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“HIV Is the New Diabetes”

Analogies of Apathy

“A Day with HIV in America” is a photo campaign designed to combat the stigma of living with HIV as the epidemic marches resolutely through its fourth decade. Sponsored by the nonprofit Test Positive Aware Network (TPAN), the 2011 operation kicked off with a four-minute promotional video featuring an array of advocates of differing races, genders, and ages. One of the spokespeople introduced is a young African American woman who declares that HIV is “the same as having diabetes … it’s something that you just have to manage.” This now common analogy to diabetes did not go unnoticed by the editors at Queerty, an online news source for LGBT issues, who singled out the statement and retorted, “But are the speakers in this campaign video correct when they say that HIV is ‘the same as having diabetes?’ … Is HIV really so manageable—or does it come with greater health risks and greater stigmas that should be addressed honestly?”1 By ending the query with a call for more “honest” deliberation about HIV management, the site indicated to readers that the analogy deserved further scrutiny, if not outright dismissal.

TPAN and Queerty are not the first to incite spirited public discussions that engage the role of analogy in the production of medical knowledge. Just as physicians, researchers, and public health officials come to know diseases in comparative fashion, publics generally become acquainted with disease through already sanctioned medical epistemologies. Articulating scientific understandings of disease to accepted cultural frames directs interpretations of communal threats and stimulates possibilities for contemplating treatment and containment. AIDS was famously, if incorrectly, labeled both “gay cancer” and “gay pneumonia.” Yellow fever and malaria were frequently studied in tandem because mosquitoes transmit both, even though their causal agents are etiologically distinct. Depending on the literature one reads, fibromyalgia, chronic fatigue syndrome, and depression are variations on a theme or unambiguously dissimilar. More recently, debates rage over analogies likening alcoholism to a disease when it may more accurately correspond to an allergy and be addressed with medication. How we come to know a disease is dependent on a complicated interplay of sociopolitical practices, medical parlance, and the lived proximity of populations to the condition being assessed. Resituating a disease such as HIV from fatal to chronic is accomplished not solely through medicine and technology, then, but by analogically reimagining it alongside conditions that are widely acknowledged as manageable.

The politics of intelligibility underlying comparisons between HIV and diabetes illustrate a conspicuous, though not unprecedented, historical moment for those invested in the shifting logics of conceptualizing chronic conditions. Rhetorically, the analogy works to stabilize the crisis of signification that once marked AIDS, reestablishing life with HIV as habitual rather than volatile. In opposition to the disquieting urgency that once underwrote the incalculability of HIV, the analogy relinquishes the precariousness of AIDS and relocates life with HIV to more secure rhetorical groundings in health and wellness.2 This movement from a tenuous embodiment to one that renders HIV dormant offers, in the words of Lauren Berlant, a lateral agency that focuses on the maintenance of the body in everyday life.3 This agency is marked not by the ongoing social trauma that once characterized AIDS narratives, but by a slow and deliberate care of the self. Technological developments for attending to HIV have been as transformative as the virus itself once was, with life expectancy rates for people living with HIV now being roughly equivalent to people who are seronegative. While stigma, depression, and economic disparities remain significant obstacles for many who are living with HIV, advances in medical treatment and prevention have been nothing short of astounding. The comparison to diabetes is not only plausible, but in many cases warranted.

In this chapter I argue that comparisons between HIV and diabetes affect the rhetorical architecture of each disease. The analogy is perhaps most potent because it can be utilized to disrupt the notion that diabetes can be unreflectively managed. Those who believe that HIV emulates features of diabetes tend to focus almost exclusively on the dynamic nature of HIV. Diabetes, conversely, is envisioned as static in the analogy, viewed as treatable with a single pill or with unmindful regimens. A statement such as “HIV is the new diabetes” might be rich with potential but often reduces diabetes to a condition that is effortlessly mastered and in doing so imparts presumptions about the ease of regulating HIV. Not surprisingly, critics sensitive to AIDS’s ruinous past assail analogies to diabetes as trivializing the perils of HIV. Those suspicious of the association rehearse familiar scripts about the precarity of HIV even as they cement torpid meanings tied to diabetes, in some cases going as far as to dismiss the reparative promise of actual medical advancements.4 The alarmist outcry exhibited by platforms such as Queerty tell us much about attitudes toward both conditions, accentuating public sentiments about the mutability of HIV and the enigmatic sedimentation of diabetes.

