Managing Diabetes. Jeffrey A. Bennett
Just as diabetes was considered a death sentence for those diagnosed prior to mass-produced insulin, AIDS was generally thought to be fatal before the development of antiretroviral medications. When AIDS surfaced in the early 1980s, it was largely treated as an acute condition whose manifestations overtook the body rapidly. Because AIDS is a syndrome, and not a singular disease, people grappled with varying symptoms that were often strikingly dissimilar. Some people exhibited signs of late-stage HIV infection through Kaposi’s sarcoma (a cancer that causes abnormal tissue growth under the skin) and others dealt with rare and aggressive forms of pneumonia, among many other possibilities. Despite this perplexing character, scientists made great headway in addressing AIDS by crafting treatments that stymied the progress of HIV in the body. These breakthroughs were often attributed not only to scientists in the lab, but also to pivotal activist groups such as ACT-UP, who worked tirelessly to raise public awareness, combat government indifference, and demand funding for scientific endeavors. Consequently, as early as 1989 some in the medical community were declaring HIV a chronic condition, even though rates of death from HIV/AIDS climbed steadily through the mid-1990s.8 These medical interventions were often purposefully obstructed by opportunistic politicians who followed a path of misinformation and homophobia in place of public health strategies that actually saved lives. Efforts toward mainstream treatments were often hamstrung by officials who refused to acknowledge HIV’s ravenous effects, media representations that reinforced stereotypes, and deeply entrenched institutional maleficence. Even today, this tumultuous legacy continues to hamper prevention efforts for people of color, transgender people, and those on the lowest rungs of the socioeconomic spectrum.
Medical practitioners, scientists, and public health officials were not the only ones grappling with the dilemmas posed by AIDS. Since the beginning of the crisis, artists, scholars, and journalists had been deciphering the ways AIDS was made intelligible as a cultural referent. Thinkers such as Paula Treichler and Susan Sontag were among the many critics who sought to demystify the ways stigma was reproduced on the bodies of marginalized populations, such as LGBT people, and to chart the analogies that brought AIDS into being.9 The burgeoning field of queer studies became preoccupied with the role of HIV/AIDS as an ordering force in social movements, in the popular evolution of same-sex marriage, and in domains that ranged from the historical to the theoretical. Although there is little room here to detail the many ways that scholarship on AIDS evolved, the ideas of normativity, abjection, and moral panic came to occupy a significant place in the literature. Importantly, as the years passed, this conceptual reservoir expanded and was eventually employed to scrutinize public discourses about a range of diseases and illnesses not confined to HIV. Eve Kosofsky Sedgwick, for example, taught us much about cancer through queer lenses. Ann Cvetkovich did the same for depression.10 Entire volumes have been penned about the intersection of disabled bodies and sexuality.11 Ellis Hanson has noted that queer theory’s genealogy with AIDS suggests it was born in disability studies, signaling an activist politics indebted to rhetorical understandings of illness and disease.12 Likewise, I believe HIV’s centrality to queer theory and that canon’s focus on normativities, temporalities, subjectivities, and affects can help to illuminate the deep complexity of diabetes’s public character. I excavate this queer archive to investigate the resistance to recognizing diabetes as HIV’s contemporary medical kin. I look to three paradigms in queer studies that have been used to chart cultural connotations associated with HIV/AIDS—that of apocalyptic rhetoric, the critical exploration of paranoia, and the recent emergence of precarity.
That HIV/AIDS have been imagined as destructive and cumbersome is so well documented that it barely requires mention. The advent of AIDS catalyzed LGBT counter-publics that variously called for radicalism and institutional reform, systemic transformation, and expanded civil rights. The urgency of AIDS activism was enlivened by slogans such as “Silence = Death” and confrontational art that denounced politicians who sat idle while AIDS buried everyone in its path. The rhetorical dynamism of AIDS exerted a plasticity that supersedes its status as a medical phenomenon. It is not an overstatement to suggest that exchanges about AIDS have been no less complicated to decipher than the syndrome itself. The crisis of meaning that marked AIDS affected everything from judgments about “risky” sexual practices to the consequences of heteronormative national imaginaries. This symbolic volatility, underwritten by institutional failures and the anxieties of futures cut short, gave rise to a rhetoric of insecurity that lives on today. The deaths of thousands of people in the face of government neglect and indifference propelled a sense of despondency and impending doom for those who lived through the epidemic’s worst days.
