Cover image for How to survive a plague : the inside story of how citizens and science tamed AIDS / David France.
How to survive a plague : the inside story of how citizens and science tamed AIDS / David France.
Hardcover edition.
Publication Information:
Toronto : Signal/McClelland & Stewart, 2016.

Physical Description:
x, 624 pages, 16 unnumbered pages of plates : illustrations (some colour) ; 25 cm
Corporate Subject:


Library Branch
Call Number
Material Type
Home Location
1 Bob Harkins Branch 362.1969792 FRA Book Adult General Collection

On Order



One of The New York Times "100 Notable Books of 2016"

KOBO "Best of the Year"

From the creator of the seminal documentary of the same name, an Oscar finalist, the definitive history of the successful battle to halt the AIDS epidemic, and the powerful, heroic stories of the gay activists who refused to die without a fight.

Shortly after David France arrived in New York in 1978, the newspaper articles announcing a new cancer specific to gay men seemed more a jab at his new community than a genuine warning. Just three years later, he was reporting on the first signs of what would become an epidemic.
Intimately reported, suspenseful, devastating, and finally, inspiring, this is the story of the men and women who watched their friends and lovers fall, ignored by public officials, religious leaders, and the nation at large. Confronted with shame and hatred, they chose to fight, starting protests, rallying a diverse community that had just begun to taste liberation in order to demand their right to live. We witness the founding of ACT UP and TAG (Treatment Action Group), the rise of an underground drug market in opposition to the prohibitively expensive (and sometimes toxic) AZT, and the gradual movement toward a lifesaving medical breakthrough. Throughout, France's unparalleled access to this community immerses us in the lives of extraordinary characters, including the closeted Wall Street trader turned activist; the prominent NIH immunologist with a contentious but enduring relationship with ACT UP; the French high school dropout who finds purpose battling pharmaceutical giants in New York; and the South African physician who helped establish the first officially recognized buyers' club at the height of the epidemic.
Expansive yet richly detailed, How to Survive a Plague is an insider's account of a pivotal moment in the history of civil rights.

Author Notes

David France is the author of Our Fathers , a book about the Catholic Church's sexual abuse scandal, which Showtime adapted for film. He co-authored The Confession with former New Jersey governor Jim McGreevey. He is a contributing editor for New York , and has also written for The New York Times . His documentary film, How to Survive a Plague , was an Oscar finalist and won two Emmys, a Directors Guild Award, and a Peabody Award, among other accolades. The author lives in New York City.

Reviews 3

Publisher's Weekly Review

Journalist France (Our Fathers) illuminates the origins and progress of the fight against AIDS in this moving mix of memoir and reportage, a companion book to his eponymous Academy Award-nominated 2012 documentary. He covers a revolution in drug development that occurred as patients, for the first time, "joined in the search for their own salvation." France begins in 1981, when a buried New York Times story first identified a "Rare Cancer Seen in 41 Homosexuals," and continues through 1996, when a medical system transformed by activism delivered treatments that rendered AIDS a manageable illness. He juxtaposes his personal involvement with that of a group of self-proclaimed "HIVIPs," key ACT UP leaders from their Treatment + Data Committee whose collective mission was getting the medical establishment to put "drugs into bodies." Eventually, ACT UP became unwieldy and the group spun-off into the Treatment Action Group. France shares with passion and pathos the personal battles of these activists, offering both plaudits and opprobrium to an array of players who constituted the fabric of the community. As important as Randy Shilts's And the Band Played On was in 1987, France's work is a must-read for a new generation of empowered patients, informed medical practitioners, and challenged caregivers-lest history repeat itself. (Dec.) © Copyright PWxyz, LLC. All rights reserved.

