How to Survive A Plague is the best AIDS documentary I’ve seen. Why? Because it is important, yes, but so are so many other AIDS docs out this year and last, including Vito, HBO’s recent documentary about film scholar and gay activist Vito Russo, and We Were Here, 2011’s film about survivors of the AIDS crisis in San Francisco. What makes How to Survive a Plague, directed by magazine veteran David France, so distinctive is that it is almost entirely and seamlessly archival, using footage shot by many Act-Up participants as well as the occasional news images.
How to Survive A Plague shows us that not only were Act-Up—the AIDS Coalition to Unleash Power—and then the breakaway offshoot Treatment Action Group’s* members brave, articulate, and furious, they were, filmically, from the 21st century even as they documented the 1980s and ’90s.
Act-Up was a well-documented movement. Today, this level of documentation is the rule, not the exception, with YouTube political videos and countless images of unrest snapped by ordinary people and shared by their mobile devices. Act-Up’s endless visual documentation of itself by itself presaged everything from the Occupy films to cellphone videos by demonstrators of the Arab Spring.
Due to this meticulous documentation, this film can tell a coherent narrative in real time: the story of how Act-Up and Treatment Action Group struggled and triumphed, using what is called an “inside-outside” strategy. The tactic was for some tough talking, some theatrical AIDS activists to take to the streets, while the Treatment Action Group were wearing suits and talking to the FDA, congress, chemists, doctors, and pharmaceutical companies, trying to convince them all to accelerate drug funding, development, and testing. By letting images and the voices of the movement from a quarter century ago dominate How to Survive a Plague is the best representation yet of America’s most passionate and clever social justice group.
That a number of the people appearing in the film are dead makes it all the more searing and persuasive. The effect is something best expressed by Jean Cocteau: all film is a kind of “death at work.” (Steve Erickson just made that point about the film.)
As the film makes clear, Act-Up nearly single-handedly made the FDA speed up drug approval and design better clinical trials, among other accomplishments. They also lent their “inside-outside” strategy to their documentation as they recorded themselves for the history (e)books.
That’s why director France was right to stand back, edit this material, and do as little original filming as possible to let the material speak for itself. Yet he was also right, at the end, to give us the remaining participants in a forceful coda, one talking about the PTSD that has accompanied his own survival. We have watched them young, beautiful, and sometimes wasting away for over an hour, so the shock of their aged, generally healthy faces at the film’s close is heartening yet also uncanny. As someone who was a teenager then and watched the movement from a close distance, an ACT UP button pinned to my jacket, the temporal confusion is simultaneously disturbing and brilliant. Is that now or the long-ago past? What are we to make of all this?
The overall effect of the film is Greek tragedy crossed with a medical mystery. It’s also a narrative, nearly verite film, that is, perhaps inevitably, also a coming-of-age film about the activists themselves: They grow up before our eyes, on the edge of apocalypse. The film also reminds us that while the Holocaust and so many other major tragedies of the 20th century have been amply memorialized, AIDS—despite the quilt, The Normal Heart’s revival, these new documentaries, the planned memorial in Manhattan, and all the extant archival footage—has not been adequately remembered. Is it amnesia? Inequity? Or partially due to the unprocessed pain of it all for survivors that the remarkable activist Peter Staley mentions at the film’s close? The Act-Up of that time was movement, an aesthetic, and a way of being: How to Survive A Plague is one of its more worthy memorials.
*Correction: The Treatment Action Group was incorrectly called the Treatment Advocacy Group in the original version of this story.
Alissa Quart is the executive director of the Economic Hardship Reporting Project, a journalism nonprofit devoted to covering inequality. The author of five nonfiction books (including Bootstrapped (2023) and two poetry collections, she has also contributed to the New York Times, The Guardian, and the New York Review of Books, among other publications.