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How to Survive a Plague
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.
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.
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Displaying 1 - 4 of 4 reviews
September 11, 2025
An incredible resource and visceral firsthand account of the AIDS epidemic - many personal stories are interwoven with the fierce activism centered in 80s/90s New York that pushed science and politics forward on the matter. A wonderfully educational read.
February 25, 2025
David France’s How to Survive a Plague is a long, dense, and deeply detailed account of the AIDS crisis. While it takes commitment to get through, it’s an incredibly valuable read, covering the scientific, political, and activist battles that defined the fight against AIDS. It’s both a history lesson and an emotional rollercoaster, showcasing the determination of a marginalized community forced to save itself when the government and pharmaceutical industry failed them.
Reading Experience: A Long but Gripping Journey
I read this book during a ski trip, mostly while sitting in gondolas between runs. Despite its length, I was hooked—the pacing of historical events, the slow realization of the epidemic, and the increasing urgency as the crisis unfolded made it impossible to put down. It’s one of those books that’s exhausting but necessary.
The narrative starts with the earliest known cases in the U.S., when doctors began noticing a rise in rare conditions like Kaposi’s sarcoma (KS). Some dermatologists who had previously seen only a handful of KS cases in their entire careers suddenly found themselves diagnosing hundreds. Initially, doctors had no idea what was happening—some thought it was a type of cancer, others speculated a new form of pneumonia.
What’s terrifying is that, for a long time, no one even considered that all these cases were linked. Even when patterns started emerging—primarily affecting gay men—it took time for people to acknowledge the connection, especially since many men weren’t open about their sexuality. This slow realization was made worse by stigma and misinformation, which led to delays in both recognition and response.
The Fight for Medical Recognition and the Scientific Rivalries
One of the most frustrating aspects of the book is how medical discoveries were slowed by bureaucracy, capitalism, and ego battles. Even when doctors and researchers began identifying the mode of transmission—fluids like blood and semen—there were competing voices trying to claim credit. I don’t remember all the names, but I recall that two researchers were fighting over who had first identified HIV as the cause of AIDS. Legal disputes followed, delaying actual progress in getting treatment to patients.
Pharmaceutical companies, unsurprisingly, weren’t interested in developing AIDS treatments until they saw a financial incentive. They only began serious research when they realized there was profit to be made—either through insurance companies, government subsidies, or mass distribution. Until then, they largely ignored the crisis, further prolonging the suffering.
The selfishness of scientists was also shocking. Even those who genuinely wanted to help were often more interested in securing recognition for their work than in ensuring that treatments reached people as quickly as possible.
The Culture of Drug Experimentation
The desperation of the AIDS crisis led to a unique culture of drug experimentation. With no official treatment available, people were willing to try anything—literally anything—to stay alive. There were underground networks where people stockpiled untested medications, distributing them to others in the community.
• AZT, a cancer drug, became a major focus of trials.
• There were experimental herbal remedies, including some egg-based treatment that gained traction.
• People bootlegged their own versions of pharmaceuticals, bypassing regulatory bodies.
This created a wider culture of drug experimentation in the gay community, something that still has an impact today. While many factors contribute to higher drug use in queer spaces, this era of desperate self-medicating played a significant role in normalizing trying whatever was available.
The Role of Activism: ACT UP and the Fight for Survival
Activism was the only reason AIDS became a priority. Groups like ACT UP fought relentlessly for recognition and treatment. The book paints this activism as nothing less than war—people were fighting for their own lives, protesting, lobbying, and forcing the media and government to acknowledge the crisis.
These activist groups were incredibly effective, but also fractured. Over time, disagreements on strategy led to splinter groups, but their collective impact was undeniable. Without them, it’s likely that government action would have been delayed even further.
One of the most painful takeaways from this book is how once effective treatments were developed, the sense of community began to fade. During the height of the crisis, there was a deep sense of camaraderie—people were bonded by trauma and survival. But when the crisis eased and HIV became more manageable, that unity started to dissolve. Survivors dealt with PTSD and survivor’s guilt, while the broader queer community shifted away from the wartime mentality that had held it together.
Anthony Fauci: A Complicated Figure
Before reading this book, I thought of Anthony Fauci as a hero for queer people. He’s widely credited for eventually pushing AIDS onto the national agenda. However, the book paints a more complex picture.
• Yes, he was one of the few government figures who cared—but his scientific skepticism often slowed down treatments.
• He refused to approve experimental drugs without hard data, which, scientifically speaking, makes sense. But at the time, people were dying by the thousands and didn’t have time to wait for perfect trial results.
• He had to balance political realities, trying to secure funding under Reagan, who was completely indifferent to the epidemic.
