‘How to Survive a Plague’: Critical Lessons for a New Era

“These are young, vibrant people, and all of a sudden, they’re being snatched.”

— Dr. Barbara Starrett, AIDS physician

Arriving home after a rough day at work, I hit the ‘play’ button on the answering machine. Among the messages were two from my closest friends, each with quivering voice, telling me to call as soon as I got home. I knew before I ever picked up the phone what they wanted to tell me. Rick was dead.

Rick wasn’t the first person I knew to die of AIDS, but he was the closest. Rick and Kathy, Barbara and Michael — we were always together in some combination. That changed after his diagnosis. Suddenly, he didn’t want to see anyone, or rather, he didn’t want anyone to see him. To see how he had wasted away, his body skeletal. To see the lesions that littered his face and arms. To see that he was going to die.

AIDS had been a public health crisis for several years before Rick got sick, so it’s easy to ask why drugs didn’t help prolong his life, especially for those who have grown up in an era when a steady regimen of drugs can hold death at bay. However, despite years of research and because of governmental inaction, there were no effective treatments for AIDS when Rick was diagnosed. It’s well-known among gay activists that it was 1987 before President Ronald Reagan mentioned the disease in a public address — nine years after the first cases of AIDS showed up. No doubt, Reagan’s sudden awareness of the issue was the result of changing perceptions of the disease, increased education, and the vigilant work of a group of men and women who formed a group called ACT UP.

ACT UP and its splinter group TAG’s truggle to make the virus a priority in both the medical and legislative communities, and their role in saving the lives of thousands by forcing the issue of drug trials, has been recorded in a recent documentary, How to Survive a Plague, a nominee for Best Documentary at this year’s Oscars and winner of several critics’ awards. It’s a frightening film, showing the ravages of AIDS up close and providing a body count as the years go by. In the time span covered in the film, 1988 — 1995, the death toll rose from 800,000 to more than eight million.

How to Survive a Plague portrays an important era in LGBT history, a time when the gay community banded together in a way that politics or prejudice could never have fostered. It was during this time that the LGBT community became a force to be reckoned with in the political and business arena. Indeed, there’s something about watching close friends, neighbors, relatives, and even acquaintances die a slow and miserable death that can move people to action.

Younger individuals don’t recall the time when AIDS was an automatic death sentence. As leading activist in ACT UP and TAG Peter Stanley noted at the time, “It’s like living in a war. All around me, friends are dropping dead.” Because our understanding of the virus was so limited, many hospitals, mortuaries, doctors, ambulances, and police would have nothing to do with AIDS patients, and it was not uncommon for them to be turned away from ERs. Years dragged on with no medical advances, and the administrations of Reagan and George H. W. Bush appeared to the LGBT communities to be indifferent to the suffering. The perception among many, including Senator Jesse Helms, was that “these people” had brought this plague on themselves, and if they would just stop being queers, then the crisis would be over.

Consequently, the documentary explains, ACT UP was formed, with the intent of forcing action through civil disobedience. Sit-ins, marches, take-overs of offices — all were fair game in the war to get someone to listen to the gay community. (Among the more outrageous acts protestors carried out was to climb Senator Helms’ house and drape it in a giant condom.) Yet, the activists didn’t just rely on rhetoric and stunts to get drug manufacturers and lawmakers to pay attention. They educated themselves and developed proposals, protocols, and procedures to expedite the approval of much needed medications. As one of the group’s leaders, Mark Harrington, recalled, “Activists created a system that was able to do everything faster, better, cheaper, more ethically, and more efficiently.” Many in ACT UP and TAG were HIV positive themselves, so their urgency was personal.

Still, How to Survive a Plague doesn’t portray these men and women as angelic presences swathed in white and a soft glow. Infighting and grandstanding, as well as differing agendas and a great deal of miscommunication, splintered the original ACT UP (AIDS Coalition to Unleash Power), driving many of its leaders to create the splinter group TAG (Treatment Action Group). The two groups’ blemishes are visible, and producers are clear that many of their tactics were ill-received. In one scene, leader Bob Rafsky is lectured by presidential candidate Bill Clinton after Rafsky’s questioning becomes loud and accusatory. At another point in the film, playwright Larry Kramer interrupts the bickering of those at a meeting with a sudden scream, “PLAGUE! PLAGUE! We are fighting a plague!”, reminding those in attendance of the larger and more important issue.

Ultimately, the film is an emotional journey, with numerous tear-inspiring moments, such as the scene of an aging mother holding the ashes of her son, ready to march alongside others carrying ashes to dump some or all of those ashes on the grounds of the Bush White House. While the images of emaciated, diseased men lying on their death beds are disturbing, it is images of their funerals, among the mourning survivors, that are perhaps the most moving.

More than anything, How to Survive a Plague‘s importance is that it reminds us of the ravages of AIDS in a time when many have forgotten or never knew how horrific this disease was and still can be. Recent trends have shown a growing indifference to the disease’s presence, allowing it to spread again, along with a host of other sexually transmitted infections. As of 2009 in the United States, gay men carried 65 percent of all cases of syphilis and 36 percent of the cases of gonorrhea, despite making up less than five percent of the population. That same year, men who have sex with men (MWM) had the largest number of new HIV infections; 61 percent of all new infections.

According to the governmental website AIDS.gov, the numbers are not encouraging for MWM. Rates of new infection are particularly high among young, black MWM, but all ages and races are affected. One million people are currently living with HIV in the US, and approximately 200,000 of them don’t even know it. The disease spreads at such a fast rate that there is a new infection every nine and a half minutes.

Nonetheless, gay porn featuring “barebacking”, anal sex without condoms, and “breeding”, ejaculating inside your partner, has grown in popularity, especially online, and numerous websites have been created for those looking for others who want to participate in such activities. It’s not unusual to see men who are negative wanting to be bred by an HIV positive partner. Again, activists are fighting back. In February of this year, the AIDS Healthcare Foundation sued gay porn giant Treasure Island to get them to stop making barebacking films.

It’s quite possible this rise in unsafe sex is due to the medical advances that have occurred over the years. The common perception is that AIDS is no longer a death sentence, just a condition to be lived with, like arthritis or diabetes. Such thinking is rosy at best. As How to Survive a Plague notes in the conclusion, still today, someone dies of AIDS every four minutes, and the main reason that they die is an inability to pay for the drugs necessary to stay alive. According to the website AIDSmap.com, the average annual cost of AIDS treatment is $19,912, a prohibitive cost even for those with insurance, as deductibles can eat up a large chunk of one’s salary. Of course, as the condition worsens, the costs increase.

How to Survive a Plague serves not only as an important historical document and exceptionally-made documentary, but also as a reminder as to why the fight against AIDS and the drive to educate the public are still so important today. Senator Helms was right in one aspect: personal behavior is the catalyst behind this disease. Before we understand what this disease was and how it spread, unsafe behavior could be more easily overlooked. Today, unsafe sex is inexcusable.

Cheers, Queers: To NFL players Chris Kluwe and Brendon Ayanbadejo, along with the Obama administration and countless others, who have filed friends of the court briefs urging the Supreme Court to allow gay marriage in California.