Analogies are complex rhetorical configurations that suggest relations of similitude and difference. The power of analogies lies not in their ability to bestow uncompromising truth claims, but to act as sites of invention for judging something anew. Chaïm Perelman reminds us that etymologically, analogies indicate proportionality, a relation that contributes to the logic (the logos implied in the second half of analogy) of argumentative form.5 The degree to which affinities are accepted depends on a number of factors that are not reducible to discrete variables. As Isaac West has noted, analogies are not best understood as quasi-mathematical formulations; rather, they are dependent on a rich network of contexts, contingencies, and articulations that actualize the potential for knowledge creation in figurative manners apart from encoded meanings.6 It is the innovative power of analogy that I am most invested in here—looking not to a priori conclusions about one set of experiences at the expense of another, but to the productive possibilities that might be cultivated from the analogy’s circulation. In short, if diabetes functions as a stabilizing mechanism for those living with HIV, the latter might also constructively destabilize the sedentary connotations associated with diabetes, reformulating troubling perceptions that glucose irregularities are controlled through sheer force of will. What might the analogy tell us if we asked not how HIV resembles diabetes, but how diabetes—culturally, discursively, and politically—is similar to HIV? I approach this question by scrutinizing the entanglements of the analogy to unsettle the tropes of convenience and placidity that underwrite oversimplified management scripts. In what follows I contemplate how vernacular exchanges about HIV reproduce narrowed understandings of chronic conditions in an era of ongoing endemics. Although the imperative to manage diabetes is at times clarified by the exaggerated nature of HIV, the analogy tends to conceal the former’s protean character.

Working from the premise established in the introduction that diabetes is made intelligible in diverse contexts, and that understandings of diabetes are often contradictory, incompatible, and asymmetrical, this chapter looks to the trope of diabetes as a mechanistically governed disease. This figuration stands in sharp contrast to fatalistic rhetorics that personify diabetes as essentially unstable, which is explored in chapter 3. Challenging the credo that diabetes is fundamentally languid, I first examine the ways that HIV has been represented as erratic, immedicable, and destructive. I concoct a rhetorical genealogy of HIV/AIDS from queer theory that imagines HIV’s character as cataclysmic, a quality that is captured through the reoccurring figures of apocalypse, paranoia, and precarity. This calamitous narrative delineates shifting interpretations of HIV over time and ultimately provides the grounds for detractors to reject comparisons to diabetes. Next, I turn to the curious case of diabetes being an iterate referent in the emergence of HIV as a manageable condition through the oft-recited refrain that “HIV is the new diabetes.” The allusions between HIV and diabetes are increasingly prevalent, shaping the ways each is brought into discourse, even as residual notions of HIV hold tight. I then invert the pair to untidy conventions about signification, stigma, and agency, asking how we might reimagine the ways diabetes is personified. This inversion is not meant to suggest an equivocation of the two diseases or an artificial supplanting of the public health strategies related to one condition onto another. Rather, I contend that the discursive features of HIV/AIDS and its storied history can shape the rhetorical texture of diabetes to complicate the nomenclature of personal sovereignty and medical determinism.

Analogical Parallels? Apocalypse, Paranoia, and Precarity

The evolution of diabetes from a fatal disease to a proxy for surmountable conditions like HIV has been centuries in the making. Diabetes was first observed in ancient times, and situating it as a nominally stable illness is itself a relatively new phenomenon.7 The “siphoning” of the body suggested in diabetes’s etymological root indicates a rapidly deteriorating subject, one who did not have the benefit of time on their side. The mercurial nature of the disease was presumed until the discovery of insulin in the early 1920s, when treatment modalities began to resituate it as a manageable condition. Since that time diabetes, especially type 2, has become associated with passive bodies and states of decay. That typification has had tremendous implications, as it is often falsely assumed that diabetes is easily corralled with medicine and diet changes. Although diabetes has been depicted as both fervently precarious and markedly static, HIV has been couched almost exclusively in the former category. Indeed, HIV’s haphazardness has generally prevented its classification as a tractable condition until recently.

