"How to Survive a Plague: A Film Review"

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On March 24, 1987, the radical AIDS advocacy group ACT UP (AIDS Coalition to Unleash Power) held its first action, organized largely by activists’ handing out photocopied flyers, on Wall Street and Broadway in New York City. The documentary “How to Survive a Plague,” which recently screened at the prestigious Maine International Film Festival in Waterville, Maine, chronicles the birth and growth of ACT UP and its splinter group, the Treatment Action Group. “How to Survive a Plague” focuses primarily on the work of ACT UP's New York-based activists, though the film also features actions from Toronto to DC to Kennebunkport, Maine. The film, which includes archival footage of ACT UP’s first action, is a comprehensive look at the issues confronting a group of activists facing a virus killing at rates unseen in modern history — a group of activists whom elected officials ignored, shunned or blamed for causing their own problems in the mid-to-late-1980s.

The film provides a candid look into one of the most dynamic and effective direct action and advocacy groups of modern times. While many members of ACT UP worked on the direct actions that made national news in the 1980s, a small group of activists formed a group that focused on treatments and drug trials (many underground drug trials are documented in the film). A Long Island, NY, woman with a Ph. D. (who did not originally know anyone with AIDS) met with ACT UP members and educated them about a variety of medical and drug-related issues, including how the virus replicated itself, how the drug trial process worked, and how the drugs were ultimately approved. Given that the drug-approval process could take as long as seven to ten years, and many of the activists in the group counted their life expectancy in months, a long waiting period for drug approval seemed like a death sentence. Nevertheless, the activists were determined to survive an epidemic where friends “would be at work on Thursday and be dead on Saturday,” and the force and immediacy of their determination led them to do extraordinary things.

One of the most telling (and often overlooked) details is how knowledgeable and articulate the ACT UP activists became about drug trials and approvals; a small group of activists spent so much time educating themselves about the drug trial process that they became experts. These activists frequently asked the head of the Food and Drug Administration questions about drug trials, and he often gave them incorrect answers or brushed them off with an “I don’t know.” The film documents how the activists persuaded an FDA advisory commission to reduce the amount of time required for trials of new drugs (sometimes to a period as short as six months). In 1990, the first time the International Biannual AIDS Conference was held in the U.S., ACT UP distributed a document containing its own proposed version of a national AIDS policy. When this document reached the FDA, members of the FDA were impressed by the activists’ grasp of the details of policy, in contrast to the George H. W. Bush Administration, which had no national AIDS policy of its own. (Many of the historical details of the film were captured on video shot by activists.) 

The film does an incredible job of capturing the GLTBQ culture of the late ‘80s and early ‘90s. It was an era in which hospital security guards assaulted people with AIDS, U.S. Senators spewed homophobic slurs, and there were no real legal protections for gay people in most of the United States. Two successive Republican administrations barely uttered the word “AIDS,” let alone tried to come up with a cure for an epidemic that killed more than a million people by 1991. 

In the years covered by the film, azidothymidine (AZT), the first drug to treat AIDS, was first brought to market in 1987 with a $10,000 per year price tag (the drug was later shown to be ineffective in the treatment of AIDS). ACT UP successfully protested to get the drug’s price lowered, and the price was reduced to $8,000 dollars per year. There were other victories; the researchers at Merck worked with TAG in the development of protease inhibitors, a significant step which paved the way for the more effective antiretroviral “drug cocktails” most people with HIV now use.

It’s also important to remember that the AIDS epidemic started right around the introduction of the consumer video recorder. Much of this film relies on camcorder- quality footage shot on VHS. The video was restored and looks visually stunning on the big screen. As a video geek, I would be interested to know which process was used to transfer the video footage to film. 

The film is edited beautifully, and the director, David France, was one of the first journalists to cover the AIDS crisis. Over 300 videotapes were used for the film, coming from the closets and attics of people involved in the movement and from the relatives of activists who died. The intimacy the video footage lends to the documentary cannot be understated; seeing an enraged Larry Kramer addressing activists during a disruptive meeting in which the Treatment and Drug Trial group split from the larger ACT UP was intense (the film’s title came from Kramer’s speech that day). This splinter group of elite activists went on to become the TAG, which would later be credited with spearheading major reforms both within the FDA and in the way drug trials are conducted. In 1997, the MacArthur Foundation awarded members of the TAG one of its “Genius Grants.” 

“How to Survive a Plague” is an intensely personal and authentic documentary about the early days of the AIDS epidemic, before the advent of drug cocktails. I do not think there are enough words to express how powerful and honest this film is; it’s definitely worth seeing. The film is produced by Public Square Films and has been screened at the Sundance and Silverdocs festivals. It opens nationally in theaters on September 21. 

For more information, you can visit the film’s website at www.surviveaplague.com
For more information on the film, visit its website.

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