Would You Rather....?

Have diabetes or HIV?

The obvious answer to that for I'd say 99% of the country -- and 100% of San Antonio -- is diabetes. But on further thought I'm personally not so sure. One of my ID staff, however, is entirely sure that HIV is the far better way to go, and the more I think about it the less I think he may be crazy.

HIV, typically once a death sentence only a few years after diagnosis, is no longer the viral grim reaper it once us. Whereas everyone with rare exception would progress from HIV+ to full blown AIDS in an average of 8 to 10 years followed by a few years of progressive misery unto death today this happens in only the rarest of cases (at least in the United States.) Now we have medicines, and not only do we have medicines but we have combo pills, and not only do we have combo pills but we have once daily dosing, and not only do we have a single pill that you take only once a day but we have a single pill that has remarkably minimal side effects. For those prudent enough to take their medicines consistently the reward is an AIDS free life that, aside from a high frequency of medical visits and a slightly increased risk of developing a few chronic illnesses, is essentially indistinguishable from the HIV- life they may have otherwise had. People need not get AIDS any more and certainly need not die from it. Truly now it is in many ways simply one more chronic condition.

Diabetes, on the other hand, though curable is rarely cured. As the disease progresses the consequences accumulate as do the medical therapies. It may start painless, but as it progresses to heart disease, kidney failure, nerve damage, immunodeficiency, and vision loss the pain becomes irreversibly real. During this time often over years to decades the number of medicines progresses from one pill daily to a handful of pills throughout the day and finally to the routine injection of shots and pricking of fingers for samples of blood. The roads are different -- heart attack, dialysis, blindness, amputation, infection, and stroke -- but the destination is the same. People die from diabetes. Not all and not directly, but an appalling sum of morbidity and mortality every year is brought on in part or in whole from diseases which diabetes brings. People view it as only a chronic condition, some people almost taken as a given, but few such medical diseases will change your life as much as diabetes.

To say I'd prefer HIV over diabetes still sounds a bit brash, but I think it may nevertheless be the better choice of the two. Due to the stigma of the disease I imagine most people will always largely favor diabetes. Unfortunately this is probably a large part why we spends billions of dollars and lose thousands of quality adjusted life years annually to the latter. On a lighter note, though, would you rather live free or die? Share a bunk with Kathy Griffin or share a bunk with Carrot Top? Bare knuckle box an angry Michele Bachmann or an angry kangaroo?