Protesters organized by ACT UP lie in front of the New York Stock Exchange in 1989 to draw attention to the high cost of the AIDS drug AZT. (Tim Clary/Associated Press)

Rick Whitaker is author of “Assuming the Position: A Memoir of Hustling,” “The First Time I Met Frank O’Hara: Reading Gay American Writers,” and “An Honest Ghost,” a novel.

The AIDS crisis began in the summer of 1981, when a mysterious “rare and often rapidly fatal form of cancer” was reported to have afflicted 41 gay men in San Francisco and New York, eight of whom were already dead. By the end of 2012, the official count of American dead from AIDS was 658,507, with more than 100,000 from New York alone, and more than 40 million dead worldwide. In his new book, “How to Survive a Plague,” a companion to his 2012 documentary film of the same name, David France delivers a monumental punch in the gut; his book is as moving and involving as a Russian novel, with the added gravitas of shared memory from the not-distant past. It is both an intimate, searing memoir and a vivid, detailed history of ACT UP, which was one of the most effective grass-roots movements in recent American history. The activist collective began in New York in 1987 and at its peak in the early 1990s had 10,000 members in 148 chapters in 19 countries. Few activist movements have been so objectively victorious: Its efforts pushed the American government and the pharmaceutical industry to fund the research needed to tame AIDS. Its work has been an enormous success story haunted by death.

France’s cast of characters is also reminiscent of a compelling novel. There are villains, heroes and ordinary people; many of them die. Some of the heroic people are doctors, such as South African Joseph Sonnabend, a divorced bisexual in New York. From the very beginning of the plague, Sonnabend, whose office was “filled with frightened young men with a confounding array of symptoms,” fearlessly treated them and studied their symptoms. He was the first to confirm that the mysterious disease was caused by a pathogen, not a chemical (such as recreational drugs) or homosexuality itself, “a macabre suggestion being advanced in certain quarters.” A complex, melancholy man, he is one of France’s points of focus throughout.

It was under his guidance that two of his patients, both promiscuous gay men with HIV, conceived and recommended what quickly became known as safe sex. Michael Callen and Richard Berkowitz in 1983 published a pamphlet, “How to Have Sex in an Epidemic: One Approach,” which encouraged men to use condoms, those foil-wrapped oddities formerly known as “English Overcoats” and “French Letters.” At just the same time, Bobbi Campbell in San Francisco, the first person in America to come out as having AIDS, helped create “Play Fair!,” a booklet of advice for having safer gay sex. Condom use immediately skyrocketed, and the incidence of all sexually transmitted diseases, including HIV, went way down. “Gonorrhea diagnoses were down 73 percent in San Francisco and more than 50 percent in New York. By igniting a craze for safe sex, the activists on both coasts did more to save lives than anything anybody had done before. . . . It came too late for many, though. By then, more than half of all gay men in New York and San Francisco were infected [with HIV]. For them, safe sex at least offered the possibility of a return to intimacy.”

"How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS," by David France (Knopf )

Mathilde Krim, one of the founders of AmFar (a leading foundation for AIDS research), was among the first straight people to become involved in fighting the epidemic. A wealthy European married to Arthur Krim, the chairman of United Artists and then Orion Pictures, Mathilde Krim knew almost nothing about homosexuality in 1981. France describes her education in all things gay by none other than Callen and Berkowitz. Callen died of AIDS in 1993, age 38. Berkowitz was a sex worker whose specialty was being a sadistic master. “In a succession of meals near her lab, they led their very formal older student on an anthropological survey of their community’s way of life, sparing nothing. Though sometimes she nearly went lightheaded at the descriptions, Krim seemed genuinely fascinated, and was riveted especially by Berkowitz’s stories from his dungeon. ‘Oh my,’ she gasped again and again.”

Another key figure is the novelist and playwright Larry Kramer, who was among the very first to respond forcefully to the epidemic. While his voluntary work was crucial to the success of the movement, his strident personality clashed with almost everyone else’s. He quickly became notorious for singing just one note: “He wanted GMHC [Gay Men’s Health Crisis] to assume the role of stern father, telling gay men to stop having sex.” Others involved in GMHC at its inception (such as the writer Edmund White) wanted it to become the social-service organization the gay community desperately needed. Kramer, though, felt that the Red Cross and other mainstream agencies should step up and do their jobs, and he “angrily excoriated his colleagues for letting the homophobia of the social safety net go unchallenged.” France, like a novelist, ventures an interpretation of Kramer’s frustrated, angry demeanor and deep conviction of unfair neglect: “He tended to see the world as a battle between aloof parent figures and rejected children, a fixation set into motion by his own father, George, an underachieving and vindictively angry presence, who wished out loud that his gay son had never been born.”

As Randy Shilts (who died of AIDS in 1994 at 42) says in the opening pages of his 1987 book, “And the Band Played On: Politics, People, and the AIDS Epidemic” (a sad precursor to France’s book), “The bitter truth is that AIDS did not just happen to America — it was allowed to happen by an array of institutions, all of which failed to perform their appropriate tasks to safeguard the public health.” “How to Survive a Plague” argues eloquently and irrefutably that the people running government agencies — federal, state and local — were inclined to do far too little in response to a deadly disease that seemed to be afflicting only sexually active gay men in big cities. In 1984, after “thirty months of plague, a time in which 1,340 New Yorkers were diagnosed and 773 were already gone, [New York Mayor Ed] Koch had spent just $24,500 on AIDS. In the same time frame, San Francisco had allocated and spent more than $4 million on care and prevention. That gap was even more striking considering that the city by the Bay had just 12 percent of the nation’s caseload compared to New York City’s 42 percent.” Ronald Reagan, president since 1981, did not even mention AIDS in public until 1985. And, as France describes, Reagan did shockingly little to prevent the proliferation of such a deadly virus.

Thousands of activists based in New York, led by Peter Staley, Mark Harrington, Spencer Cox, Barbara Starrett, Robert Rafsky, David Barr, Derek Link and many others, pushed in imaginative, rude, loud, passionate manifestations for a reversal of deadly homophobia, treatment for AIDS, more rapid introduction of experimental drugs and an end to the plague. Their work undoubtedly saved lives; how many lives, we’ll never know. (The invaluable ACT UP Oral History Project provides access to a wide range of diverse voices on the crisis.) Though there is still no cure or vaccine, being diagnosed with HIV is no longer a death sentence, if you can afford to see a doctor and take daily meds, and we now have an effective, widely available prophylactic to prevent HIV infection. ACT UP’s rallying cry still echoes in the ears of many of us who survived those years as frightened gay men in big cities whose friends and lovers were dying heartbreakingly young: “Act up. Fight back. Fight AIDS.”

hOW TO sURVIVE A pLAGUE
The Inside Story of How Citizens and Science Tamed AIDS

By David France

Knopf. 624 pp. $30