Managing Diabetes. Jeffrey A. Bennett
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HIV and, by extension, queer lives.
If apocalypse constitutes one early framework for contemplating the AIDS crisis relevant to the analogy with diabetes, then the tropes of “paranoia” and the “reparative” mark the second. Even as queers had substantive reason to cede some fears about HIV, paranoia continued to unfold with conspiracy theories about genocide, lurid tales of bug chasing and gift giving, and scandalous stories about life on the “down low” in communities of color.22 In a widely circulated essay, Sedgwick pursued a controversial thesis about a paranoid style that had crept into activist and academic queer work. Using as her starting point the rapid uptake of AIDS conspiracy theories, Sedgwick expressed concern about an intellectual predilection that had lost its critical edge and often reproduced the very structures of oppression that queer scholarship sought to tear down.23 Sedgwick found that paranoia had come to occupy a daunting presence in queer studies, which sought to expose homophobia in even the most progressive of instances. She humorously expounded on the embrace of paranoia, reflecting on the pervasive utilization of Paul Ricoeur’s “hermeneutic of suspicion,” even in the face of political conditions that suggested otherwise.24 Sedgwick argued that paranoia had essentially become methodological: It embraced gloomy affects, was highly anticipatory of the future, and its boisterous negative critiques allowed for no surprises. In short, a paranoid perspective bestowed answers before the questions were even asked. Why, Sedgwick speculated, did queers repeatedly turn to a paranoid predisposition of the world in the face of social, medical, and political advancement? To her, queers were more than happy to elect the monogamy of paranoia over the polyamory of difference and the realities of medical enrichment. Ultimately Sedgwick questioned whether this “uniquely sanctioned method” really made queer lives better or simply provided ready-made conclusions for assorted phenomena. In its place, she called for reparative techniques to cultivate innovative and subversive meaning-making practices that would foster productive strategies for navigating convoluted situations.
Paranoid and reparative reading strategies are not necessarily dichotomous and scholars, including Sedgwick herself, have intimated that anxiety might actually underlie each. Just as apocalyptic discourse can strongly imply longing for utopia, both paranoid sensibilities and reparative desires can stem from the unpleasantries of everyday life, each cruising unrealized dreams in the face of ideological stasis or queer ambivalence about the nature of progress. And, to be sure, paranoia envelops many management frameworks related to both HIV and diabetes because there is no guarantee that ritual care will necessarily prolong one’s life. Indeed, Sedgwick speculated on the bleak future of an HIV-positive friend in a segment of the paranoia essay that focuses explicitly on reparative tendencies.25 Paranoia persists in HIV vernacular, being a recurrent referent in everything from disputes about queer hook-up apps to the anxieties expressed over pre-exposure prophylaxis (PrEP), which has shown to be resoundingly effective in preventing HIV transmission when adherence is maintained.26 If reparative critiques were underscored by “weak theories” that privileged localize knowledges, AIDS discourse circles back to universal predispositions that centralize paranoia and trauma. The dialectical pairing of apocalypse and utopia, and that of paranoid and reparative, linger in the queer corpus, even if subtly, when HIV is the object of study. Recent developments in queer theory, however, have moved in the direction of precarity and the chronic suffering of populations at the hands of state agencies and capitalist orders. It is not so much that HIV need be fatal, but without proper access to care and modern medicine, perilous circumstances leave people at risk. The analogy to diabetes becomes even more pronounced when this figurative turn is made.
Precarity is a new key word in the critical queer lexicon, emerging concurrently in activist and academic contexts. The concept has been articulated to phenomena as disparate as terrorism and the emergent creative class, although the term was not even listed in some English dictionaries just a few years ago.27 Scholars engaging the idea of precarity seek to unmask operations of power that exploit vulnerable communities and advocate for ethical imperatives to counteract irreparable harm. In Judith Butler’s words, precarity designates “politically induced conditions in which certain populations suffer from failing social and economic networks of support and become differentially exposed to injury, violence, and death.”28 Butler contends that precarity is performatively crafted; only those who are able to reiterate sanctioned cultural norms will be recognized as human to those in power. Without such recognition, no agency is afforded to marginalized people, and the capacity to be undone by oppressive regimes is actualized. The reverberations of apocalypse/utopia and paranoia/reparative resonate in precarity even as this work rarely engages HIV/AIDS, instead finding 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