David France’s How to Survive a Plague Is a Remarkable, Infuriating History of AIDS

To read How To Survive A Plague, David France’s written companion to his award-winning documentary of the same name, is to be confronted with the absolute extremes of human nature. An authoritative account of a bleak time in human history, the book spans both abject horror and radiant hope—regularly moving you to tears.

France was on the frontline of the titular plague, moving right into the hottest of hot zones, Manhattan, in 1981. The first inkling of what was to come was hidden in a New York Times article weeks after his arrival, which described a spate of rarely-diagnosed Kaposi’s sarcomas (KS) that had manifested in gay patients in Manhattan and San Francisco. Usually seen in old men of Jewish or Mediterranean descent, KS is most obvious in the purple spots it raises on the skin. In time, it would be discovered that the “gay cancer” was in fact an opportunistic infection that flourished in the face of its’ patients weakened immune systems, immune systems brought low by HIV.

The early history of the plague is confusing and infuriating from our privileged seat in the present; every misstep and incorrect scientific theory identified through hindsight feels like the machinations of a great antagonist. France traces the doctors and scientists who, after wrestling with more years, death, and theories than one can conceive, finally pinned down the villain. And in the discovery of HIV, France reveals the reason for his book’s subtitle: “The inside story of how citizens and science tamed AIDS.” It’s because AIDS was a plague where politics and pathogens both had to be battled.

Most obvious and nefarious was the homophobic reaction, which manifested in everything from attacks against victims in a violent spasm of fear to the rhetoric of Reagan’s America damning the diagnosed, declaring that they deserved death for their “degenerate” lifestyle. Jesse Helms, a GOP senator from North Carolina, held up federal AIDS funding, because he feared it would condone homosexuality. Reagan’s Press Secretary, Larry Speakes, literally laughed at the crisis. And Reagan himself would not mention AIDS publicly until 1985, by which point thousands had already died.

The enraging conclusion is that, had those thousands been straight and/or white, we’d be reading a completely different history.

In the face of mounting societal pressure, science had to act. But American and French scientists jockeying to find AIDS’ cause first ultimately delayed the reveal of HIV, which in turn held up research. A focus on the virus, at the expense of the opportunistic infections it allows, killed scores more. And the slow wheels of the pharmaceutical industry proved untenable to the HIV positive who were desperate to live.

In addition to the groundbreaking science necessary to tame AIDS—France’s subtitle word choice is apt—there arose a social movement aiming to put the patients directly in contact with the scientists, the government agencies, and the corporations who held their lives in their hands. Mobilized in the face of unimaginable fear and hostility, the AIDS activists France chronicles became more than victims. They became self-taught experts, powerful orators, and sympathetic faces. Integrated with the pharmaceutical companies and government agencies, they played a role in their own survival—perhaps the first time in history that a plague’s victims held such a crucial role.

When science and society come together, France’s history transforms from gutting tragedy to human triumph. And with each false breakthrough, life shattered, and new day, How To Survive A Plague lives up to its name, providing a blueprint for our continued existence.

In a time where it is no longer considered a death sentence per se, Plague reestablishes HIV as a ruthless pestilence which is an affront to humanity, deserving eradication. The virus penetrates and hijacks our immune system’s cells, hewing our DNA and inserting its own genetic code in a disgusting suturing which causes rapid mutation. Weakened from within, it torturously holds us open for any number of opportunistic infections; tumors grow, fungi sprout, lungs fill, people die.

But, if Plague throws the villainy of viruses and people into proper relief, it also showcases the virtues of humanity in both heart and mind. Humanity has tamed HIV, like it has other diseases, not only because of knowledge, but because of empathy. We won when we cared, and we will continue to win because we care. The lesson of How To Survive A Plague is this: Even in the face of one of the Four Horsemen, whipsawed by a particularly canny virus and our own prejudices, we can and will empathize, organize, fight, and live.

B. David Zarley is a freelance journalist, essayis, and book/art critic based in Chicago. A former book critic for The Myrtle Beach Sun News, his work can be seen in Hazlitt, Sports Illustrated, The Chicago Reader, VICE Sports, The Creators Project, Sports on Earth and New American Paintings, among numerous other publications. You can find him on Twitter or at his website.