Managing Diabetes. Jeffrey A. Bennett
of HIV and diabetes is routine both in medical vernacular and in internet comment sections, appearing in academic journals, news reports, and scattered throughout popular culture. The connection between the two surfaces in vastly divergent contexts, ranging from debates over immigration policy and HIV status to the morality of bareback porn.35 Typically, these comparisons are made casually, as when Marie Browne of the Straight and Narrow Medical Day Care noted, “I think the (US government) looks at HIV like diabetes.”36 The parallels are not entirely unwarranted from a medical perspective, as ongoing studies are finding unusual links between the conditions. Some HIV medications have been suspected of initiating type 2 diabetes by killing islet cells, and some drugs spark weight gain, inevitably leading to increased incidences of diabetes. The two diseases also share some consequences if left untreated. Each can lead to the deterioration of the retina and to kidney damage and can cause peripheral neuropathy. Comparisons between the two diseases in medicine are frequent, as more studies are examining the concurrent complications of HIV and diabetes in the United States and abroad.37 My own endocrinologist has told me that she participates in meetings about the commonalities between HIV and diabetes.
I am not invested here in affirming or negating the viability of the analogy in all instances. In a Foucauldian sense, this discourse is neither wholly regulatory nor entirely liberating. Rather, this portion of the analysis is concerned with the uptake of the analogy to explore the anxieties that surface when diabetes is employed to impart agency to people who are HIV-positive. Those who dismiss the analogy believe management is exclusive to conditions like diabetes, but usually in ways that misunderstand the consequences of glucose irregularities. Even those who embrace the analogy and welcome the reparative potential of the affiliation can oversimplify the ease of diabetes care. I locate fragments of this discourse to discern how the analogy circulates among publics invested in HIV awareness. Those most protective of HIV’s unique status stress visions of injurious subjects and paranoid predispositions about medicine, politics, and technology. There is no singular text that best illuminates the ongoing relationship between HIV and diabetes. As such, following the work of scholars such as Bonnie Dow, I take it as a necessity to understand texts and contexts, in this specific case study, as “created, not discovered.”38
More often than not, people uncomfortable with the association expel outright the analogy between HIV and diabetes. Critics reject the intricacies of analogical reasoning and posit a one-to-one relationship between the conditions that inevitably assumes incommensurability. This tension has been long in the making, preceding technological advancements for both HIV and diabetes. Writing for the HIV resource The Body in 1999, Dennis Rhodes contended, “My problem is we’ve dampened our rage and replaced it with complacency. A lot of people with HIV smoke and drink like there’s no tomorrow. And I keep hearing this absurd analogy between HIV disease and diabetes. Excuse me, but you can take my HIV back—I’ll take my chances with diabetes.”39 That same year contributors to a journal dedicated to HIV/AIDS and the law wondered if the Americans with Disabilities Act would still protect people who are HIV-positive if they were recognized like those with diabetes.40 Almost a decade later Clint Walters, the founder of Health Initiatives, rejected the analogy, believing that HIV was more dire than diabetes: “We have the facts and yet we are still missing the message. Don’t buy into the myth that HIV is like diabetes. There is nothing manageable when dealing with an uncertain future, side effects from medication and, to top it all off, rejection based purely on your positive status. An HIV diagnosis can rip through your core and make you question everything.”41 AIDS activist Jeff Getty told the Associated Press, “People are thinking, ‘Oh I’ll just take a pill a day until I’m an old man and everything will be fine.’ This is not diabetes. I would love to have diabetes. Compared to HIV, diabetes would be a picnic.”42 An HIV-positive man lamenting advertisements that did not illustrate the side effects of antiretroviral medication exclaimed to The Oregonian, “I hear people say it’s the new diabetes … but it’s not.”43 The fears pervading these comments may have been valid at one time, but only if one imagines those with diabetes casually managing the disease and those with HIV at perpetual risk of death.
In each instance, diabetes is visualized as a wholly manageable condition that is seemingly without ramifications. The rendering of diabetes as readily overcome is pervasive in these exchanges, highlighting the extent to which it is imagined as invariable. Complications with insulin, daily struggles with food, the pain associated with injections, and the burdensome costs that accompany care are all elided by an oversimplified discourse of manageability. Disregarding the glut of contingent factors that constitute diabetes gives license to forego the analogy, dispelling innovative possibilities and fortifying staid notions of HIV. The tautology is striking. Those who challenge the analogy trivialize the relationship management has to diabetes, but on the very grounds that they believe management trivializes the effects of HIV.
The preceding remarks comport well with Sedgwick’s musings about paranoia being highly anticipatory, affectively negative, and placing much faith in the exposure of analogical failures. The nod to an “uncertain future” Walters mentioned hints at the temporal character of this paranoia, consistently speculating on the struggles that await those who are not vigilant. Chronic conditions are, after all, defined by their relationship to time and the becoming (or disintegration) of the body. And yet this seemingly innocuous statement about the future is telling in its morbid prognostications. There is little room for interpreting the future as anything but bleak, as it is couched in a language that suggests anyone with HIV can predict the (non)surprise of degeneration that awaits. Paranoia’s expectant form functions to make visible all mechanisms of oppression and the mendacity of progress narratives that normalize the contours of HIV management.
Although much ink has been spilled attempting to refute analogies to diabetes, these debates are not monolithically one-sided. Where we find apocalyptic projections, we are sure to discover utopic impulses, and where we observe paranoid suspicions, we can always unearth reparative inclinations. The complex interplay of meaning-making by competing factions highlights a still-emerging, frenzied quality to deciphering management rhetorics. The reactionary tone against the analogy was perhaps most powerfully illustrated when columnist Andrew Sullivan published an editorial in the pages of the Advocate mocking HIV advocates, whom he saw as exacerbating the effects of HIV, even as people like him lived longer, healthier lives. Sullivan pontificates:
Far fewer gay men are dying of AIDS anymore. Sometimes local gay papers have no AIDS obits for weeks on end. C’mon, pozzies. You can do better than that! Do you have no sense of social responsibility? Young negative men need to see more of us keeling over in the streets, or they won’t be scared enough to avoid a disease that may, in the very distant future, kill them off. You know, like any other number of diseases that might. They may even stop believing that this is a huge, escalating crisis, threatening to wipe out homosexuality on this planet. What are those happy, HIV-positive men thinking of? Die, damn it.44
Sullivan attests that HIV transformed his life, making him a better writer, a healthier person, and a more sexually and spiritually activated gay man. Even as he acknowledges the effects of HIV on some people, he foretells a bright future:
I’d even be prepared to stop taking my meds if that would help. The trouble is, like many other people with HIV, I did that three years ago. My CD4 count remained virtually unchanged, and only recently have I had to go back on meds. Five pills once a day. No side effects to speak of. I know that others go through far worse, and I don’t mean to minimize their trials. But the bottom line is that HIV is fast becoming another diabetes.
Unlike those who dismissed the relation between diabetes and HIV on the grounds that the analogy oversimplified life with HIV, here Sullivan embraces the homology for that very reason. Despite his divergent appropriation of the condition, and his more reparative positioning of HIV, Sullivan shares with the aforementioned critics an oversimplification of life with diabetes. He subscribes to scripts that foster the imagined benefits of “merely” having diabetes and that belief, paradoxically, buttresses notions of diabetes in ways similar to his detractors. It is a theme he would return to when defending the PrEP medication Truvada.45
Readers and bloggers retorted that Sullivan was downplaying the negative attributes of living with HIV and accused him of being unaware of the privileged position he occupied. One reader snapped back, using Sullivan’s