'How to Survive a Plague': Film Review | Sundance 2012

How to Survive a Plague

U.S. Documentary Competition

A major addition to the body of work chronicling the AIDS epidemic, this is a passionate account of the hard-won breakthrough in making HIV a manageable conditon.

Words like "important" and "inspiring" tend too often to be meaninglessly attached to nonfiction filmmaking, but in the case of David France's compelling snapshot of a revolutionary period in AIDS treatment, they are amply justified.

Perhaps the most remarkable aspect of David France’s emotionally charged documentary, How to Survive a Plague, is that despite the wealth of books, films and plays dealing with AIDS, this feels like a part of the story that hasn’t yet been told — certainly not with such probing insight. Packed with fascinating interviews and stirring footage from the trenches, the film deftly shapes its information stream into a powerful drama recounting the highs and lows, setbacks and victories in the fight for an effective HIV treatment.

Picked up by IFC Films sister division Sundance Selects, France’s film is a sequel of sorts to seminal AIDS works like Larry Kramer’s The Normal Heart or Randy ShiltsAnd the Band Played On. Those and many other chronicles focus on the plague years — the discovery of the virus, the spread of the epidemic, the battle against an unresponsive government, and the decimation of the gay community in the 1980s.

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While it has considerable overlap, How to Survive a Plague is by definition of its title the next chapter. It traces the path from the dark days when AIDS was a death sentence through the protease inhibitor revolution of the mid-‘90s. That breakthrough shift from monotherapy to combination therapy brought a massive decline in AIDS-related deaths in the U.S. and transformed HIV into a manageable chronic illness.

The battle of a small New York-based group of gay activists against the FDA, the NIH and major drug companies might sound more earnest than engaging. It’s not. The film is actually an epic celebration of heroism and tenacity, and less directly, a useful template for any fledgling activist movement, demonstrating the effectiveness of inside/outside strategy. It also shows the enduring government apathy toward gay-rights issues that slowed research funding and cost so many lives.

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A journalist who has been covering AIDS since 1982, France is working on a major history of the epidemic, due from Knopf in 2013. Written by the director with his editors T. Woody Richman and Tyler H. Walk, the film was clearly a monumental research project, culling material from 700 hours of video. France’s reporting skills are impeccable. But in his first documentary, he also shows a firm grasp of narrative, giving this decade-long chronicle a driving, fluid through-line enhanced by Stuart Bogie and Luke O’Malley’s music.

The film’s visceral emotionality kicks in from the pre-titles sequence. Over the wracked, shrunken bodies of AIDS patients, talking heads and clips reveal that significant medical research remained minimal while the government stayed silent.

Realizing the need for a political voice, Kramer and others formed the frontline AIDS activist group ACT UP, who were called fascists by New York City Mayor Ed Koch, later backpedaling to “concerned citizens.” In this volatile “Silence = Death” era, doctors, journalists and protesters of all ages are shown being shoved into police vans at demonstrations while chanting, “Healthcare is a right.” Even for those familiar with this history, the footage is powerfully affecting.

The central figure here is Peter Staley, a closeted Wall Street bond trader who became HIV-positive in 1987 at age 26. Forced to go on disability and given less than two years to live, he joined ACT UP and began campaigning for increased research spending. The worldwide death count from AIDS that year was in the high 400 thousands and counting. France tracks that rapid rise into the millions with year-by-year digital displays throughout the film.

The film makes trenchant points about the unparalleled indifference shown by the American government to a major health epidemic, which remains a mark of shame on the Reagan and first Bush administrations. It seems unthinkable that despite the overwhelming human losses, in order to galvanize research and accelerate the dawdling FDA drug-approval process, an ACT UP faction “had to become scientists to some degree.”

Schooled in media relations by former network news producer Ann Northrop and guided on the medical front by retired pharmaceutical chemist Iris Long, the group changed direction. They studied virology and immunology, compiled symptom data, developed their own glossary of AIDS terminology and wrote and distributed a treatment manifesto, all while being told by Federal health institutions to butt out.

Meanwhile, the backlash against the gay community was being fueled by conservative figures like Pat Buchanan, who insisted celibacy was the solution, or Jesse Helms, blocking AIDS spending while proclaiming that decadent behavior gets what it deserves. In one of the film’s more amusing protest clips, a giant condom is stretched over Helms’ home. The disinformation campaign of the Roman Catholic Church also contributed to keep the general public unenlightened, prompting the “Stop Killing Us” occupation of St. Patrick’s Cathedral, shown in emotional footage.

But it was the shift away from rage toward science that ultimately broke the gridlock on AIDS treatment. This entailed a divisive split from the activism-oriented ACT UP core. Staley founded breakaway unit TAG (Treatment Action Group) in 1992, eventually getting them a seat at the research table where they could make sure mistakes with early drugs like the prohibitively expensive and minimally effective AZT were not repeated.

Tracking the fits and starts in the evolution of HIV treatment might have made for clinical fodder. But France has a knack of presenting even the driest and densest of information in pithily accessible terms, at one point making smart use of 3D animation to unravel the complexities of cellular biology.

One of the high points of the film is Staley’s turning-point address to the 1990 International AIDS Conference in San Francisco, giving an impassioned account of the neglectful government policy that ostracized the afflicted.

Among many other key figures whose contributions are honored here is Bob Rafsky, who famously heckled Bill Clinton on the campaign trail in 1992, prompting a shouting match that made AIDS an election issue for the first time.

Coming out at age 40 at the height of the epidemic, Rafsky wryly confesses that his most successful relationship is with his daughter, and home movies of his birthday celebrations with her and his ex-wife are lovely interludes. Rafsky delivers a searing eulogy following the funeral of an activist, forcefully underlining its dual function as a political epitaph for George H.W. Bush. Rafsky's eloquence makes the news of his death the following year even more poignant.

These individual stories stitched within a broad journalistic canvas are what make How to Survive a Plague such a rewarding experience and a vital testament to courage and endurance. AIDS has been given moving treatment in recent docs such as last year’s Sundance entry, We Were Here, or Vito, about activist and film historian Vito Russo. But there’s a big-picture view here that significantly advances the collective history.

Venue: Sundance Film Festival (U.S. Documentary Competition)
Production companies: Ninety Thousand Words, France/Tomchin, in association with Ford Foundation/JustFilms, Impact Partners, Little Punk
Director: David France
Screenwriters: David France, T. Woody Richman, Tyler H. Walk
Producer: Howard Gertler, David France
Executive producers: Joy Tomchin, Dan Cogan, Alan Getz
Directors of photography: Derek Wiesehahn
Music: Stuart Bogie, Luke O’Malley
Editors: T. Woody Richman, Tyler H. Walk
Sales: Submarine
No rating, 109 minutes