Managing Diabetes. Jeffrey A. Bennett

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.