A great debate: Is HIV really now a chronic illness like diabetes?

One of the most haunting feelings in life is considering your own mortality. At age 25, I felt all too young to have even the slightest brawl with death. My HIV doctor worked patiently to calm down the havoc in my brain – saying that improvements in HIV treatment have gone so well that the disease had been reclassified from fatal to chronic. By the blank stare on my face, my doctor knew that I didn’t understand what this meant, so clarified with an analogy: HIV now functioned more like a disease such as diabetes.

Though I didn’t know much about diabetes, it did help put my mind at ease. My doctor said that while HIV is still possibly fatal, the diagnosed person can live a long and healthy life if HIV is managed properly.

I considered how nicely the general population treats those with diabetes, and wondered if that could perhaps mean the same for HIV. If a sweet, old man like Alfred Brimley could go on national television ads endorsing supplies to keep his disease under control, then there can be hope for other diseases of equal caliber – right?

When I told close friends and family about my diagnosis, I repeated the diabetes analogy. Even if they were skeptical, the comparison seemed to comfort them. But I quickly learned that my doctor was not the only one who used this comparison, and people had all sorts of opinions.

Some appreciated the comparison; others said it was bullshit. The two diseases have so little in common, some said, that comparing them is insulting to both. While both HIV and type II diabetes can be behaviorally acquired, only HIV can be contracted from another person. The fact that HIV is transmitted mostly sexually and intravenously brings a deeper stigma; no Alfred Brimley would dare touch it as a spokesperson.

The prick of these opinions burst my bubble of diabetes-normality. This country seemed comfortable with discussing diabetes; social terror is a much more obvious aspect of life for those living with HIV.

After one of my HIV public speaking gigs, during my routine one-on-one appreciations with people from the audience, a young man thanked me for talking so publicly about something so difficult. As I prepared to reply with the appropriate modest gratitude, he disclosed his own experience with disease. He doesn’t have HIV, he said – he has diabetes.

He’d had his own struggles growing up as the odd guy out. When he was a kid, he said, his family encountered difficulty keeping him in school due to other people’s fear. Apparently diabetes had its own stigma to overcome twenty years ago – regular testing for blood sugar and insulin injections were quite frightening to the general public.
It got my brain cranking for days about the debate as to whether these two diseases should be compared or not. Perhaps diabetes stigma did once resemble today’s perception of HIV. While the lag is discouraging for some, it might be hopeful for others.

If stigma was the only thing making HIV seem like a worse diagnosis than diabetes, I couldn’t help but wonder about other differences. Both are deemed chronic rather than fatal – yet, I got the sense that a diabetic person has much more to consider in managing her or his disease than a person with HIV does.

As someone living with HIV, I find that the strictly regimented pills are often a hassle. But a diabetic person must regularly monitor her or his blood sugar levels with blood draws mostly through finger sticks. She or he also must monitor eating habits or feel extremely sick, risk coma or even death. If that isn’t enough, a person with diabetes must be injected with insulin regularly. A person with Type I diabetes can opt for an insulin pump that hooks to the body, but that can leave a person feeling even more self-conscious about her or his disease. This all made me feel like my daily pill regimen isn’t such an inconvenience after all.

Those with diabetes and those with HIV have familiar concerns, of managing stigma and becoming meticulous about health maintenance tasks. They’re not identical, but debating the differences could be key to approaching the similarities: Though for some, it seems like apples to oranges, for others it looks like it’s still all just fruit.