Hep C stigma as a pharmaceutical marketing device

A new campaign funded by Janssen-Cilag P/L under the Hepatitis Australia brand uses Hep C stigma to drive users to its product.

Update 31/7/13: Hepatitis Australia has announced they’ve removed the video. Well done all who expressed their concerns to Hep Aust and Janssen-Cilag P/L.

Update 1/8/13: And they’ve uploaded a new version!  See the video below.  Thanks to Lyn Carruthers for pointing this out.  What do you make of it?  Feel free to post your thoughts in the comments.

At first glance this looked like an anti-stigma message. Forcing people living with blood borne viruses to use their own crockery is an extremely common form of discrimination linked to HIV and viral hepatitis stigmas.

Under Australia’s national strategies for blood borne viruses, community organisations have three main goals: (1) promote prevention; (2) promote treatment; and (3) challenge stigma.

Challenging stigma is essential to achieving our prevention and treatment goals. When stigma is strong, people may feel they’d rather not know their status. People who don’t know their status can’t get treatment. People on treatment may hide their status to avoid stigma, and as a consequence, don’t receive the support they need from friends, partners and family.

So I waited for the ad to pivot to a conclusion challenging the discrimination and stigma it portrays.

*        *        *        *        *

My last post was about a personal experience of discrimination linked to HIV stigma that I had on a gay chat application.

In that post I talked through some of the different theories about stigma, each one contributing a different piece of the puzzle. I argued that stigma is an inherently multi-level, complex concept.

In one influential definition by Bruce Link and Jo Phelan (2001), stigma consists of five components occurring together. We can see all of them in the hep C advertisement:

  • Labelling — the paper bag saying “I have Hep C” placed over Vladimir’s head in the ad;
  • Stereotyping — Vladimir’s co-workers believe he poses a threat of infection through casual contact;
  • Separation — his ex-partner, co-workers and football team mates see Vladimir as ‘other’ because of his Hep C status;
  • Status loss and discrimination — Vladimir is singled out and excluded in love, at work and on the footy field, and his identity as a lover, colleague and teammate in good standing is ‘spoiled’ (Goffman, 1967);
  • Power relations — these actions occur within the workplace and a sporting contest — environments where individual personality is expected to be subordinated within a hierarchical social structure; rejected as a lover as well, Vladimir is also denied entry to a caring and supportive relationship of equals.

For a short clip, it packs in some pretty heavy themes. The heavier it gets, the more important it is for viewers to see the clip pivot and challenge the stigma underlying  the discrimination Vladimir experiences.

What we see is Vladimir tearing the paper bag off his head in disgust, deciding to go visit and talk to his GP.

*        *        *        *        *

In Australia, it is illegal to advertise a prescription medicine direct to consumers. ‘Talk to your GP’ is code for ‘there’s a new product on the market that can treat the condition described in this advertisement’.

The implication is that Vladimir is going to get treated and stop allowing himself to be labelled Hep C-positive. All of the other dimensions of stigma will remain completely unchallenged — they just won’t apply to Vladimir anymore, once he’s cured.

Janssen-Cilag P/L has new anti-hepatitis C drugs on the market. That’s why they’re funding this clip. The clip itself was uploaded by Hepatitis Australia in the Nonprofits & Activism category of Youtube, but the “See the Real Thing” campaign website contains the following statement:

This website is published by Janssen-Cilag Pty Limited (Janssen-Cilag), which is solely responsible for its content. It is intended for Australian residents. Last updated on 08 July 2013.

Even though the video was selected by a competition involving members of the public, the prize money was funded by a drug company and the clip directs people to a website for which a drug company is solely responsible.

From a stigma point of view it has the potential to cause the following harms:

  • By vividly portraying but not challenging stigma and discrimination, it reinforces hepatitis C stigma;
  • It places the onus on the target of stigma/discrimination to take steps to evade it;
  • It uses the stigma/discrimination portrayed to place marketing pressure on people to get treatment;
  • If it works, the funders will have a commercial interest in the stigma not being challenged.

I am surprised and disappointed in the management and Board of Hepatitis Australia lending their brand and organisational credibility to a message that is so obviously counter to the National Hepatitis C Strategy principles.

Let’s be clear: we need more people getting treatment for hepatitis C. Newer treatments are easier to take than before. Taking hepatitis C treatment can lead to people being cured of hepatitis C, reducing their risk of liver failure and liver cancer and meaning they no longer need worry about passing it on to others.

But treatment doesn’t work for everyone, and not everyone is ready for treatment. A supportive environment, free from stigma and discrimination, is essential to motivate people to get treated and to minimise the impact on people for whom treatment hasn’t worked or isn’t appropriate. This campaign is a step in the wrong direction.

Author: Daniel Reeders

I study the cultural dimensions of the social governance of health.

17 thoughts on “Hep C stigma as a pharmaceutical marketing device”

  1. That Video stands for supporting STIGMA . . . Jesus Christ WTF is gong on in the Heads of the decision makers of Janssen-Cilag as well as the Management and Board of Hepatitis Australia . . . . . .

    My politeness stop me writing more . . .

  2. Holy crow! This reminds me of our FB discussion about herpes, which acquired “panic” status with the development of a treatment for it. Lesson well learned by Pharma, I’m afraid!

  3. I absolutely agree, I looked at this initially thinking it was a positive message about challenging stigma, and liked it for that reason, but on getting into it realised that it was pretty uncomfortable viewing, Hence i have unliked it and feel let down by janssen. They appear to have badly missed the point. Badly.

  4. Its appalling for the Hep c community when we are trying to educate awareness and acceptance. Their are many hep c advocates worldwide disgusted by this video. I say remove the video Hepatitis Australia… wheres your logic for asking us to share this appalling video with the world.
    Thank you Daniel Reeders, keep up the good work!!! Please feel free to express your concerns on Hepatitis Australia facebook page.
    I am, but nothing has changed to date.

