The AIDS crisis in America...

How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS. By David France. Knopf; 640 pages; $30. Picador; £25.

NEWS of a fatal new disease affecting gay men first broke in 1981. But it took many years and very many deaths before the public noticed. In New York, the plague’s epicentre, a new case of AIDS was soon being diagnosed every day, yet Ed Koch, the mayor, did next to nothing to prevent its spread. According to a new book, “How to Survive a Plague”, the virus had infected 7,700 people in America by 1984 and killed 3,600, yet a question about it at a White House press conference aroused laughter. It was only in 1985, after Rock Hudson, a Hollywood star, was hospitalised with AIDS, that President Ronald Reagan publicly acknowledged the virus. But he did little to help the epidemic’s largely gay victims. In 1987, after nearly 20,000 Americans had died, he quipped: “When it comes to preventing AIDS, don’t medicine and morality teach the same lessons?”

David France’s masterful account of the epidemic offers plenty of opportunity for outrage. America’s response to this public-health crisis was one of federal neglect, bureaucratic incompetence, corporate greed and brazen prejudice. AIDS would claim over 300,000 Americans—a third of them in New York—before a pharmaceutical breakthrough in 1996 enabled the infected to lead ordinary lives. For those who have survived, Mr France writes that the betrayal of so many politicians, doctors, clergymen and family members remains “impossible to forget”.

At a time when several states still banned gay sex, many Americans saw AIDS as a punishment for sinful behaviour. Early patients were thrown out of hospitals, ignored by ambulances and locked out of their homes. Nearly every New York undertaker refused to handle the corpses. The popular press initially avoided the story; it took two years and 600 dead before the New York Times covered it on the front page. When reports became inevitable, editorials frequently castigated gay men as public-health menaces. Anti-gay hate crimes surged, rarely resulting in arrests. Gay foreigners entering the country were often quarantined and deported.

HIV, which causes AIDS, was a tenacious foe, genetically far more complex than other known retroviruses. AIDS suppressed the immune system and by 1990 one American was dying from the disease every 12 minutes, often after succumbing to a preventable infection. But even as hospitals overflowed with AIDS patients, the federal government failed to help states treat and prevent the disease, and federal research remained sluggish and disorganised. Drugs that officials called promising in 1985 had still not been tested five years later. Others that were transforming lives in off-market experiments, such as an anti-blindness drug called DHPG, still awaited clinical trials, ensuring that many AIDS patients would go blind unnecessarily. Federal officials dithered for years before issuing guidelines on treatable infections. Nine years of the country’s war on AIDS had extended the average 18-month lifespan of patients by a mere three months.

Public indifference and political ineptitude drove activists to take matters into their own hands. Gay men began circulating materials promoting “safe sex” in 1983. Condoms became popular, bath houses closed and transmission rates for all sex-related diseases slowed dramatically. Yet it would take over a decade for Washington to fund a safe-sex campaign nationally. The government’s flat-footed strategy for researching and testing new drugs and the cripplingly high costs of developing therapies spurred black-market clubs that peddled unapproved drugs by the truckload. Activists staged protests to highlight the cost of federally approved drugs, and they learned enough about virology, chemistry and immunology to propose essential drug-trial innovations. Federal and private researchers eventually took note of what they were saying. Never before had a group of patients done so much to guide the agenda of so-called experts.

As a gay man in New York during this time, Mr France buried many friends and lovers. His own story is one of those he knits together in this riveting account of the men and women who refused to surrender in the face of AIDS. Despite its grim subject, this is an inspiring book. At a time when many Americans are worried once again about the wisdom and compassion of their elected leaders, “How to Survive a Plague” offers a salient reminder of what can be achieved by citizens who remain unbowed and unbroken.