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 ways paranoia inflected the tenor of discussions about HIV and, by extension, queer lives.

If apocalypse constitutes one early framework for contemplating the AIDS crisis relevant to the analogy with diabetes, then the tropes of “paranoia” and the “reparative” mark the second. Even as queers had substantive reason to cede some fears about HIV, paranoia continued to unfold with conspiracy theories about genocide, lurid tales of bug chasing and gift giving, and scandalous stories about life on the “down low” in communities of color.22 In a widely circulated essay, Sedgwick pursued a controversial thesis about a paranoid style that had crept into activist and academic queer work. Using as her starting point the rapid uptake of AIDS conspiracy theories, Sedgwick expressed concern about an intellectual predilection that had lost its critical edge and often reproduced the very structures of oppression that queer scholarship sought to tear down.23 Sedgwick found that paranoia had come to occupy a daunting presence in queer studies, which sought to expose homophobia in even the most progressive of instances. She humorously expounded on the embrace of paranoia, reflecting on the pervasive utilization of Paul Ricoeur’s “hermeneutic of suspicion,” even in the face of political conditions that suggested otherwise.24 Sedgwick argued that paranoia had essentially become methodological: It embraced gloomy affects, was highly anticipatory of the future, and its boisterous negative critiques allowed for no surprises. In short, a paranoid perspective bestowed answers before the questions were even asked. Why, Sedgwick speculated, did queers repeatedly turn to a paranoid predisposition of the world in the face of social, medical, and political advancement? To her, queers were more than happy to elect the monogamy of paranoia over the polyamory of difference and the realities of medical enrichment. Ultimately Sedgwick questioned whether this “uniquely sanctioned method” really made queer lives better or simply provided ready-made conclusions for assorted phenomena. In its place, she called for reparative techniques to cultivate innovative and subversive meaning-making practices that would foster productive strategies for navigating convoluted situations.

Paranoid and reparative reading strategies are not necessarily dichotomous and scholars, including Sedgwick herself, have intimated that anxiety might actually underlie each. Just as apocalyptic discourse can strongly imply longing for utopia, both paranoid sensibilities and reparative desires can stem from the unpleasantries of everyday life, each cruising unrealized dreams in the face of ideological stasis or queer ambivalence about the nature of progress. And, to be sure, paranoia envelops many management frameworks related to both HIV and diabetes because there is no guarantee that ritual care will necessarily prolong one’s life. Indeed, Sedgwick speculated on the bleak future of an HIV-positive friend in a segment of the paranoia essay that focuses explicitly on reparative tendencies.25 Paranoia persists in HIV vernacular, being a recurrent referent in everything from disputes about queer hook-up apps to the anxieties expressed over pre-exposure prophylaxis (PrEP), which has shown to be resoundingly effective in preventing HIV transmission when adherence is maintained.26 If reparative critiques were underscored by “weak theories” that privileged localize knowledges, AIDS discourse circles back to universal predispositions that centralize paranoia and trauma. The dialectical pairing of apocalypse and utopia, and that of paranoid and reparative, linger in the queer corpus, even if subtly, when HIV is the object of study. Recent developments in queer theory, however, have moved in the direction of precarity and the chronic suffering of populations at the hands of state agencies and capitalist orders. It is not so much that HIV need be fatal, but without proper access to care and modern medicine, perilous circumstances leave people at risk. The analogy to diabetes becomes even more pronounced when this figurative turn is made.

