Managing Diabetes. Jeffrey A. Bennett

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СКАЧАТЬ 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.

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