New York Review of Books Review

A question has always hung over the reaction of gay men to the plague that terrorized and decimated them in the 1980s and 1990s: Why did they not surrender? They came of age in an era of intense stigma; and AIDS, as many Christian fundamentalists gleefully noted, appeared almost as confirmation that the wages of sin are death. They were surrounded by a culture that emphatically believed that they had asked for this, that mass death was, as National Review put it, "retribution for a repulsive vice." How did they not entirely internalize this? Why, after a brief moment of liberation in the 1970s, did they not crawl back into the closet and die? David France's remarkable book tries to answer that question. It's the prose version of France's Oscar-nominated documentary of the same name - and somehow manages to pack all the emotional power of that film with far more granular detail and narrative force. I doubt any book on this subject will be able to match its access to the men and women who lived and died through the trauma and the personal testimony that, at times, feels so real to someone who witnessed it that I had to put this volume down and catch my breath. Here again are the manifestations of terror: the purple cancerous lesions of Kaposi's sarcoma, fatal when they migrated to your lungs; toxoplasmosis - a brain disease that turned 20-somethings into end-stage Alzheimer's patients; pneumo-cystis carinii, which flooded your lungs until you drowned; cytomegalovirus, which led to blindness, so that young men in AIDS wards were "hugging walls and scraping the air to find their nurses" ; mol-luscum contagiosum, covering the body in "small, barnacle-like papules" that oozed pus; peripheral neuropathy, with which a mere brush of a sheet against your skin felt like an electric shock; and cryptosporidiosis, a parasite that took over people's gastrointestinal tract, slowly starving them to death. It's been over a decade since those Latin nouns were household words in gay life, and reading them still traumatizes. Here's the emergency room at St. Vincent's Hospital in Manhattan in 1984: "Scanning the rows I could see that every third or fourth man had 'the Look' - sunken cheeks, sparse hair, eyes that showed fear, shoulders that bent in pain. One, all spots and bones, balanced painfully on a pillow he'd brought along from home. Another seemed to be dozing; his head was cocked backward onto a companion's arm, and his mouth and eyes were both wide open. The blind, like horses and snakes, don't need to close their eyes to sleep." In the end, hundreds of thousands would die often agonizing deaths, disproportionately taken from a closeted and isolated minority that had, at that point, barely any contact with the broader world, let alone mainstream science or government funding. This was a time when only one funeral home in Manhattan would embalm the dead; when 20 states debated laws to quarantine or control the sick; when Bill Clinton signed a law barring any non-American with H.I.V. from entering the country (the restriction lasted until the end of 2009); when it took two years and almost 600 dead after AIDS was first detected as a unique disease for this newspaper to mention it on its front page; and when President Reagan could publicly throw back his head and laugh at a crude AIDS joke as late as 1986. The resistance began with the strange and unaccounted-for appearance of posters on the walls and windows of New York City: the Nazis' pink triangle inverted on a black background over the words "SILENCE = death." It grew with the small heroism of doctors like the permanently frazzled Joseph Sonnabend in Manhattan and spread slowly to gay activists who were as much at war with one another as with the disease. It took years to gain traction, but the courage of the resistance turned out, over time, to be as persistent as the virus itself. And the merit of this book is that it shows how none of this was inevitable, how it took specific, flawed individuals, of vastly different backgrounds, to help bring this plague to an end in a decade and a half. This is not a hagiography; it's a history and often an unsparing one. There were those, France recalls, who, desperate to maintain the sexual freedom that had given their community meaning, staggered forward in acute denial. There was the despised Larry Kramer, fresh off excoriating gay men's sex lives in his novel "Faggots," who bravely confronted the core problem of transmission, but who also displayed a personal viciousness that derailed the movement as much as galvanized it. There was Anthony Fauci at the National Institutes of Health, who emerges as a key figure in moving the science forward alongside activists, but whose stubborn refusal to permit an off-label prophylactic treatment for pneumonia led to countless premature deaths . Robert Gallo, the most brilliant of all the scientists trying to figure out a new retrovirus, comes across as an intellectual thief and petty egomaniac whose battle with Luc Montagnier for credit for discovering H.I.V. was a distracting sideshow. Charles Ortleb was the visionary editor of New York Native, a small magazine that for a long time was the only real source for news and information about the epidemic. The book