        1. I don’t like it at all Daniel and either do lots of others. I think the visual impact in itself is enough to keep the” misconceptions and stigma” alive no matter what the closing statement says. Its a poor attempt to try to counteract the negative message that goes out to the world I feel. The statement that all people with Hep C need your support & understanding is true indeed, but feel this contradicts itself by what is portrayed sadly. It certainly isn’t a video to build ones self esteem through positive reinforcement if you are affected by this serious disease. The labelled paper bag really gets to me personally in the fact that it depicts we should feel ashamed and hide. Apparently this is just a misconception, so is this supposed to justify it all by telling us that it is. Thankyou for your support Daniel, I feel your contribution made Hepatitis Australia sit up and listen after I posted Bad Blood on their fb page. I also asked them if we don’t clear the virus with treatment ,do we put the paper bag back on our heads until we do. I would like to give credit to Hepatitis NSW who removed the video after 1 complaint and also replied to me. Hepatitis Australia to date hasn’t replied to me. All in all, a non productive event for the Hep C community I feel !!!

    1. A friends thought on the situation, what do think Daniel?

      still think it’s a cock-up rather than a conspiracy. And TBH I think this is just ludicrous “Hep C stigma as a pharmaceutical marketing device” because anybody in the Marketing Industry will tell you that if you stigmatise something you force it underground. Folks don’t get tested, drugs aren’t prescribed and Pharma Cos lose out on sales. Self defeating strategy.

      1. There are a couple of misunderstandings in that remark. A total ‘cock-up’ and still be stigmatising: intention is not required. And stigma has a whole range of effects, not just ‘forcing (things) underground’. I’ve argued in an article in HIV Australia that straight people expecting gay people to ‘come out’ is stigmatising, for instance, and at the very same time, the elaborate concern for confidentiality in clinical practice can send the signal that positive status is something people with a BBV need to hide. In both cases, the reproductions of stigma are unintentional. There’s no secret meeting of the Heterosexual Society or HCV-Negative Australians Inc or Pharmaceuticals Australia to decide to stigmatise gay people or people with Hep C, which is what your friend’s image of the ‘conspiracy’ suggests.

  5. As an advocate for people with Hep C I am appalled at this “winning” video. It sends entirely the wrong message to people who have either been diagnosed with Hep C and to people who may need testing. I am not an Australian, but I am a board member of a non-profit that works to remove the kind of stigma that this sort of thing creates. Think again, I say to the people who both created and are releasing this video, and maybe you need to talk to people in the Hep C community, and I know many in Australia that are outraged and they have contacted me to share their frustration and displeasure.

    Daryl Luster
    Hep C advocate
    Vancouver, Canada

    1. From Daryl Luster with his permission.

      Stigma or Discrimination?
      The not so subtle reality for people diagnosed with Hep C

      While attending a meeting a while back that included Hep C advocates, and many were people who themselves had been diagnosed with Hep C, the topic of stigma came up. During an impassioned and insightful discussion, one of the people there suggested that stigma was too kind, or gentle a word to describe what people who carry the label of Hep C Positive carry. We carry it for life I suppose, because it remains a part of our medical record, as well as a social “mark” on us if we choose to disclose that we have been diagnosed with this disease.
      They suggested that we should call it discrimination. I agree.
      Simply put, we are discriminated against again and again. I am suggesting that we are diminished as people because of this. We should never feel that way. These are issues that others have, through their own lack of understanding and their readiness to label us as something less, and by doing that they marginalize us. This is unfair and painful for many who suffer enough with the ravages of Hep C, not to mention the impact on things like family,employment opportunities, social lives, and many more parts of our life which can be diminished in quality.

      Those of us whom have carried this “mark” or designation, know all too well what we face almost day in and day out, depending on how the people around us choose to deal with our disease. Mostly what I see is ignorance, and as a consequence, far too often comes across as wild and crazy ideas about the disease, and I have seen this with people I know well, including Dr’s, Nurses, and just about everybody that is not well informed about what Hep C is and what having it means.

      I have spoken often about the need for more awareness, and I remain committed to this more and more, as it clearly needs the effort of many to make change in this area. My voice is small, but I do what I can to affect change. Some believe that we should just not talk or think about it. I disagree.

      We will not be quiet and go away, and if we speak out about how we are discriminated against, maybe, just maybe we can change things for the better.

  6. I think most have said exactly what i think being through triple therapy and suffering the indignant remarks and also losing a job and freinds over this virus, I am appalled that such a place would blatantly help re enforce peoples fears. Disgusted

  7. I work for gay men’s health charity in the UK. I was shocked to see stigma used as a marketing tool in this way. I was less surprised to find that the video had been selected by public vote, as it is a very human reaction to try to ‘other’ and exclude people with sexually transmitted infections. Unfortunately this tendency can prevent people from considering their own risk behaviour clearly. The new coda feels tacked on and will not dispel the overriding visual message within the advert.

  8. Good post Matthew and I understand for sure where your coming from by exclusion. I have attended support meetings in the UK with those co infected with HIV & HCV. Hep C in itself is not classified as a STD due to such a minimal chance of transmission. Its amazing how many participate in unsafe sex, if you reveal though that you have Hep C then it can take on a whole new mindset for sure. Hep B is a definite STD but it doesn’t appear to ring as many warning bells as Hep C, I personally feel.. is this due to Hep B being more treatable?

  9. A horrible video. I didn’t get to see the original version but I was appalled by the updated one. A minute depicting stigma with images, metaphors and stories will never be effectively “counter-balanced” by ten seconds of abstract assertions in plain text, where you would expect the credits and acknowledgements to appear.

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