Thursday, November 24, 2016

The AIDS Fight: Andrew Sullivan on a History of the Movement

Ken Meeks, a patient with AIDS, in 1986. Credit Alon Reininger/Contact Press Images
HOW TO SURVIVE A PLAGUE
The Inside Story of How Citizens and Science Tamed AIDS

By David France
Illustrated. 640 pp. Alfred A. Knopf. $30.

A question has always hung over the reaction of gay men to the plague that terrorized and decimated them in the 1980s and 1990s: Why did they not surrender? They came of age in an era of intense stigma; and AIDS, as many Christian fundamentalists gleefully noted, appeared almost as confirmation that the wages of sin are death. They were surrounded by a culture that emphatically believed that they had asked for this, that mass death was, as National Review put it, “retribution for a repulsive vice.” How did they not entirely internalize this? Why, after a brief moment of liberation in the 1970s, did they not crawl back into the closet and die?

David France’s remarkable book tries to answer that question. It’s the prose version of France’s Oscar-nominated documentary of the same name — and somehow manages to pack all the emotional power of that film with far more granular detail and narrative force. I doubt any book on this subject will be able to match its access to the men and women who lived and died through the trauma and the personal testimony that, at times, feels so real to someone who witnessed it that I had to put this volume down and catch my breath.

Here again are the manifestations of terror: the purple cancerous lesions of Kaposi’s sarcoma, fatal when they migrated to your lungs; toxoplasmosis — a brain disease that turned 20-somethings into end-stage Alzheimer’s patients; pneumocystis carinii, which flooded your lungs until you drowned; cytomegalovirus, which led to blindness, so that young men in AIDS wards were “hugging walls and scraping the air to find their nurses”; molluscum contagiosum, covering the body in “small, barnacle-like papules” that oozed pus; peripheral neuropathy, with which a mere brush of a sheet against your skin felt like an electric shock; and cryptosporidiosis, a parasite that took over people’s gastrointestinal tract, slowly starving them to death. It’s been over a decade since those Latin nouns were household words in gay life, and reading them still traumatizes.

Here’s the emergency room at St. Vincent’s Hospital in Manhattan in 1984: “Scanning the rows I could see that every third or fourth man had ‘the Look’ — sunken cheeks, sparse hair, eyes that showed fear, shoulders that bent in pain. One, all spots and bones, balanced painfully on a pillow he’d brought along from home. Another seemed to be dozing; his head was cocked backward onto a companion’s arm, and his mouth and eyes were both wide open. The blind, like horses and snakes, don’t need to close their eyes to sleep.”


Outside the World Health Organization at the United Nations, New York, October 1987. Credit Alon Reininger/Contact Press Images

In the end, hundreds of thousands would die often agonizing deaths, disproportionately taken from a closeted and isolated minority that had, at that point, barely any contact with the broader world, let alone mainstream science or government funding. This was a time when only one funeral home in Manhattan would embalm the dead; when 20 states debated laws to quarantine or control the sick; when Bill Clinton signed a law barring any non-American with H.I.V. from entering the country (the restriction lasted until the end of 2009); when it took two years and almost 600 dead after AIDS was first detected as a unique disease for this newspaper to mention it on its front page; and when President Reagan could publicly throw back his head and laugh at a crude AIDS joke as late as 1986.

The resistance began with the strange and unaccounted-for appearance of posters on the walls and windows of New York City: the Nazis’ pink triangle inverted on a black background over the words “SILENCE = DEATH.” It grew with the small heroism of doctors like the permanently frazzled Joseph Sonnabend in Manhattan and spread slowly to gay activists who were as much at war with one another as with the disease. It took years to gain traction, but the courage of the resistance turned out, over time, to be as persistent as the virus itself. And the merit of this book is that it shows how none of this was inevitable, how it took specific, flawed individuals, of vastly different backgrounds, to help bring this plague to an end in a decade and a half.

This is not a hagiography; it’s a history and often an unsparing one. There were those, France recalls, who, desperate to maintain the sexual freedom that had given their community meaning, staggered forward in acute denial. There was the despised Larry Kramer, fresh off excoriating gay men’s sex lives in his novel “Faggots,” who bravely confronted the core problem of transmission, but who also displayed a personal viciousness that derailed the movement as much as galvanized it. There was Anthony Fauci at the National Institutes of Health, who emerges as a key figure in moving the science forward alongside activists, but whose stubborn refusal to permit an off-label prophylactic treatment for pneumonia led to countless premature deaths. Robert Gallo, the most brilliant of all the scientists trying to figure out a new retrovirus, comes across as an intellectual thief and petty egomaniac whose battle with Luc Montagnier for credit for discovering H.I.V. was a distracting sideshow. Charles Ortleb was the visionary editor of New York Native, a small magazine that for a long time was the only real source for news and information about the epidemic. The book charts his descent into conspiracy theories about African swine fever.

There are a few genuine heroes: the chain-smoking onetime punk Mark Harrington, who mastered both the science of H.I.V. and the federal bureaucracy so that spectacular protests could be backed by rigorous analyses to force the government to do better; Garance Franke-Ruta, a high school dropout who became one of the key women, along with Iris Long, in mastering treatment options and scientific data; Peter Staley, a closeted Wall Street trader, who found his life’s purpose by becoming first a radical activist and then perhaps the most important liaison between the activists and the scientific community; and most movingly, Michael Callen, an effeminate reed of a realist, who refused to be a passive observer of his own death. It was Callen who pioneered the idea of patients’ proudly controlling their own destinies and treatments. “We condemn attempts to label us as ‘victims,’ which implies defeat,” he declared as early as 1983, “and we are only occasionally ‘patients,’ which implies passivity, helplessness and dependence on the care of others. We are People With AIDS.” It was an idea that has transformed medicine since.

And what France also gets right is the narrative. This was not a long, steady march toward success. It was a contentious, sprawling, roller coaster of dashed hopes and false dawns — a mini-series where major characters suddenly die and plot twists shock. Nine years into the fight against H.I.V., the average survival time had increased from 18 months . . . to 22. As late as 1994, after more than a decade of organization and activism and research, the activists had split between centrists and radicals, and the new class of drugs, protease inhibitors, were failing in early clinical trials. Worse, the deaths climbed in numbers year after year. AIDS was not an early crisis that finally abated; it was a slowly building mass death experience. The year with the most corpses in America was 1995. The darkest night really was just before the dawn.

You wonder, of course, how many of those deaths could have been avoided. France makes a strong case for the staggering insouciance of government at all levels, especially in the early years. He’s brutal about bureaucratic incompetence and political cowardice. And yet he is also fair enough to show that the science of disabling a dazzlingly resilient retrovirus was fiendishly difficult and that by 1982, 42.6 percent of gay men in San Francisco and 26.8 percent of gay men in New York had already been infected. The community’s own adoption of safer sex — and the vital gains activists made in pushing for cures and treatments for various opportunistic infections — made the most difference in preventing further catastrophe. But in the end, science takes time. Some made it over the line before the war ended. Many never made it. Some of us live lives still haunted by that distinction.

And what lingers in France’s book is the toll that memory took and still takes. These young men both witnessed their friends and lovers dying excruciating deaths, knew that they were next and yet carried on. Some of this was a gut-level human desire to live; some was a means to compensate for the grief that would otherwise overwhelm them; but a lot was simple, indelible courage. This courage didn’t just end a plague; it revolutionized medicine and, in turn, became the indispensable moral force that led, as the plague abated, to the greatest civil rights revolution of our time. This is the first and best history of this courage, and a reminder that if gay life and culture flourish for a thousand years, people will still say, “This was their finest hour.”


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