How to Survive a Plague by David France

How to Survive a Plague

by David France

Winner of The Green Carnation Prize for LGBTQ literature

Winner of the Lambda Literary Award for LGBT non-fiction

Shortlisted for the Wellcome Book Prize 2017

'This superbly written chronicle will stand as a towering work in its field' Sunday Times

'Inspiring, uplifting and necessary reading' - Steve Silberman author of Neurotribes, Financial Times

How to Survive a Plague by David France is the riveting, powerful and profoundly moving story of the AIDS epidemic and the grass-roots movement of activists, many of them facing their own life-or-death struggles, who grabbed the reins of scientific research to help develop the drugs that turned HIV from a mostly fatal infection to a manageable disease. Around the globe, the 15.8 million people taking anti-AIDS drugs today are alive thanks to their efforts.

Not since the publication of Randy Shilts's now classic And the Band Played On in 1987 has a book sought to measure the AIDS plague in such brutally human, intimate, and soaring terms.

Weaving together the stories of dozens of individuals, this is an insider's account of a pivotal moment in our history and one that changed the way that medical science is practised worldwide.

Reviewed by Heather on

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This book tells the story of ACT UP. This was a group founded to pressure scientists, politicians, and drug companies to increase the number of drugs being investigated for possible treatment for AIDS.

One of the main problems in the beginning, besides a lack of funding, was government scientists' insistence on doing double-blind controlled studies. They weren't wrong from a science perspective. These trials have patients in two groups. One group gets the treatment and the other gets a placebo. Neither the patient or the doctor knows who is in each group. The problem was that people with AIDS were dying so quickly that being in a placebo group for a few months, especially if you were required to go off all other medication, was basically a death sentence. There are stories of trials in this book where all the placebo group died in the course of the trial.

Without these studies to cover them from liability no one was willing to go on record and recommend using drugs off label. Doctors in the field, especially if they didn't handle many AIDS cases, then didn't know that giving a common antibiotic decreased the chances of patients dying of opportunistic pneumonia, for example. This was the leading cause of death in AIDS patients. It was almost entirely preventable and no one would officially say so.

I don't remember hearing anything good about ACT UP at the time. I only knew of them from news coverage that was always negative because of their dramatic demonstrations. What they did to change the culture of drug companies and to humanize the drug trials is amazing.

This book is a long, slow read. It is very densely packed with names and actions and committee meetings. The author was a young, gay journalist reporting on AIDS in New York at the time. It is very focused on New York. Occasionally it talks about San Francisco but you could get the sense that except for occasional mentions of Africa, that AIDS was only a New York/California problem. It is also focused primarily on white gay men. This was one of the criticisms of the drug trials. They wouldn't enroll women, people of color, or drug users. Although ACT UP seemed to give equal representation to women, those women aren't discussed much in the book with a few exceptions.This review was originally posted on Based On A True Story

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Reading updates

  • Started reading
  • 12 June, 2017: Finished reading
  • 12 June, 2017: Reviewed