Sunday, June 24, 2012

"How to Survive a Plague": How ACT UP and TAG pressured the establishment to find effective medications for HIV

AFI Silverdocs screened the new documentary “How to Survive a Plague”, by David France (from Sundance Selects), Sunday night (the second time) in its largest auditorium in Silver Spring.  It did not sell out, but the audience was large.

The film documents how AIDS (that is, HIV infection – and I’m accepting this as medical fact) became a medically manageable disease by about 1996 because of the efforts of ACT UP  and its intellectually rebellious offshoot, TAG (the Treatment Action Group).

We know that the first anti-retroviral drugs, like AZT, were moderately effective, but tended to fail in time.  The new class of drugs, protease inhibitors, turned out to be much more effective when given in combination.
The film presents many early ACT UP activists, with footage of them as young men in the 1980s, and footage of several of them today as having survived, because of the new protocols. The most articulate is Peter Staley, along with Mark Harrington, Bill Bahlman, and attorney David Barr, as well as playwright Larry Kramer ("The Normal Heart") who gets very blunt.  Staley insisted that he expected to die of the disease, but was one of the men whose viral load went to zero a month after starting the right mix in the mid 1990s.  Protease inhibitors have probably saved six million lives, but in the US at least two million have died because they can’t afford them.  Around the developing world (Africa) it’s much worse.

At first protease inhibitors had many side effects, including muscle loss and development of fat (the "protease pot").  These side effects have become much less of a problem in recent years with fine tuning of medication (see link). 

The earlier parts of the film do delve into the moral questions.  At various points, with varying degrees of decorum, Pat Buchanan, George H. W. Bush, and Jesse Helms (whose Arlington VA home gets cuckolded) all complain that this is all the result of unwise or (religiously) immoral behavior.  On the other side, the film presents the view that a moral society cannot let people drop on the floor because of “human” actions, and makes a comparison to tobacco use (and obesity and drugs) which has a lot of attention today.

The film is also quite graphic in showing early People with AIDS, including a few patients with graphic Kaposi’s Sarcoma lesions, one of them form a notorious Geraldo Rivera 20-20 broadcast in May 1983. KS used to occur particularly in gay men, and dropped off rapidly with safer sex (in relation to other OI’s).  It is thought to be caused directly by another herpes virus, type 6, in immunocompromised persons.

I was living in Dallas in the 1980s when the epidemic broke loose, and I volunteered with the Oak Lawn Counseling Center (comparable to Whitman Walker in Washington or the Gay Men’s Health Crisis in New York).  I lost several friends, including one who made a fully recovery from KS (mysteriously) in 1986, only to relapse a year later and then pass away quickly.   You would go to buddy sessions, and see people you know show up with forearms shaved for multiple iv hookups.

The political climate got rancid in Texas in 1983, when a right wing group called “Dallas Doctors Against AIDS” tried to reinforce the sodomy law (“2106”) with a measure (“HR 2138”) to ban gays from many occupations, pre-DADT style.  Oh, and they wanted to ask.  The religious right floated hypothetical "chain letter" theories that gay men were incubating diseases that could mutate and endanger the general population -- essentially inventing horror or disaster movie scenarios.  But, according to Randy Shilts's "And the Band Played On" (which became a long HBO movie with Michael Moriarity) even Anthony Fauci (who appears a lot in this film) ran at the mouth about this once in 1983, and Robert Bazell made a similar speculation from NBC that this could happen with some other unimagined virus or "andromeda strain" (a kind of Ridley Scott or Michael Crichton scenario. But most viruses, if they become widespread, become less virulent.  Generally, viruses which are too deadly can't spread themselves well (a consideration today with novel influenzas like H5N1 which may be casually transmissible).

The official site for the film is here.  

See also review of “We Were Here”, May 8, 2011. 

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