Precarity is a new key word in the critical queer lexicon, emerging concurrently in activist and academic contexts. The concept has been articulated to phenomena as disparate as terrorism and the emergent creative class, although the term was not even listed in some English dictionaries just a few years ago.27 Scholars engaging the idea of precarity seek to unmask operations of power that exploit vulnerable communities and advocate for ethical imperatives to counteract irreparable harm. In Judith Butler’s words, precarity designates “politically induced conditions in which certain populations suffer from failing social and economic networks of support and become differentially exposed to injury, violence, and death.”28 Butler contends that precarity is performatively crafted; only those who are able to reiterate sanctioned cultural norms will be recognized as human to those in power. Without such recognition, no agency is afforded to marginalized people, and the capacity to be undone by oppressive regimes is actualized. The reverberations of apocalypse/utopia and paranoia/reparative resonate in precarity even as this work rarely engages HIV/AIDS, instead finding footing in global economic and labor crises. Nonetheless, the frequent mentions of inaccessible health care in the literature comport well with critical studies of medicine that articulate those at risk of dying from HIV infection and the politics of well-being.

The volatility of HIV/AIDS has gradually morphed in precarity literatures, either rendered to the annals of history or taking on more insipid forms.29 This progression is noteworthy considering that the affective turn in queer studies directly conjoined paranoia to precarity; the former is built on a foundation of panic and loss that directly informed the latter.30 AIDS materializes as a study in memory or in the form of a cautionary tale about the perils of poor policy decisions, deficient medical care, and the efforts to garner recognition of non-normative kinships. Butler writes:

It is worth remembering that one of the main questions that queer theory posed in light of the AIDS crisis was this: How does one live with the notion that one’s love is not considered love, and one’s loss is not considered loss? How does one live an unrecognizable life? If what and how you love is already a kind of nothing or non-existence, how can you possibly explain the loss of this non-thing, and how would it ever become publicly grievable? Something similar happens when the loss or disappearance of whole populations becomes unmentionable or when the law itself prohibits an investigation of those who committed such atrocities.31

I detail the evolution of AIDS rhetoric from apocalyptic to paranoid to precarious not to trivialize the import of such scholarship, which remains vital in a world where rates of HIV transmission remain startlingly high. Nor do I wish to diminish the harsh realities that confront those who are seropositive. Rather, I hope to have established the force of impermanence and foundational relentlessness that continues to lurk beneath the rhetorical composition of HIV. There persists in the above examples an emphasis on the potential for misrecognition, grieving, loss, and disappearance. While activists have successfully incorporated vital world-making practices to redefine safer sex and alleviate stigma, the signifiers associated with HIV continue to lend gravitas to notions of instability and death. Alongside HIV’s dire history, diabetes would appear to be a readily controllable condition.

The connotations of consumer capitalism and labor undergirding theories of precarity draw attention to the perils of people attempting to manage conditions in the face of a ravenous for-profit healthcare system. The care of the self is tiresome and is especially confounding when attempted without medical insurance or access to health care. The laborious conditions of daily life suggest not the trauma of apocalyptic discourse, but the dilapidation of the self in everyday life, what Berlant has described elsewhere as a “slow death.”32 Berlant contends that living with HIV is now constituted by an ellipsis, a symbol that suggests both an absence and a bridging device, states of being that have ushered in new subjectivities and normativities related to well-being. How might these refurbished norms and power differentials inform comparisons to diabetes? If scholars are correct in noting that precarious subjects necessitate an Other, the pairing of diabetes and HIV indicates not only an oppositional comparison but one that might also be congruently productive.33 In most populist literature about precarity, that projected antagonist is the economic 1 percent. In the analogy between HIV and diabetes, it appears to be the lazy diabetic who does little to manage the disease, securing those with HIV in a precarious position and those with diabetes in one that is decrepitly still.

