Dallas Buyers Club – review

"Screw the FDA, I'm a DOA!" With a deadly virus in his body and red tape around his throat, Ron Woodroof is fighting back. "This is a drama of entrepreneurial self-help from the Reaganite 1980s – based on a true story – about a heterosexual good ol' boy in Dallas, Texas, with what no one identifies as a sex addiction. That had yet to be invented, and it has in any case here been superseded by another diagnosis.

Ron is told in 1986 that he has Aids and has 30 days to live, but defies the odds, gives the finger to the complacent doctors and the AZT merchants of Big Pharma, and, like Erin Brockovich in a later era, knuckles down to some research, finding alternative drug therapies in foreign countries – no mean feat in that pre‑internet era. Soon, Ron has set up a buyers' club, niftily sidestepping US Food and Drug Administration (FDA) rules about drug‑selling by getting HIV/Aids patients to pay for "membership" in which imported medicines are notionally free. He makes common cause with the gay guys he used to hate, and this former scallywag becomes an inspirational figure, breaking down the ignorance and general homophobia thereabouts – his own included.

Matthew McConaughey gives a barnstormer of a performance as Ron himself, one in which the weight-loss is the least interesting aspect. With the stetson, unattractive centre-parting, aviator sunglasses and moustache, he is a new version of the Marlboro-Man-with-cancer. His Ron is ornery – and smug with it. He makes good money as an oilfield electrician and spends a great deal on cocaine and prostitutes and not a lot on fixing up his place, which is hardly better than a trailer. His real passion is the rodeo, and he hangs around there a great deal, sometimes even going out into the ring himself.

I still can't be sure exactly how overt, or even intentional the "bare-backing" analogy in the rodeo scenes actually is. In the first few minutes, we see rangy cowboys bucking and thrashing and hollering on the great beasts, while in a shady recess under the bleachers, Ron is bucking and thrashing and hollering with two women. The guys on the bulls aren't using saddles and neither, in this elusive metaphorical sense, is Ron. Yet there is an important way in which this film does not want to stigmatise such a patriotic tradition as unhealthy, and in fact, the final, sentimental image is of Ron at the rodeo, defiantly holding on for dear life. Perhaps that is the analogy we are expected to absorb.

Well, as soon as Ron comes to terms with the fact that straights can get Aids, too, and that his sense of identity will not therefore be infected, he snaps into action. First he buys black-market AZT from a crooked hospital porter, until it runs out and he realises that in any case this brutal chemo is causing more problems than it fails to solve. Ron grasps something that the doctors don't: symptom-management is a greater priority, and he journeys far afield to investigate foreign drug treatments that the lazy FDA can't or won't look into. In hospital, Ron has a grumpy meet-cute with transgender woman Rayon (Jared Leto), who is witty and wise in the cage‑aux-folles style, and whose connections allow Ron to hook up with potential "club" members. The movie is partly about their Non‑Brokeback Bromance.

Politically, Dallas Buyers Club looks pretty conservative, and veterans of the Act Up campaign may not be delighted by this story of a straight man riding to the rescue of gays, and also exerting himself to make America feel good about itself. He has a fierce capitalist ethic: the second word in the title is the clue.

The film is also very much in favour of abstinence: Ron refrains from sexual activity after he accepts his diagnosis – except for one woman who has "full-blown Aids" – and his romantic interest with a doctor (Jennifer Garner) is of course entirely platonic. The idea of safe sex for people with HIV is not discussed, and it is unusual for a movie on this subject to avoid the subject of condoms so entirely.

But what is striking about the film is its lack of parochialism. Evidently, Ron is not one of the majority of Americans without passports. He travels to Mexico, Holland, Israel and Japan, and discovers that these places actually know something America doesn't. They have something to teach him, and Ron learns – and passes it on. Like a Gary Cooper in the era of sexual crisis, McConaughey hits a very sure stride.