charts his descent into conspiracy theories about African swine fever. There are a few genuine heroes: the chain-smoking onetime punk Mark Harrington, who mastered both the science of H.I.V. and the federal bureaucracy so that spectacular protests could be backed by rigorous analyses to force the government to do better; Garance Franke-Ruta, a high school dropout who became one of the key women, along with Iris Long, in mastering treatment options and scientific data; Peter Staley, a closeted Wall Street trader, who found his life's purpose by becoming first a radical activist and then perhaps the most important liaison between the activists and the scientific community; and most movingly, Michael Callen, an effeminate reed of a realist, who refused to be a passive observer of his own death. It was Callen who pioneered the idea of patients' proudly controlling their own destinies and treatments. "We condemn attempts to label us as 'victims,' which implies defeat," he declared as early as 1983, "and we are only occasionally 'patients,' which implies passivity, helplessness and dependence on the care of others. We are People With AIDS." It was an idea that has transformed medicine since. And what France also gets right is the narrative. This was not a long, steady march toward success. It was a contentious, sprawling, roller coaster of dashed hopes and false dawns - a mini-series where major characters suddenly die and plot twists shock. Nine years into the fight against H.I.V., the average survival time had increased from 18 months . . . to 22. As late as 1994, after more than a decade of organization and activism and research, the activists had split between centrists and radicals, and the new class of drugs, protease inhibitors, were failing in early clinical trials. Worse, the deaths climbed in numbers year after year. AIDS was not an early crisis that finally abated; it was a slowly building mass death experience. The year with the most corpses in America was 1995. The darkest night really was just before the dawn. You wonder, of course, how many of those deaths could have been avoided. France makes a strong case for the staggering insouciance of government at all levels, especially in the early years. He's brutal about bureaucratic incompetence and political cowardice. And yet he is also fair enough to show that the science of disabling a dazzlingly resilient retrovirus was fiendishly difficult and that by 1982, 42.6 percent of gay men in San Francisco and 26.8 percent of gay men in New York had already been infected. The community's own adoption of safer sex - and the vital gains activists made in pushing for cures and treatments for various opportunistic infections - made the most difference in preventing further catastrophe. But in the end, science takes time. Some made it over the line before the war ended. Many never made it. Some of us live lives still haunted by that distinction. And what lingers in France's book is the toll that memory took and still takes. These young men both witnessed their friends and lovers dying excruciating deaths, knew that they were next and yet carried on. Some of this was a gut-level human desire to live; some was a means to compensate for the grief that would otherwise overwhelm them; but a lot was simple, indelible courage. This courage didn't just end a plague; it revolutionized medicine and, in turn, became the indispensable moral force that led, as the plague abated, to the greatest civil rights revolution of our time. This is the first and best history of this courage, and a reminder that if gay life and culture flourish for a thousand years people will still say, "This was their finest hour." ? The resistance began with unaccounted-for posters declaring 'SILENCE = DEATH.' Andrew Sullivan is a contributing writer for New York magazine and the author of the memoir "Love Undetectable: Notes on Friendship, Sex and Survival."

Library Journal Review

Prepare to have your heart buoyed and broken in this riveting account of the response to the AIDS epidemic that's as educational as it is difficult to put down. Based on thorough research and the author's own experience as a gay man and a reporter in New York when the disease emerged, this book presents the fear, hope, and civil rights struggles of the 1980s and 1990s. In unflinching, brutally honest detail, France traces the lives of the people behind the constellations of aid and advocacy movements and presents their struggles in a way that will have readers stirred by each diagnosis, cheering the efforts to find a cure, and growing frustrated at the political establishments that ignored the terrible tragedy as it unfolded. Readers will learn of the medical efforts, the clashes of personalities within groups such as the Gay Men's Health Crisis, and the people who raised awareness of a disease that would claim hundreds of thousands of lives. -VERDICT This highly engaging account is a must-read for anyone interested in epidemiology, civil rights, gay rights, public health, and American history. [See Prepub Alert, 5/23/16; see "Editors' Fall Picks," p. 30.]-Susanne Caro, Univ. of Montana Lib., Missoula © Copyright 2016. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

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