“HIV Is the New Diabetes”

The inspiration for this chapter comes from a pithy remark made by a character on the television program Nip/Tuck, who expressed her feelings about being HIV-positive by exclaiming, “HIV is the new diabetes.”34 That this dialogue is embedded in a quasi-medical program known for its whimsy, hyperbole, and cynical critique of America’s obsession with aesthetics should not distract from the reality that the analogy is now conventional in the public sphere. Bridging aspects 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 words against him: “Sullivan claims no side effects, but what about the diarrhea, exhaustion, regular doctor visits, and other nuisances that he admits to on his blog? What about the unending worry about infections and the higher incidence of disease among HIV-positive folks? This is no diabetes.”46 Thomas Gegeny, executive director of the Center for AIDS Information and Advocacy, countered, “Extolling the newly dubbed descriptions of HIV as ‘another diabetes’ (i.e., a chronic, manageable condition) is appealing, but what about the myriad health problems faced by people with HIV, whether on or off medicine?”47 Rebuking Sullivan, one blogger wrote, “HIV medications don’t work for everyone; I know this first-hand: my virus is resistant or intolerant to most of them. Unlike diabetes, HIV is associated with damning social stigma and pozzies bear the burden of becoming a carrier of a deadly virus.”48 Of the many letters and blog posts written against Sullivan’s position, I could find only one that condemns him for potentially misrepresenting diabetes.49

Skeptics occasionally reconstruct the rhetorical scaffolding that frames the analogy to ensure diabetes remains static compared with the dynamic nature of HIV. Even in cases where it would appear a reparative approach is being taken up, the comparison is manipulated to guide an interpretation of HIV’s inconstancy. Such was the case when John-Manuel Andriote published an editorial on the Huffington Post titled, “HIV Is ‘Like Diabetes’? Let’s Stop Kidding Ourselves.” After carefully detailing the challenges and complications confronting people with diabetes, Andriote refocused his attention from management to cure. It’s worth quoting him at length to illustrate fully this sleight of hand and the wounded attachment he crafts:

We need to banish the notion that HIV infection today is ‘like diabetes,’ in spite of their similarities. Consider:

Both are transmitted through intimate behavior, one through sex, and the other, frequently, through family habits passed down over generations. Both diseases are alike in that they are best avoided and challenging to manage. They both cost a great deal of money for medications, medical specialists, and lab work. Certainly, HIV and diabetes each could destroy your health and likely kill you if they aren’t properly managed. As for people with type-two diabetes seeking to manage their illness, a healthy diet and exercise strengthen an HIV-positive person’s ability to handle the daily impact of toxic chemotherapies; the hassle of medical appointments and blood work every few months; the discipline of taking pills every day, and dealing with their physical side effects; and the emotional, financial, and psychological tolls of having a financially and socially expensive medical condition.

But beyond this, and in spite of the obvious differences between a viral disease and a metabolic one, the most striking difference between having HIV and type-two diabetes today is this: There’s not even a remote chance that changing my diet or exercise habits can cure what I have.

If only.50

Andriote handcuffs himself to the precarity of illness, stifling a nuanced and original exposition with oversimplification and shaming in the space of a few words. Even in the face of extensive similarities, he positions diabetes as easily eliminated by alterations in diet or physical activity.

In fairness, the anxiety expressed by many of the aforementioned activists and writers is not fabricated out of thin air; there is strong precedent for distrusting that HIV is on the brink of being cured. People with HIV continue to be undone by the devastating effects of stigma, medical complications, and economic hardship. The concern expressed by people assailing the analogy exhibits a distrust of stability and comfort because advocates want people to remain vigilant against HIV’s dangers.51 In this way, they are justified in dramatizing the uncertainty that confronts many people with HIV. Invocations of management potentially occlude the quotidian struggles faced by people who do not have access to health care, medicine, and social support services. We should not forget that HIV, like diabetes, is increasingly a problem experienced by the poor. And, as Berlant reminds us, those on the lowest rung of the socioeconomic spectrum are not quick to embrace additional struggles or stigmas.52 Even those who have resources grapple with the daily contours of chronic conditions that dilapidate their worlds at a glacial pace. These commonalities might potentially create kinship among diabetes and HIV, but the rhetoric often signals a move toward estrangement and not conviviality.