‘How to Survive a Plague’ Has a Message for the Young: AIDS Isn’t Over

At the finale of TheWrap's awards screening series, the "Plague" filmmaker told of whittling through hundreds of hours of ACT UP footage to preserve a historical record

"How to Survive a Plague," which tells the story of how ACT UP moved the government and medical establishment to move faster on AIDS in the 1980s and '90s, is certainly being pegged as one of the front-runners in this year's non-fiction Oscar race. You could almost make a making-of documentary about the documentary that might be titled "How to Survive Whittling 800 Hours of Footage Into a Two-Hour Feature."

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"In June of 2011, we had a 13-hour cut," producer Howard Gertler said at  TheWrap's screening of the film Wednesday night at the Landmark Theatre. "It was the 'Shoah' of AIDS activism documentaries."

Director David France briefly gave thought to trying to do something longer-form for television and admitted to "an initial fantasy that I could become the Ken Burns of AIDS documentaries. But I wanted to convey the story to the largest possible audience, and a naïve audience…and that’s what feature-length films are so good at, involving you in a small narrative that tells epic truths."

In the Q&A that followed the final screening in The Wrap's awards series, France talked to TheWrap's founder and editor-in-chief Sharon Waxman about his mission statement when it came to the film's content.

"I had one rule that was hard to stick to but ultimately did, which is that we weren’t gonna use any of this vintage footage as B-roll," France said. "We weren’t going to let people reminisce from today about those days and use the images from them as just a textural backdrop for the storytelling. I wanted this story to tell itself. There are 33 different cinematographers whose work we brought in and used"—cinematographers in the loosest vintage-VHS-camera sense—"and not all of them steady of hand, as it were… 

"But we found a language, I think, in that unsteadiness that was really key in helping to convey that sense of destabilization and uncertainty, especially in the beginning third of the film, when there was very little plan and a strategy that was very vague. And as that started coming into better focus, the camerawork is better, and we see the newer generations of this old video technology coming into sharper focus. So there’s really a progression not just of the traction that the activists were getting but the traction the videographers were getting, too."

France had never made a film of any kind before, but had been "on the ground, as a journalist" when AIDS was first striking — and ACT UP was first attempting to strike back — in the early '80s. "At first I thought I wanted to kind of refresh my memory about this time," he said.  "The fact that there was such a substantial body of this witnessing record from these years made me wonder if it would be possible to tell the whole story using this footage. So I lay that out as a challenge to myself to see if I could find enough. It took three years to pull the footage together and was kind of detective's work."

Looking at the footage ACT UP had donated to the New York Public Library, he looked for other people shooting footage in the background of those shots and attempted to track them all down. In the end he came up with several thousand hours' worth of footage, about 800 hours of which was relevant to his story to bring into the editing bay.

He left out some of ACT UP's more notable incidents, like their infamous traffic-stopping Grand Central Station protest, to focus on the organization's specific attempts to intimidate drug companies and government agencies to move quicker on potentially life-saving "cures."

When France shows the film to audiences today, he finds that younger people not only have little awareness of the battles that were fought to force awareness of the epidemic, but how shocked they are to see footage of former senator Jesse Helms denouncing homosexuality as unnatural, in a way that raised few mainstream hackles in the late '80s and early '90s.

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"One of the things we’ve discovered in showing the film these past months is people under 30 can’t imagine why anyone would want to speak like that on the floor of the senate," France said. "You couldn’t imagine it today. Now Rick Santorum this week was saying goofy things, of course, and all the people who are defending the Boy Scouts’ 103-year policy of excluding gay people are saying goofy things. But they sound goofy today …Back then you thought, 'This is the steel wall between the main power center and the rest of us.'"

The awards screening circuit has made him realize the film is more of a time capsule than he knew. "The whole current modern gay or lesbian movement really grew from the crucible of AIDS. The cultural transformation of the arrival of gay and lesbian people to civic life in America has been so thorough in just 25 years… It’s not to say there’s not a ton of work to be done… When AIDS struck in 1981, there were no gay people in public life. I mean, none. We were absent from the discussion in America. We just didn’t exist."

"How to Survive a Plague" focuses on the nine-year period from when ACT UP had its first meetings to the eventual arrival at a three-drug treatment for AIDS that has saved millions of lives. Similar to "Argo," we know there's going to be a real-life happy ending after two hours of tension. But there's more at stake as France occasionally inserts an annual ticker to show the death toll rising from a few hundred thousand to tens of millions.

But the story isn't over. Waxman brought up a new, as-yet-unbought Sundance documentary, "Fire in the Blood," that could be a sequel to "Plague," as it tells how the epidemic has continued largely unabated in some African nations. And as France pointed out, it's hardly over here, either.

"Spencer Cox, one of the central figures in the film, and one of the people who did those innovations that made it possible to bring those drugs to market and save people’s lives, unfortunately didn’t survive himself," France noted. "He died about a month ago — of AIDS.

"There are still 18,000 American deaths of AIDS every year," the director said. "Because the drugs don’t work for everybody, they are hard to take, and it’s hard to keep to the regimen. The virus is wily; it can mutate in ways that make it very hard to treat. And Spencer also struggled with that psychological baggage that all of us who survived that time carry with us. He was one of the first people to start talking about this post-trauma syndrome that so many of us have suffered in ways that haven’t been recognized. That was one of his demons also. It was a really tragic loss. He died very quickly, within a few days of going to the hospital."

France admits being stunned by how little AIDS awareness exists in the youngest part of the gay population today—a failure not just to appreciate history but to plan for survival.

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"The epidemic is once again a gay epidemic in this country, and we’re not talking about that," said the filmmaker. "I think one of the things we can fairly say about this film is that it's one of the things that has begun a conversation about AIDS again in the country. How do we reach these kids? There are 55,000 AIDS transmissions in this country every year—a shocking number.And the majority of those transmissions are among young gay men under the age of 27.

"We used to say in 1990-92 that the new face of AIDS is the heterosexual population and the IV drug use community, and that was true until a number of years ago, but those numbers have gone down. [There are] Significant declines in the number of women contracting HIV. The near elimination in mother to child transmission. IV drug use is down double digits in rates of transmission. Gay men are increasing at this phenomenal pace. I just read that in Baltimore 45 percent of gay men are HIV-positive. It’s crazy.

"And we don’t know about it so much because people go on drugs, and we’re not seeing the streets full of young skeletons the way we used to. It looks different. But it's a more serious epidemic now I think because we’re not talking about it and because you can’t see it and because it kills so much more slowly now. So hopefully the film has a positive impact on that. That’s one of the reasons we made the film."