Nick Hopkinson: 120 beats per minute—living and dying and making a difference

“What is a good life? For a start, a good life is one that goes on long enough. A short life may be good while it lasts, may be a sweet thing in the memory of others. But if it is only half the length it should have been, if it is cut down to that, it is not a good life. A good life might be as long as one you know that comes back to mind, maybe like the life of my father, who departed during his afternoon nap. It might be seventy-five years.” The moral philosopher Ted Honderich writing in “After The Terror.”

Robin Campillo’s film, 120 BPM (Beats Per Minute), is an account of shortened, heightened lives. Set at the start of the ‘90s, it follows members of the AIDS campaign group Act Up Paris. HIV treatment is rudimentary, the introduction of effective combination antiviral therapy will not occur until 1996, and the activists, most HIV positive, seem at the mercy of an unpredictable, but relentless clock. CD4 counts decline and AIDS related illnesses manifest in sequence—Kaposi’s sarcoma, PCP, toxoplasmosis, CMV, wasting, and encephalopathy. It is a disconcerting trip back in time for anyone working in healthcare then, both in terms of medicine and of attitudes—fear of needlestick injuries and of the other.

Campaigning to raise awareness, challenge attitudes, and speed up medical research, Act Up face an establishment taking only token steps, concerned to reassure mainstream society rather than protect vulnerable groups. The film is patient, allowing their discussions and debate to unfold. How best to proceed, what forms of protest will be most effective? Between the debates there is action—hurling fake blood around the offices of a pharmaceutical company which is withholding the results of its trials of a new drug; waiting until next year’s big conference while people are dying for want of treatment. Activists take their message into classrooms unannounced where schools are refusing to provide safe-sex education. Alongside campaigning zeal there’s dancing too—hence 120BPM, and the stories and loves of the campaigners are revealed.

Act-Up Paris includes and represents people who have contracted HIV from a variety of sources. As well as gay rights, there is a need to address issues of legality and marginalisation—HIV infection in prisons, through prostitution, drug use, or blood transfusions. For wider society there are always hierarchies of victims—the more or less deserving sick—see the current surge in interest in non-smoking-related lung cancer. The film demonstrates how this can both be used and challenged, the opportunities and the dangers. In one section the mother of a child infected with HIV because of treatment for his haemophilia, the most “innocent” of victims, has called publicly for the health minister to be imprisoned. Her anger is understandable, but at the weekly meeting she herself is criticised, as her statement contradicts Act Up’s campaigning to reduce incarceration. Law enforcement is harming the most marginalised groups, making them even more vulnerable. The issues are complex, conflicting, and have to be addressed.

As well as lives lived brilliantly, Campillo captures the practical, material tasks associated with lives continuing after a death—folding away the sofa-bed, coming together to drink coffee, the search for biscuits. The struggle continues, extending on to planning funerals and a scene where a campaigner’s ashes are scattered over a gala buffet for health insurers.

Finally, the film is a lesson in commitment and campaigning—the need for clear appealing messages, the way that different groups can be complementary, the need to listen to the people who you want to help.

Nicholas Hopkinson, reader in Respiratory Medicine, Imperial College London.

Competing interests: None declared.