After watching Dallas Buyers Club several years ago, I wanted to learn more about the early treatment challenges that caused people with AIDS to criticize and bypass the FDA’s slow-moving and bureaucratic drug approval process. This led me to a copy of Randy Shilts’ classic 1987 book, And the Band Played On, which covered the AIDS epidemic through 1985. I hesitated to start it, however, because of the 25+ years of subsequent developments that wouldn’t be covered, including significant advances in treatment options in the mid-90s. So when David France’s How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS showed up on the New York Times “100 Notable Books of 2016” list, I jumped on it!
David France is an investigative reporter who has been covering AIDS since the early 1980s. He moved to New York City in June 1981, immediately after graduating from college and just weeks before a headline in the July 3 New York Times proclaimed “Rare Cancer Seen in 41 Homosexuals.” This put France at a major epicenter of the epidemic from its opening days—and from the very outset of his adult life. It is this embedded perspective that gives an intense intimacy to what is also a thoroughly researched and gripping account of the gay community’s mobilization to political and scientific activism and advocacy.
Although death and dying pervade France’s narrative, there is hope and inspiration in the formation of groups like Gay Men’s Health Crisis, ACT UP, with its rallying cry of “Drugs into bodies,” and TAG (Treatment Action Group). Members with an affinity for research, though lacking scientific background and in some cases without college degrees, educated themselves on the inner workings of government health agencies like the FDA, CDC, and NIH, and became experts on immunology and virology. This allowed them to challenge and ultimately collaborate as partners with a medical establishment used to patients passively accepting whatever treatment options were prescribed. They were able to press for an accelerated drug approval process, modifications in clinical trial protocol, reductions in drug costs, and more.
France’s account traces drug development through the January 1996 annual Conference for Retroviruses and Opportunistic Infections, where breakthrough results of two clinical drug trials were reported, heralding the arrival of new treatment options supporting long term survival of people with AIDS. Finally, AIDS no longer equaled death! While this is a victorious point at which to conclude his story, a happily-ever-after ending would have been inappropriate, and France avoids one with the final words of his final chapter: “It was not over. It would never be over. But it was over.” His epilogue also bears witness to the toll the plague took on surviving activists, often in the form of depression, drug addiction, underemployment and unemployment. Not only had they lost so many friends and lovers, they were now set adrift without purpose in a life they hadn’t prepared for, because they never expect to live to see it.
Although I still plan to read Shilts’ And the Band Played On, I’m glad I started with David France’s book; it provided me with the education I was looking for, in a compelling and thorough manner. If you’re interested in this topic but don’t want to tackle a 600+ page book (either Shilts’ or France’s), you may want to consider watching the 2012 documentary written and directed by France, also titled How to Survive a Plague. It is currently available to stream on Netflix.
France, David. How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS. New York: Knopf, 2016.