When Prior shows Louis a purple lesion in the first act, the audience of 1991 knew what it meant: a death sentence, with almost no treatment, in a country whose leaders mostly preferred not to talk about it.

1981–1984: “Gay cancer”

On June 5, 1981, the CDC reported a rare pneumonia (Pneumocystis, PCP) in five young gay men in Los Angeles. Within days, doctors in New York, San Francisco and other cities reported similar cases. A month later the New York Times wrote about Kaposi’s sarcoma, a rare skin cancer, in 41 gay men. By the end of 1981, 270 cases of severe immune deficiency had been reported among gay men and 121 of those men had died. The illness was given a name, AIDS, in September 1982. By 1983 scientists knew it spread through blood and sex, not casual contact, but fear and stigma ran far ahead of the science.

1985–1986: the world of the play

In July 1985, Rock Hudson’s diagnosis became public. His death that October made AIDS impossible to ignore. Historian Randy Shilts later wrote that people commonly spoke of AIDS “before Rock Hudson and AIDS after.” A blood test now existed, but there was no treatment. A diagnosis usually meant months or a few years of opportunistic infections: pneumonia, lesions, wasting, blindness and dementia. Many hospitals and families shunned patients.

The government’s response was slow. President Reagan first mentioned AIDS publicly in September 1985 and did not give a major speech on it until May 31, 1987, by which time more than 20,000 Americans had died. Congress repeatedly gave AIDS research more money than the administration requested.

1987–1996: drugs, activism, mourning

AZT, the first HIV drug, was approved in March 1987. It was expensive and toxic, and it worked only briefly on its own. That is why, in Perestroika, Roy Cohn uses his connections to hoard a private supply, and why Belize steals some for Prior. Activists forced faster drug approvals. The AIDS Memorial Quilt turned grief into a public monument. The turning point came in 1996, when combination therapy with protease inhibitors was shown to control the virus. U.S. AIDS deaths fell by nearly half within a year.

Today

With treatment, people living with HIV can expect a near-normal lifespan, and people whose virus is suppressed to undetectable levels do not transmit it sexually. PrEP, approved in 2012, prevents infection. HIV has not been cured, and access to care remains unequal by race, income and geography, which are the same lines of injustice Belize names in the play.

ACT UP doesn’t exist yet when the play begins. It was founded about a year after the main action ends. But it was the world of the play’s first audiences. Kushner wrote Angels while ACT UP was shutting down federal agencies, and many people who saw it in 1991–93 had come straight from the meetings and the funerals.

Founding

In March 1987, Larry Kramer filled in at the last minute for an ailing Nora Ephron in a speaker series at New York’s Lesbian and Gay Community Services Center. He told the crowd that, at the current rate, many of them would be dead within a few years. He attacked GMHC, the organization he had co-founded, as too polite and too focused on services, and he asked whether they wanted a new organization devoted to political action. About 300 people returned on March 12 to create ACT UP.

Tactics

ACT UP was leaderless, run by weekly meetings and small “affinity groups,” and it was built for media attention. Members staged die-ins, chained themselves to buildings and carried tombstones and coffins. Its Treatment and Data Committee taught itself the science of drug trials well enough to negotiate with the scientists who ran them. Ann Northrop summed up the media strategy this way: “We communicate through the media, not to the media.” Its graphic identity, an upright pink triangle on black above the words SILENCE = DEATH, came from the Silence = Death Project collective and is still one of the best-known protest images in American history.

What it changed

After the 1988 FDA action, the agency shortened its drug approval process. After “Storm the NIH” in 1990, Dr. Anthony Fauci met with ACT UP’s treatment activists and the agency began including people with AIDS in research decisions. ACT UP’s Women’s Committee pushed the CDC to expand its definition of AIDS to include symptoms common in women. The model of patient activism ACT UP created, with patients at the table and science made accountable, has since been copied by movements for breast cancer, rare diseases and more.

If Angels in America is the epidemic’s great fantasia, Larry Kramer’s The Normal Heart is its great alarm bell, and Kramer himself was its loudest voice.

Born June 25, 1935, in Bridgeport, Connecticut, and educated at Yale, Kramer began as a screenwriter. He earned an Oscar nomination for adapting D.H. Lawrence’s Women in Love. As the epidemic began, he co-founded Gay Men’s Health Crisis in 1982. His confrontational style clashed with the board, and he resigned in 1983.

He poured that experience into The Normal Heart, produced by Joseph Papp at the Public Theater in April 1985. The play follows Ned Weeks, a furious writer much like Kramer, as he tries to rouse politicians, the press and his own community while his friends die. It opened six months before the time in which Angels begins. Its 2011 Broadway revival won the Tony for Best Revival, and HBO’s 2014 film won the Emmy for Outstanding Television Movie. A sequel, The Destiny of Me, followed in 1992.

In March 1987 his speech at the Gay Community Center sparked ACT UP. He kept raging for the rest of his life. At the 2011 revival of The Normal Heart, theatergoers leaving the theater found Kramer, in his seventies, handing out leaflets telling them that everything in the play had happened and that the plague was not over. Dr. Anthony Fauci, a frequent target of his attacks, said that once you got past the rhetoric, Kramer made a great deal of sense and had a heart of gold.

Kramer died of pneumonia in New York on May 27, 2020, at 84. His husband, David Webster, survived him.