The trope of “apocalypse” is perhaps the longest-standing figure in AIDS’s unruly mnemoscape. Apocalypse and its dialogical partner utopia are pervasive in the queer canon, operating as two sides of the same coin to mobilize LGBT publics. The pink triangle and the rainbow flag, for example, are both emblematic of LGBT movements, but it is the more obtrusive and ominous triangle that is ubiquitous in AIDS’s legacy.13 Projections of grief and uncertainty can be found in everything from public art to political manifestos to postmodern theories of identity. Focusing on ACT-UP’s imposing visual politics, Thomas Long observed the group’s provocative graphics “attempt to assess the tactical and strategic instrumentality of apocalyptic discourse” to arouse rage and action.14 Peter Dickinson took the relationship between AIDS and apocalypse as a starting point, contending, “the problem with abstract theorizing about AIDS is that it frequently lacks a subject, a body, a corpus, a corpse. This would seem to be even more the case when theorizing AIDS as apocalypse.”15 The AIDS Memorial Quilt, Tony Kushner’s polemic Angels in America, and Larry Kramer’s anthology about the early 1980s titled “Reports from the Holocaust,” all point toward apocalyptic impulses that dwelled beneath the socio-production of AIDS.16
Despite the dire nature of these predispositions, apocalyptic discourse paradoxically imparts agency to those grappling with crises. A breakdown in meaning leaves open a void to be filled, an ascription of purpose that allows people to interpret events and act on them accordingly. Scholars note that apocalyptic rhetoric energizes a feeling of control over uncertain conditions, even if this clout is figuratively fashioned in a manner that is not politically practical.17 Contemporary appropriations of apocalyptic speech rarely follow the formal characteristics born in religious genres. Rather, modern-day “secular” or “civil” forms of apocalypse are derived from historically contingent appropriations of these worldviews for addressing anxieties in the present.18 A simple phrase like “an impending sense of doom” might capture the spirit of such secular inclinations. The expression lends itself to shifting political needs (such as environmental issues or affective political attachments) more so than it does religious dogmas. Fragmented and formally displaced, tropological appropriations of apocalypse discern the malaise of traditional laws and the breakdown of social orders.19 As the voices in this chapter decrying the analogy to diabetes exhibit, the apocalyptic highlights a temporal disorientation, where the present both fails to bring the past to “utopic completion” and represents a deterioration of collective goals.20 Apocalyptic attitudes stress the dissolution of long-standing group practices and the inability to realize communal aspirations. The individuation of privately managing the body solves neither the problems presented by AIDS nor collective neglect, inciting renewed calls for vigilance and care until the epidemic recedes once and for all. As we shall see, these themes surface with regularity in comparisons to diabetes.
Advancements in retroviral therapy and access to life-saving drugs made life with HIV less cumbersome for people in positions of privilege as the millennium passed. The panic and strong motivation to combat AIDS—and with it, homophobia—heralded the feasibility of a prolonged life in what some have hailed as a post-AIDS era. No longer relegated to the margins of the polis or the shadows of scientific neglect, HIV was slowly reconfigured into a chronic condition. To be sure, plenty of barriers continued to disenfranchise those living with HIV. Draconian measures that prohibited those who were HIV-positive from entering the United States remained in place. The criminalization of people with HIV who failed to disclose their status to sex partners was (and to some extent remains) widespread. The economic realities of an incongruent and segregated healthcare system presented institutional obstacles for scores of patients. To this day, fears over HIV contamination continue to prevent men who have sex with men from donating blood.21 Still, much positive change ensued and queer critics began raising questions about the