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Oscar Watch 'How to Survive a Plague': From a Tale of Disease, a Primer for Empowerment

Photo of Jacob Combs By Jacob Combs | Thompson on Hollywood February 6, 2013 at 2:53PM

David France didn't set out to make a film about the AIDS crisis. He didn't even set out to be a filmmaker. Speaking to me from Los Angeles on the afternoon before the Directors Guild of America Awards—for which he was nominated for his first documentary, "How to Survive a Plague"—France told me that the project (also nominated for the documentary feature Oscar) grew out of his feeling that a crucial chapter of the history of AIDS in America had been lost. That story, he knew from personal experience, was one of activism and empowerment, one that had changed the United States forever. France wanted to bring it back.

France's two central characters are Peter Staley, a former bond trader turned full-time activist, and Bob Rafsky, a PR executive who would become ACT UP's New York media coordinator. "There were people who more scientifically attuned," France told me, "who had better research minds: Spencer Cox, Mark Harrington.  But Peter brought a kind of politician's acumen.  He became the negotiator.  And Bob Rafsky was the person who always made it clear what the stakes were.  And he did it as a kind of a poet.  A poet and a politician seem to be the driving forces—for me—of what was happening at the time.  Their stories were the backbone of this narrative of AIDS treatment activism. 

As we follow these men and their community of activists, the sheer mortality that they and other AIDS sufferers felt in that time is presented with clear, un-dramatic simplicity.  At several points in the film, France includes footage of Rafsky with his daughter—first, when she is a young child, and later, when she is older and he is visibly, undeniably dying.  In several contemporary interviews throughout the film, when Staley is asked if he expects to die, he says "Yes," without a moment of hesitation.  France conveys this emotion with a sure but light hand—the film has no narration, instead letting the footage speak for itself.

"Like any war, you wonder why you came home."

But the true power of "How to Survive a Plague" is the fact that France's film is not the story of a crisis.  It is the story of the incredible humanity and empowerment that that crisis engendered in a group of people who looked squarely in the face of death and a government which refused to recognize AIDS for the public health emergency it was.  It is the story of a group of people who said, we must change this ourselves.  And in this way, it is a deeply American story—as France puts it, "a story of innovation and activism and the enfranchisement of the outsider."  Not only does this make the experience of watching "How to Survive" equal parts heartbreaking and joyful, it makes it, ultimately, deeply inspiring. 

"It was crazy, Nobel Prize-winning stuff," France told me, "brought to you by people who had never studied science."  When ACT UP began its activism, it often took up to 12 years for a drug to go from a scientist's idea to the medicine cabinet; years later, ACT UP had changed the entire experimental process, with that time period shrinking to just two years, or even six months in some cases.  Those advances—captured in this documentary—have radically transformed modern American medicine, and not just in terms of HIV and AIDS.  "Everything about the way that science and medicine are practiced," France said during our interview, "is a product of AIDS and AIDS activism. 

The ones who made it

The final image of Bob Rafsky in "How to Survive a Plague" is a newspaper photo with then-presidential candidate Bill Clinton.  During the 1992 race, it was Rafsky who made AIDS part of the campaign discussion.  He died in 1993, during the depths of the crisis.  As David Barr, one of the members of ACT UP who survived, tells France towards the end of the film in one of its few non-archival shots, "'93 to '95 were the worst years.  It was a really terrifying time.  And then we got lucky."

Barr smiles, ruefully, and then, in a reveal that is both dramatic and understated, France shows a wordless video montage of the ACT UP members featured in the film who survived the epidemic and are alive today living healthy lives with AIDS thanks to the drug therapies they themselves helped bring into reality.  (One of the activists shown in the montage, Spencer Cox, died last December in New York City.)

The final survivor is Peter Staley.  In a quiet, deeply poignant moment, he struggles to find the words to express himself before finally saying to France, "Like any war, you wonder why you came home."  But even for him, despite the great losses that he and his fellow activists endured, the story of ACT UP, it seems, is fundamentally a positive, life-affirming one.  "To be that threatened with extinction," Staley says in the film, "and to not lay down but instead to stand up and fight back—the way we did it, the humanity that we showed the world, is just mind-boggling."

For anyone coming to "How to Survive a Plague" without some previous knowledge of the period it chronicles—as I did when I watched the film—this under-stated revelation brilliantly underscores the hard-won successes that ACT UP and other AIDS activists accomplished.  Even more so, it reinforces France's central aim in making the film: it makes us aware that many of us were born into a different world because of what these activists did.

An opportunity for self-examination

Ed Koch died last week in New York City at the age of 88.  An often-irascible figure alternately maligned and revered through his three terms as mayor of New York, Koch oversaw the city's lackadaisical response to the AIDS crisis and served as the target of some of the ACT UP demonstrations shown in "How to Survive a Plague."  In the opening minutes of the film, asked at a press conference to addressP ACT UP's actions, he responds by calling them "fascists." When asked in reply whether the activists are simply exercising their rights as concerned citizens, he answers flippantly, "Fascists can be concerned citizens."

But, surprisingly, after Koch himself watched "How to Survive," he wrote a review of the film in the Westside Spirit (a tiny Upper West Side paper where he shared his views as an amateur critic) saying that the movie "should not be missed" and calling for the very activists he had railed against as mayor to be awarded the Presidential Medal of Freedom.

"For the first time, as an American culture, we might be able to swallow that history whole and call it ours."

The day after Koch's death, France penned an article for New York Magazine about the former mayor in which he wrote, "Koch's failure in AIDS should be recalled as the single-most significant aspect of his public life.  The memories of all we've lost deserve no less."

When I asked France about Koch's death—and the mammoth 5,500-word New York Times obituary of the former mayor that originally omitted any mention of AIDS and was later amended by the paper—he paused for a moment.  "I want to believe that Ed Koch began in his last months to build a bridge between his own past and what would have been the right thing to do," he told me.  "To look back and reassess what he's done.  I do believe his review of the film was part of that."

But just as important as Koch's legacy—or perhaps even more so—France maintains, is the very fact that a conversation is currently taking place around Koch's death and his response to AIDS.  "If he had died a year ago, nobody would have been asking these questions," France said.  "The journey of the film from last January has allowed AIDS to come back into the discussion and look back at that time and actually declare who the heroes were.  For the first time, as an American culture, we might be able to swallow that history whole and call it ours."

That history is not just a lesson about how to survive a plague.  It's a lesson about how to transform the world—to make it more humane, to make it more just, and to do so with abiding humanity.

This article is related to: Documentary, Academy Awards, How to Survive a Plague, Awards, Awards, Oscars, Documentaries, Interviews, Interviews

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Born and raised in Manhattan, Anne Thompson grew up going to the Thalia and The New Yorker and wound up at grad Cinema Studies at NYU. She worked at United Artists and Film Comment before heading west as that magazine's west coast editor. She wrote for the LA Weekly, Sight and Sound, Empire, The New York Times and Entertainment Weekly before serving as West Coast Editor of Premiere. She wrote for The Washington Post, The London Observer, Wired, More, and Vanity Fair, and did staff stints at The Hollywood Reporter and Variety. She eventually took her blog Thompson on Hollywood to Indiewire. She taught film criticism at USC Critical Studies, and continues to host the fall semester of “Sneak Previews” for UCLA Extension.