Managing Diabetes. Jeffrey A. Bennett

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СКАЧАТЬ 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 СКАЧАТЬ