This cautious approach meant that treatments were delayed, and while Fauci may have been acting in accordance with medical ethics, his stance felt like a lack of urgency to the people fighting for their lives.
Safe Sex Messaging and the Challenge of Prevention
Another major theme of the book is the battle over safe sex messaging. When researchers first understood how AIDS was transmitted, they had a dilemma:
• Telling gay men to stop having sex entirely wasn’t realistic.
• It would also sound homophobic, reinforcing negative stereotypes about gay men.
Instead, they took a sex-positive harm reduction approach, publishing guides that ranked sex acts by risk level:
• Anal sex without condoms = high risk.
• Oral sex = lower risk.
• Frotting and other non-penetrative acts = lowest risk.
It took years for these messages to be widely accepted, and many people resisted them out of fear, denial, or sheer exhaustion.
Another tragic part of this book was how many people deliberately avoided testing out of anxiety. Some even went as far as bug chasing, preferring to get infected so they wouldn’t have to live in fear of when it might happen.
The Racial Disparities of AIDS
While AIDS initially hit gay white men the hardest, by the 90s, queer people of color were the most vulnerable.
• They faced greater stigma within their own communities.
• They had less access to healthcare and information.
• Many were too afraid to seek help, fearing additional persecution.
This racial disparity still exists today, and the book highlights how efforts to combat AIDS became less effective once the primary affected group shifted from white men to people of color.
Final Thoughts and Next Steps
How to Survive a Plague is one of the most powerful books I’ve read. It’s not an easy read, but it’s essential. It highlights the sheer neglect, discrimination, and cruelty that allowed an entire generation to be decimated, and the sheer force of will it took to fight back.
I’m also really excited to watch the documentary, which actually came out before the book. I think it will add an even deeper layer of understanding to everything I’ve read.
Ultimately, this book proves a few things:
1. Activism saves lives. The government and pharmaceutical industry weren’t going to act until they were forced to.
2. Science is political. Research is shaped by funding, legal battles, and corporate interests.
3. Queer history is often erased. This book ensures that the AIDS crisis—and the people who fought through it—are remembered.
A long read, but worth every page.
Reading Experience: A Long but Gripping Journey
I read this book during a ski trip, mostly while sitting in gondolas between runs. Despite its length, I was hooked—the pacing of historical events, the slow realization of the epidemic, and the increasing urgency as the crisis unfolded made it impossible to put down. It’s one of those books that’s exhausting but necessary.
The narrative starts with the earliest known cases in the U.S., when doctors began noticing a rise in rare conditions like Kaposi’s sarcoma (KS). Some dermatologists who had previously seen only a handful of KS cases in their entire careers suddenly found themselves diagnosing hundreds. Initially, doctors had no idea what was happening—some thought it was a type of cancer, others speculated a new form of pneumonia.
What’s terrifying is that, for a long time, no one even considered that all these cases were linked. Even when patterns started emerging—primarily affecting gay men—it took time for people to acknowledge the connection, especially since many men weren’t open about their sexuality. This slow realization was made worse by stigma and misinformation, which led to delays in both recognition and response.
The Fight for Medical Recognition and the Scientific Rivalries
One of the most frustrating aspects of the book is how medical discoveries were slowed by bureaucracy, capitalism, and ego battles. Even when doctors and researchers began identifying the mode of transmission—fluids like blood and semen—there were competing voices trying to claim credit. I don’t remember all the names, but I recall that two researchers were fighting over who had first identified HIV as the cause of AIDS. Legal disputes followed, delaying actual progress in getting treatment to patients.
Pharmaceutical companies, unsurprisingly, weren’t interested in developing AIDS treatments until they saw a financial incentive. They only began serious research when they realized there was profit to be made—either through insurance companies, government subsidies, or mass distribution. Until then, they largely ignored the crisis, further prolonging the suffering.
The selfishness of scientists was also shocking. Even those who genuinely wanted to help were often more interested in securing recognition for their work than in ensuring that treatments reached people as quickly as possible.
The Culture of Drug Experimentation
The desperation of the AIDS crisis led to a unique culture of drug experimentation. With no official treatment available, people were willing to try anything—literally anything—to stay alive. There were underground networks where people stockpiled untested medications, distributing them to others in the community.
• AZT, a cancer drug, became a major focus of trials.
• There were experimental herbal remedies, including some egg-based treatment that gained traction.
• People bootlegged their own versions of pharmaceuticals, bypassing regulatory bodies.
This created a wider culture of drug experimentation in the gay community, something that still has an impact today. While many factors contribute to higher drug use in queer spaces, this era of desperate self-medicating played a significant role in normalizing trying whatever was available.
