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John-Manuel Andriote Headshot

HIV Is 'Like Diabetes'? Let's Stop Kidding Ourselves

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My antenna perked up when I read a gay man's comment that HIV infection is essentially no big deal anymore. "It's like diabetes these days," he said. As an HIV-positive 53-year-old, familiar with the health details of some near and dear diabetics, and having just written an article about the type-2 ("adult onset") diabetes epidemic, I'd say this: we need to choose our analogies carefully.

A naïve image of type-2 diabetes is understandable if your perception is based on the trim, middle-age joggers touting their finger-stick tests and blood glucose meters in TV commercials during the evening news. In actual fact, diabetes is the seventh leading cause of death in America. As many as 7 in 10 people with diabetes will die of heart disease or stroke. In 2007 diabetes killed or contributed to the deaths of 231,404 deaths in this country alone, and this year the World Health Organization projects 3.2 million worldwide will die from diabetes. Diabetes is also the leading cause of blindness. One of every 50 people with diabetes will be blind within 15 years. It's the top cause of kidney failure. In 2008 a total of 202,290 people with end-stage diabetes-related kidney disease depended on dialysis or a kidney transplant to stay alive. Diabetes is behind most non-traumatic lower-limb amputations. Thirteen million men in the U.S. over age 20 -- 11.8 percent of all adult men -- have diabetes. Among women, 12.6 million, or 10.8 percent of all women over age 20 have it. An estimated 7 million Americans are believed to have diabetes but don't know it. The percentages are highest among blacks, Hispanics and Asian-Americans.

Sure it's possible to manage type-2 diabetes once someone has a diagnosis and is aware that their pancreas isn't producing enough insulin to regulate their blood sugar. It's even better to prevent diabetes by reducing the behaviors that lead to obesity, the number-one cause of type-2 diabetes. At best, someone with type-2 diabetes can commit to a strict regimen of healthy eating and exercise that for some has reversed the disease to the point that they need no more medication. The American Diabetes Association says that five years of normal blood glucose readings without medication can be considered a "complete remission." Many more, however, struggle to alter their longtime eating habits or make time for exercise as basic as walking. Without making the changes it takes to successfully manage diabetes, they pit their medication against their poor nutrition and sedentary habits and hope for the best. They may be diligent about taking their meds and keeping their many medical appointments, but even the labels on the diabetes medications explain that they are to be "used along with diet and exercise," and, on some meds, "weight loss."

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-2 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-2 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.