledgment of the suffering that threatens to destroy an entire population. This is how ACT UP and TAG are eventually born.

The first activists' earliest campaigns center on connecting patients and their loved ones to the few social services equipped to help them. They also target sexual behavior in the gay community, advocating for safer sex practices, which seems, at the time, to be the only thing preventing the disease from spreading.

At every turn, activists—and AIDS victims, in general—encounter hostility and discrimination from an uncaring public. Hospitals refuse to admit or treat people with AIDS, and when they do, they quarantine AIDS patients in locked wards, where no nurses or doctors will visit them. The response in the larger world reflects this mindset, with people demanding quarantines for anyone with AIDS and even for the entire gay population. The situation is further enflamed by religious leaders, who proclaim AIDS to be God's punishment for the sin of homosexuality.



Activists remain focused on their goal. More and more researchers come on board; they discover that a retrovirus, which they soon call HIV, causes AIDS. When HIV develops into AIDS, the virus attacks the immune system, making a person more susceptible to contracting—and dying from—any number of different infections. The path to death is agonizing, disabling, and extremely painful. Even when the researchers release the drug AZT, half of all AIDS patients cannot tolerate its extreme side effects—which include, in some cases, blindness—and the drug is prohibitively expensive.

This prompts the official formation of ACT UP and, a few years later, TAG. They spearhead protests of government agencies, including the National Institutes of Health and the Food & Drug Administration. These agencies are staggeringly unresponsive to the AIDS crisis, and extreme protest measures are the only option left to get their attention. It takes ten-plus years of unrelenting activism and pressure—and thousands of lives lost—before the first effective medications to manage and help prevent HIV/AIDS become available. How to Survive a Plague is a tribute to the activists who never gave up and to all the people across the world impacted by AIDS—those who survived the plague and those who didn’t.