The Role of Activism: ACT UP and the Fight for Survival
Activism was the only reason AIDS became a priority. Groups like ACT UP fought relentlessly for recognition and treatment. The book paints this activism as nothing less than war—people were fighting for their own lives, protesting, lobbying, and forcing the media and government to acknowledge the crisis.
These activist groups were incredibly effective, but also fractured. Over time, disagreements on strategy led to splinter groups, but their collective impact was undeniable. Without them, it’s likely that government action would have been delayed even further.
One of the most painful takeaways from this book is how once effective treatments were developed, the sense of community began to fade. During the height of the crisis, there was a deep sense of camaraderie—people were bonded by trauma and survival. But when the crisis eased and HIV became more manageable, that unity started to dissolve. Survivors dealt with PTSD and survivor’s guilt, while the broader queer community shifted away from the wartime mentality that had held it together.
Anthony Fauci: A Complicated Figure
Before reading this book, I thought of Anthony Fauci as a hero for queer people. He’s widely credited for eventually pushing AIDS onto the national agenda. However, the book paints a more complex picture.
• Yes, he was one of the few government figures who cared—but his scientific skepticism often slowed down treatments.
• He refused to approve experimental drugs without hard data, which, scientifically speaking, makes sense. But at the time, people were dying by the thousands and didn’t have time to wait for perfect trial results.
• He had to balance political realities, trying to secure funding under Reagan, who was completely indifferent to the epidemic.
This cautious approach meant that treatments were delayed, and while Fauci may have been acting in accordance with medical ethics, his stance felt like a lack of urgency to the people fighting for their lives.
Safe Sex Messaging and the Challenge of Prevention
Another major theme of the book is the battle over safe sex messaging. When researchers first understood how AIDS was transmitted, they had a dilemma:
• Telling gay men to stop having sex entirely wasn’t realistic.
• It would also sound homophobic, reinforcing negative stereotypes about gay men.
Instead, they took a sex-positive harm reduction approach, publishing guides that ranked sex acts by risk level:
• Anal sex without condoms = high risk.
• Oral sex = lower risk.
• Frotting and other non-penetrative acts = lowest risk.
It took years for these messages to be widely accepted, and many people resisted them out of fear, denial, or sheer exhaustion.
Another tragic part of this book was how many people deliberately avoided testing out of anxiety. Some even went as far as bug chasing, preferring to get infected so they wouldn’t have to live in fear of when it might happen.
The Racial Disparities of AIDS
While AIDS initially hit gay white men the hardest, by the 90s, queer people of color were the most vulnerable.
• They faced greater stigma within their own communities.
• They had less access to healthcare and information.
• Many were too afraid to seek help, fearing additional persecution.
This racial disparity still exists today, and the book highlights how efforts to combat AIDS became less effective once the primary affected group shifted from white men to people of color.
Final Thoughts and Next Steps
How to Survive a Plague is one of the most powerful books I’ve read. It’s not an easy read, but it’s essential. It highlights the sheer neglect, discrimination, and cruelty that allowed an entire generation to be decimated, and the sheer force of will it took to fight back.
I’m also really excited to watch the documentary, which actually came out before the book. I think it will add an even deeper layer of understanding to everything I’ve read.
Ultimately, this book proves a few things:
1. Activism saves lives. The government and pharmaceutical industry weren’t going to act until they were forced to.
2. Science is political. Research is shaped by funding, legal battles, and corporate interests.
3. Queer history is often erased. This book ensures that the AIDS crisis—and the people who fought through it—are remembered.
A long read, but worth every page.
January 9, 2025
TLDR: A fairy tale, no pun intended. Written from the inside of the AIDS activist movement, there's lots of good information here, but the first 3/4 of the book to me read like an unbalanced fairytale wherein all activists are heroes, their crusade saintly, and the system and scientists are uncaring murderous villains. The final chapters seem to acknowledge that perhaps the scientists and medical community weren’t so wrong.
AIDS activists made incredible strides in driving positive changes to the scientific, medical, and even business, communities approach to pursuing therapeutics, conducting clinical studies, and reviewing products for regulatory approval. They brought patient engagement into all aspects of frustratingly long processes, more accurately reframing the term ‘patient’ to a ‘person living with a disease” and inventing the concept of “patient partners” in the process. As the former CSO of a health charity, I can attest that we still benefit today from their courage and actions. This book is an insider’s recounting of an important, if traumatic, period of human history.
While my professional career exposed me to more of the history of AIDS than the average reader, I nonetheless learned a great deal from France’s recounting of the story. From my vantage in a fairly tolerant region of Canada I was largely unaware of the vitriol and extreme homophobic realities faced by American gays, where homosexuality was still illegal in many places. I was also unaware of a number of the guerrilla trials that patient groups sponsored and supported as well as many of the events described in the book. So, I don’t have an issue with the facts presented in fact I applaud that side of the story. I do have an issue with the unfair and unbalanced manner in which people are portrayed. France describes activists in-depth, often with detailed insights into their personal lives, including foibles, weaknesses and warts. Not so with the scientists, doctors, and various administrators with whom the activists engage.
