providing information and resources to those most in need. However, the government also refused to allow any person to opt out of the program. Privacy advocates argued that the city overreached in its efforts and that diabetes management regimens were best left to individual patients and their physicians. In response, the city situated diabetes as an “epidemic” to justify the program, a contentious move considering that diabetes is not a contagious disease. Despite its limitations, I argue that the “epidemic” frame can act as a catalyst for proffering resources that might aid people living with the disease. I offer a rejoinder to those who assail the registry over privacy concerns, a move that inevitably relegates diabetes to the domestic sphere void of any public character. Not to be overly welcoming of government surveillance, I also weigh the limits of the “epidemic” metaphor by mulling over a controversial DOHMH public service campaign. That PSA featured an African American actor whose lower leg had been photoshopped out of a picture to imply that uncontrolled blood sugar had made him an amputee and to warn about diabetes’s consequences. I find this campaign to be counterproductive to the otherwise laudable goals of government interference because such efforts inspire fear and individual loathing rather than engaging systemic features that give rise to diabetes rates in the first place.
The conclusion of the book, chapter 6, engages the role of the cyborg as an emergent figure for diabetes management. Using Donna Haraway’s infamous notion of the cyborg, I focus on the political potential of the concept to move beyond the machinist aspects of cutting-edge diabetes technologies. New innovations such as the artificial pancreas have actualized a rhetoric that foregrounds the “new frontier” of medical advancement, but always with the disclaimer that these breakthroughs do not actually cure diabetes. The incessant focus on the latest technological invention functions to occlude the ways corporations profit from populations made most vulnerable by diabetes. I look to the stalled efforts of developing generic insulins, which have been impeded by a practice known as “evergreening.” The development of biosimilars (generic insulins) would drastically reduce the cost of staying well for economically disadvantaged people with diabetes, but this possibility remains evasive more than a century after insulin’s discovery. The figure of the cyborg lends an appropriate close to the book, as its ontology accentuates a convergence of frames explored throughout this text: mechanistic ease, encroaching death, worldly transcendence, and institutional might.
2
“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
