Managing Diabetes. Jeffrey A. Bennett

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СКАЧАТЬ 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. СКАЧАТЬ