In the first three-quarters of the book, David France, the gay journalist from New York who lived the story recounted in How to Survive a Plague, describes an unbalanced fairytale wherein all activists are heroes and everyone who disagreed with any aspect of their crusade is a villain, and all too frequently accused of contributing to a ‘genocide’. It’s not clear to me if he is simply recounting what he saw and lived through or if he believes the portrayal of those perceived to be opposed or indifferent to the activists' campaigns are accurate. In the last quarter of the book it becomes clear that the scientific and medical communities likely took that right approach (as for example focusing on the cause of AIDS as opposed to the opportunistic infections that actually killed PWA).
Ultimately this is a story of a massive scientific and medical accomplishment described from the perspectives of the people who suffered and fought to ensure their, and their movements, survival. Most of the early activists didn't survive to witness the 'miracle'. In only three short decades, a nearly invisible disease was recognized, the infectious agent responsible identified and effective therapeutics developed. HIV infection was changed from a death sentence to a manageable chronic condition, with a cure on the horizon (in 2024).
AIDS activists made incredible strides in driving positive changes to the scientific, medical, and even business, communities approach to pursuing therapeutics, conducting clinical studies, and reviewing products for regulatory approval. They brought patient engagement into all aspects of frustratingly long processes, more accurately reframing the term ‘patient’ to a ‘person living with a disease” and inventing the concept of “patient partners” in the process. As the former CSO of a health charity, I can attest that we still benefit today from their courage and actions. This book is an insider’s recounting of an important, if traumatic, period of human history.
While my professional career exposed me to more of the history of AIDS than the average reader, I nonetheless learned a great deal from France’s recounting of the story. From my vantage in a fairly tolerant region of Canada I was largely unaware of the vitriol and extreme homophobic realities faced by American gays, where homosexuality was still illegal in many places. I was also unaware of a number of the guerrilla trials that patient groups sponsored and supported as well as many of the events described in the book. So, I don’t have an issue with the facts presented in fact I applaud that side of the story. I do have an issue with the unfair and unbalanced manner in which people are portrayed. France describes activists in-depth, often with detailed insights into their personal lives, including foibles, weaknesses and warts. Not so with the scientists, doctors, and various administrators with whom the activists engage.
In the first three-quarters of the book, David France, the gay journalist from New York who lived the story recounted in How to Survive a Plague, describes an unbalanced fairytale wherein all activists are heroes and everyone who disagreed with any aspect of their crusade is a villain, and all too frequently accused of contributing to a ‘genocide’. It’s not clear to me if he is simply recounting what he saw and lived through or if he believes the portrayal of those perceived to be opposed or indifferent to the activists' campaigns are accurate. In the last quarter of the book it becomes clear that the scientific and medical communities likely took that right approach (as for example focusing on the cause of AIDS as opposed to the opportunistic infections that actually killed PWA).
Ultimately this is a story of a massive scientific and medical accomplishment described from the perspectives of the people who suffered and fought to ensure their, and their movements, survival. Most of the early activists didn't survive to witness the 'miracle'. In only three short decades, a nearly invisible disease was recognized, the infectious agent responsible identified and effective therapeutics developed. HIV infection was changed from a death sentence to a manageable chronic condition, with a cure on the horizon (in 2024).
December 29, 2024
🌻"It was not over. It would never be over. But it was over"🌻
I have very little to say about this book, but I did want to highlight it a little as one of the few non-fiction books I've been gripped by.
The only real word I can use to describe this book is impactful, it really made me think and feel I'm ways I didn't expect. It was a heavy read, not just emotionally but intellectually too, filled with scientific terms and information, but it was all very interesting, and broken up with many examples of wonderful human connection.
You can tell my copy is well loved, it has travelled so far with me and it toon me a long time to get through it, but I don't regret a minute of it.
I would really recommend this book to anyone interested in modern history.
I have very little to say about this book, but I did want to highlight it a little as one of the few non-fiction books I've been gripped by.
The only real word I can use to describe this book is impactful, it really made me think and feel I'm ways I didn't expect. It was a heavy read, not just emotionally but intellectually too, filled with scientific terms and information, but it was all very interesting, and broken up with many examples of wonderful human connection.
You can tell my copy is well loved, it has travelled so far with me and it toon me a long time to get through it, but I don't regret a minute of it.
I would really recommend this book to anyone interested in modern history.
Displaying 1 - 4 of 4 reviews