The memorial for Aids victim Kenny Ramsauer in Central Park, New York in 1983, the first large gathering acknowledging the existence of the epidemic
The memorial for Aids victim Kenny Ramsauer in Central Park, New York in 1983, the first large gathering acknowledging the existence of the epidemic

In 1987, ominous posters suddenly appeared on walls all over New York City. Elderly Holocaust survivors may have felt a shiver of recognition seeing the depiction of a bright pink triangle against a black background, reminiscent of the symbol that homosexual prisoners were forced to wear in concentration camps to single them out for additional degradation, as Jews were compelled to wear yellow stars. The caption on these instantly iconic posters, developed by an anonymous team of graphic artists, was a chilling equation: “SILENCE = DEATH”. What was going on?

By that point in history, nearly 17,000 Americans had died of a terrifying disease that the president, Ronald Reagan, only deigned to mention in public after his famous friend Rock Hudson’s diagnosis became public. In America, the majority of those dying were gay, but the epidemic was also spreading unchecked through heterosexual populations in the developing world. Eventually, more than 35m people would die, many of them in the prime of life.

How an impossibly brave and unlikely coalition of gay activists, doctors, scientists and public health officials finally succeeded in putting the brakes on this global catastrophe is the subject of an important and powerfully written new book by David France, How to Survive a Plague. The book’s primary focus is the advocacy efforts of ACT UP (the AIDS Coalition to Unleash Power), a scrappy grassroots organisation of young cultural provocateurs who made it their business to educate themselves on the intricacies of epidemiology, molecular biology and public health policy, often while weathering their own hellstorms of opportunistic infections. At the same time, they had to wage pitched battles against a renewed onslaught of anti-gay bigotry directed at them by politicians, prominent religious figures and pundits who viewed the disease as (in the words of a National Review columnist) “retribution for a repulsive vice”.

As a writer for a gay newspaper called the New York Native that pioneered Aids coverage when even the New York Times refused to touch the subject, France was at ground zero, witnessing the first waves of inexplicable deaths first hand. Many original members of ACT UP — which was launched just weeks after the mysterious posters appeared — were his colleagues, friends and lovers. Instead of diluting the emotional force of his narrative, France’s personal perspective on the story amplifies it, particularly because his meticulously chronicled version of events is never clouded by sentimentality or petty score-settling. He is as clear-eyed about the infighting that nearly derailed ACT UP’s efforts as he is about the pomposity of figures such as researcher Robert Gallo, who waged an unseemly war with a competing scientist, Luc Montagnier, for credit for discovering the human immunodeficiency virus (HIV) that dragged on for years.

In the first years of the epidemic, death came with terrifying swiftness. One Thursday night, France writes, a young colleague at the Native “stayed out late at an Yma Sumac concert. Friday he had a fever. Sunday he was hospitalized. Wednesday he was dead.” The author learned that friends had vanished by calling them and discovering that their line had been disconnected. Other people with Aids hung on for years, riding rollercoasters of infections that clogged their lungs, disfigured their faces, sapped their vitality, stole their wits, and turned formerly glamorous gym rats into skeletons who expired in puddles of their own waste, shunned by family members horrified to learn that they were gay.

The response from the federal government was scandalous and unforgivable — a permanent blot on America’s history. Jesse Helms, the five-term Republican senator from North Carolina, personally blocked spending on Aids prevention, treatment or research for years, pontificating from the Senate floor, “We’ve got to call a spade a spade, and a perverted human being a perverted human being.” Another lawmaker circulated unfounded rumours accusing gay men of committing “blood terrorism”, intentionally infecting the nation’s blood supply.

The first question asked about Aids in a White House press conference in 1982, when 600 people were already infected, elicited a string of homophobic jibes from secretary Larry Speakes amid gales of laughter from the press corps. Only in 1987 did the president finally bestir himself to appoint a commission comprised of “a roster of figures whose lack of experience was matched by their reckless beliefs”, as France puts it. (For appointing a single openly gay researcher to the team, Reagan was immediately attacked by a fellow Republican, Senator Gordon Humphrey, who railed at the president that he “should strive at all costs to avoid sending the message to society — especially to impressionable youth — that homosexuality is simply an alternative lifestyle”.) The commission’s recommendations were ultimately ignored.

In the face of such intransigence, the members of ACT UP took to the streets to make the invisible holocaust visible. With a potent mixture of youthful élan, Wildean wit and laser-focused rage, they created media-savvy spectacles designed to put their demands for effective prophylaxis and treatments (“drugs into bodies” was the ACT UP mantra) on front pages worldwide, in an era when saying the word “gay” was still a bridge too far for most editorial boards. Furthermore, in a subculture that exalted sexual exuberance as an outward manifestation of liberation from internalised hatred, they diligently developed and promoted the protocols of behaviour that the world now knows as “safe sex”.

An expansion of France’s 2012 Academy Award-nominated documentary with the same title, How to Survive a Plague stands on its own as a more richly nuanced telling of a chain of events that forever changed medicine. With a novelist’s eye for telling details and a poet’s gift for indelible images, France describes blind patients in Aids wards “hugging walls and scraping the air to find their nurses”. Some of the most haunting passages in the book record twists of fate that delayed effective prevention and treatments for years. A young chemist at Merck who suspected early on that a class of drugs called protease inhibitors might yield promising avenues for research was killed on Pan Am Flight 103, downed by Libyan terrorists over Lockerbie, Scotland, in 1988. Years passed before other researchers went down that road again, discovering a drug that became a template for the “cocktails” that have turned HIV infection into a manageable chronic illness rather than a certain death sentence.

The Aids Memorial Quilt displayed in Washington, DC in 1996
The Aids Memorial Quilt displayed in Washington, DC in 1996

Obviously, any book in which charismatic characters are regularly introduced only to die in misery a couple of chapters later is hard to read without weeping and gasping in horror. Perhaps the most dramatic tribute to ACT UP’s legacy is that several central players in the book are still alive and thriving, using social media to organise resistance to a new administration in Washington that promises to send LGBT people back to the Dark Ages. Ultimately, the campy insouciance, strategic organising prowess, and passionate devotion to their cause of the young activists who wouldn’t quit acting up until they had forced the medical establishment to meet the needs of a stigmatised population make for inspiring, uplifting and necessary reading.

How to Survive a Plague: The Story of How Activists and Scientists Tamed AIDS, by David France, Picador RRP£25/Knopf, RRP$30, 640 pages

Steve Silberman is author of ‘Neurotribes: The Legacy of Autism and How to Think Smarter About People Who Think Differently’ (Allen & Unwin/Avery)

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