The Lazarus Effect

Published in: January-February 2013 issue.


How to Survive a PlagueHow to Survive a Plague
Directed by David France
Public Square Films


HOW TO SURVIVE a Plague, David France’s new documentary about ACT UP (the AIDS Coalition to Unleash Power), may surprise even people who know something about the history of AIDS (on which France, a journalist, used to write for The New York Native, among other publications). Going in, one expects it to be about Larry Kramer, the man most closely associated with the organization, but it turns out to be more about people you may not have heard of: Iris Long, Ann Northrop, Garance Franke-Ruta, Jim Eigo, Gregg Bordowitz, David Barr, Bob Rafsky, Mark Harrington, and Peter Staley. Some people are in this movie because they’re still alive to tell what happened, others because they were filmed while it was happening. But then, ACT UP was always a collective, so egalitarian it became a problem—one of the issues that makes this film so interesting.

The companion documentary to this film is probably We Were Here, which dramatizes the impact of AIDS on San Francisco, but that documentary, so gentle in comparison, is composed largely of interviews with the survivors. What’s remarkable about France’s film is the amount of footage that was shot while ACT UP was happening. Its inception coincided with an America that had just taken up the video camera, so no re-enactments are necessary. Almost everything, save some interviews at the end, was recorded in real time. It’s as if the French Revolution had been filmed. The prescience and diligence of the anonymous videographers are amazing. Toward the end, the group is starting to fall apart in bickering and recrimination, and whoever is holding the camera turns it for a moment on a silent Larry Kramer, whose feelings are betrayed only by his compressed lips. A moment later, he explodes with a single word—“plague!”—followed by a jeremiad filmed in a close-up that follows his mouth, turning down bitterly after each rebuke. As dramatic is the close-up of Bob Rafsky, speaking at the funeral of an ACT UP member. (Oration, that ancient art, is a major element of this film; Rafsky even cites Pericles’ address on the Athenian dead.)

Rafsky, Harrington, and Staley are on screen more than anyone, speaking at AIDS conferences, demonstrations, interviews, meetings—and, in Rafsky’s case, at his daughter’s birthdays. The camera is on his daughter and wife even at his funeral—the one moment when the camera’s presence seems too aggressive (though everything was probably justified if it contributed to getting the message out). These were media-savvy people: Kramer had worked in the movies, Rafsky was in public relations, and Ann Northrop was a network news producer. Northrop, at one meeting, even asks the group for a catchy slogan that they can use at the upcoming demonstration at St. Patrick’s Cathedral—a sound bite that people will remember—and everyone laughs. This was Manhattan, home of public relations, television, advertising, and theater. ACT UP was theater: kiss-ins, stopping traffic, unfurling banners, forcing police to drag people away like corpses—things one saw revived with Occupy Wall Street. Look at the sets chosen for its performances—City Hall, the Stock Exchange, Saint Patrick’s Cathedral, a golf course on which President Bush was playing, the South Lawn of the White House, onto which, in a climactic scene, protestors tossed the ashes of lovers and friends who had died.

Gay men are famously supposed to be charming and polite, ingratiating and likeable (if only as a defensive mechanism), so the question arises: how did “the Best Little Boys in the World” become adepts at confrontation, accusation, demands, and anger? (“United in anger” are some of the first words we hear in the film. “We demand” is frequent, and “We’re not leaving until…” And, of course: “Act up, fight back, fight AIDS!”) The most common explanation is that people in ACT UP were HIV+ and were therefore fighting for their lives. That’s at least what got Peter Staley into the group: the conviction that he was going to die if he did nothing (though that leaves the women: what was their motivation?). There was a rumor that the men in ACT UP were taking testosterone, as if that alone could explain their belligerence. But to view this movie years later, the images of people with AIDS, skin and bones, covered with Kaposi’s Sarcoma, remain reason enough.

France skillfully alternates shots of the demonstrations with shots of the reason for them. No scene is more powerful than a totally quiet one in which someone’s hands mix and then apply lotion, lesion by lesion, to each Kaposi’s Sarcoma dotting a man’s back. This was a time when hospital staff would not bring meals into PWAs’ rooms and funeral homes refused their bodies, when Staley’s boss on Wall Street told him gay people deserved it because they took it up the ass, Pat Buchanan urged that gay school teachers be fired, and William Buckley Jr. opined that they should be tattooed; a time when people called in to ask if it was safe to ride the subway and trash bags were used to transmit the corpses. It was not a time for the Best Little Boy in the World, even though most gay people in New York did not join ACT UP. These happy—or angry—few were but a minority of gay New York, though Kramer, at the end, says what ACT UP did was the greatest thing gay people have done in this country.

This film has no voice-overs, no mellifluous narrator giving us a chronology of events in a sedative tone à la PBS, but it does, in the sequence of its clips, give us a rise and fall. It also makes clear that the core of ACT UP was the struggle for medicine—ideally a cure, or, failing that, something that would halt the progression of the disease and its horrendous effects. This turns it into the story of the Treatment Action Group (TAG), run primarily by Mark Harrington and Peter Staley, who were eventually separated from ACT UP for being “elitist.” (They were; few people understood the science.) TAG had one goal: to get medicine to people with HIV. At one point they are simply begging for a medicine that will prevent people from going blind. The first breakthrough was AZT. Five years into the plague, TAG had to admit that AZT had been a waste of time. It wasn’t until the protease inhibitors and combination therapies arrived (in 1996) that people began to feel better; and then the change was so dramatic that it was called the Lazarus Effect. Within thirty days the new medicines could make the virus undetectable.

Although a pair of scientists from the drug company Merck periodically appear on screen to explain the research, the film does little to explain who exactly came up with the antiretroviral drugs, and how they did it. While admittedly this is a movie about ACT UP and not about the history of AIDS, the turning point in the attempt to control HIV occurs off camera. However, the film does record the irony that when the cocktail finally arrived, TAG urged caution, not speed, in testing the new drugs—because of their experience with AZT. Still, the things TAG fought for—patient input, acceleration of drug trials, cooperation with people with AIDS—are now generally agreed to be the lasting legacy of ACT UP.

There were people who felt at the time that ACT UP was simply a group of divas who suddenly had a pretext for being angry; and watching the meetings, one is constantly wondering what elements composed the psychology of the people there. Was it moral or psychological anger, love of the limelight, a passion for justice, the intoxication of rebellion, or the drive to save lives? ACT UP fought on two fronts: the social and the scientific. The first brought baggage that almost sank the ship. (In one scene a reporter asks an infected man demonstrating at the NIH if the drug trial he is in contains any women or people of color—as if that’s his immediate problem.) The scientific side was obsessed with finding something that would stop HIV from replicating.

The tactics of ACT UP were bifurcated as well—what Kramer called “good cop/bad cop”—personified onscreen by Rafsky and Staley. Both men are handsome, self-possessed, and effective as public speakers. Rafsky is the emotional, angry, mournful man whose disease we watch eat him up as he gets thinner and thinner, whose Kaposi’s Sarcoma doesn’t go away, who gets into a shouting match with Bill Clinton, and who delivers a funeral oration citing Pericles and the Athenian dead. Staley is the cool, rational former bond trader who addresses the scientists at an AIDS conference in San Francisco with the controlled aim of a heat-seeking missile and gets them to stand up to show that they don’t believe the government should prevent HIV+ people from entering the U.S., and then tells them they are now all members of ACT UP (a theatrical coup no less effective for the fact that we see him discuss it with his colleagues before he takes the podium). In another scene Staley climbs onto the portico of the NIH to unfurl a banner, his head wrapped in a white bandana, looking like someone in Les Misérables. Rafsky is Callas: passionate and tragic. Staley is Sutherland: cool and precise. But it is Staley who seems to be the hero of the piece, even if he is brought down by the anti-heroic policy of the collective—the belief that ACT UP should have no heroes—the sort of Animal Farm nonsense that Orwell would have skewered and which Kramer exposes when he shouts, “ACT UP has been taken over by a lunatic fringe!”

Eventually, like the people who stormed the Bastille, ACT UP devoured its own. But film can only show externals, and the internal version of this, in all its personal and emotional and human detail—who hated whom, who loved whom, love affairs started at those meetings—awaits an oral history or book of some sort. Perhaps Kramer’s upcoming novel, The American People, or France’s history of AIDS activism, which Knopf is publishing next year, will be able to explain the scene in which a man accuses Harrington of writing nasty anonymous letters—a brief glimpse of the personal vendettas, the soap operas, that ACT UP surely contained.

Larry Kramer was one of the few people of his generation in ACT UP—most of the people at the meetings belonged to the post-clone era: New Wave, Boy Bar, off-with-the-moustache Manhattan. Where else could a young HIV+ man meet someone like himself? Near the end of the movie, when it’s all behind them, the survivors can barely talk about the experience. David Barr speaks of the problem of how to find something as—he searches for the word—“fulfilling” as ACT UP. Harrington and Staley are unable to hold back tears when they speak of the people who did not survive—the ones for whom the combination therapies came too late. Gregg Bordowitz admits to being unable to accept the fact that he has survived. There is nostalgia for more heroic days.

Yet the whole thing seems to have been about medicine—about finding the drug therapy that ended viral replication. You may have heard of Patient Zero, but in this movie we hear from one of the Merck researchers about Patient 143: the only one whose viral load did not rise again after being given the protease inhibitor they were testing. One could argue that, in the end, the reviled system (the bureaucracy, the drug companies) came through—though not in time for everyone. More than once in the film, Staley and his colleagues are asked if they expect to die before a cure is found, and they all say Yes. Only one, amazingly, was right. It’s age that gets the survivors; the contrast between heroes in their prime, and the present—veterans weeping for fallen comrades—is stark.

Anthony Fauci, head of the Centers for Disease Control, a bête noire of the group until he became its ally, voices his admiration for the expertise that Harrington and Staley showed in their recommendations and reports. Which raises the question: if the real drama here is the search for medicine, what about the rest—the zaps, the “condom” on Jesse Helms’ house, the Mass at Saint Patrick’s, the occupation of offices at the drug companies? Presumably they were the muscle with which to get the drug companies and government to do what was needed, faster. Although criticized for alienating the very people whose help it needed, taken as a whole, its decision to fight back gained gay people respect. ACT UP coincided with the “We’re here, we’re queer, get used to it” moment, when young people ditched “gay” for “queer.” It was, in a way, another generation’s Stonewall.

If the documentary becomes tedious at times, that’s because anger is tedious, sickness is tedious, dying is tedious. This was a time when there was no good news, only bad, day after day, year after year, when living in New York, as a friend said, was like living in Beirut: you never knew where the bomb was going to go off next.

ACT UP is going to be mined by future historians, museum curators, and graduate students for all sorts of things. What France’s film does is assemble what are essentially home movies that give the viewer a visceral sense of what it was like to be at the meetings and demonstrations. Of course, a film about ACT UP is not the whole history of AIDS. A shot of the Quilt, an idea from San Francisco, reminds us how its expression of grief complemented the New Yorkers’ outrage. But try—or don’t try—to imagine AIDS without ACT UP. They fought back, fought AIDS, changed medical protocols, and saved lives. Today, the film informs us at the end, there are seven companies manufacturing protease inhibitors, even though four people still die every minute worldwide because they cannot afford the drugs