Hepatitis C – a relationship
with stigma
Construction and representation in
the mainstream print media
Aim:
To explore how the daily print media’s
representation of hepatitis C may evoke
and compound experiences of stigma and
discrimination for people with hepatitis C.
Why study the mainstream print media
and its relationship with hepatitis C ?
•Extent of hepatitis C in Australia and prevalence
of related discrimination
•The mass print media
– Plays a significant role in providing health
information
– Reflects the dominant features and cultural
norms of the social system
– Can shape and reinforce readers’ attitudes,
values and beliefs
Which newspapers? Articles?
•Eleven daily newspapers in NSW and Victoria
•January 2000 to May 2002
Herald Sun; The Australian; The Age; Sydney Morning
Herald; Newcastle Herald; Illawarra Mercury; The
Weekend Australian; Herald Sun Sunday; The Sunday
Age; Australian Financial Review; Sun Herald
•Combined readership ~ 5.5 million weekly
•Reach ~ 50% of people in NSW & Victoria
•210 articles referred to hepatitis C
–56 directly about hepatitis C
–154 mention hepatitis C in another context
–33 headlines contain direct reference to
hepatitis C
Chart 1: Hepatitis and non-hepatitis C articles
56
Hepatitis C Articles
Non hepatitis C articles
154
Method: Thematic analysis
•Goffman (1963): Stigma arises from the
classification of an attribute which conforms to a
negative stereotype
1. Abominations of the body
2. Blemishes of the individual character
3. ‘Risk, blame and consequence’
4. ‘The lived experience of hepatitis C’
5. ‘Hepatitis C: social control, supporting and
treating the sick’
6. ‘Passing, normalisation and normification’,
Method: Content analysis
• How often messages and images are seen
influence whether they will inhabit a reader’s
consciousness (Chapman et al. 1994)
• Measuring the frequency of messages and
images in the media helps to describe their
significance
• In the 56 hepatitis C articles: 514 references
to hepatitis C
• In the 154 non-hepatitis C articles: 320
references to hepatitis C
Hepatitis C – The silent
epidemic
Topic
Numbers
affected
Numbers of
articles
Breast
Cancer
HIV/AIDS
~11,000/year 1485
~2,500
deaths/year
13,000
5,500
Hepatitis C
~250,000
210
Headlines - Abominations of the body
• “Hep C “plague” outrates AIDS” – Herald Sun
• “Hep C leads notifiable disease list” – Newcastle
Herald
• “Hep C trebled in youth” – Illawarra Mercury
• “Hepatitis “epidemic” fuels doubling of liver
cancer rate” – The Australian
• “Hep C is biggest risk” - Herald Sun
• “Hep C link to mozzie” - Herald Sun
Abominations of the body - Text
• Legitimate: “potentially life threatening disease”,
“debilitating disease”, “neglected epidemic”
• Emotive: “deadly virus”, “death knell”, “deadly
affliction”, “incurable virus”, "death sentence”
Plague
• “The disease had become a plague”
• “We expect a surge in this plague which would be
disastrous as there is no vaccine”
• Australia described as “..being in the throes of an
epidemic”
• Health professionals said to be “..alarmed by its
insidious and rampant spread across the country”
Abominations of the body - Text
Moral judgments
• Suggestion that hepatitis B and C can be attributed to
“migrants from countries with a high prevalence of
hepatitis such as South East Asian countries”
• “It was crucial that those sorts of figures, along with
prevalence of hep B or C in some ethnic populations,
were not introduced as part of the present national
debate on refugees and asylum seekers” (NSW Equal
Opportunity Commission)
Misleading information
• “The family, who found a condom inside a leg of lamb –
were still taking hepatitis C vaccine after eating a lamb
roast at their home in Alice Springs in August and still
feared that they might have contracted HIV”
Headlines: Blemishes of individual
character
• “Hep C rife in jails” – The Australian
• “Hep C spread culprits widen” – The Australian
• “The hep C untouchables – one every
hour” – Herald Sun
• “Hep C in addicts declines” – The Australian
Blemishes of individual character - text
• “Desperate addicts craving drugs sell their
bodies, betray their families, rob homes and
businesses to fund their habits, commit murder,
and spread diseases such as AIDS and hepatitis
C by sharing dirty needles”
• “In Australia the most common cause of hepatitis
C infection remains unsterile injecting drug use. It
is said to account for a staggering 91% of all new
infections”
• “She stole money from her mother, contracted
hepatitis C, then dropped out of school. At
Christmas she fell pregnant to her drug dealer
boyfriend but had an abortion”
Blemishes of individual character - text
• “So we’re told that we must keep handing out 4.1
million needles each year to stop addicts getting
hepatitis C – yet learn that half of them get the
disease from shared needles anyway.”
• “The survey provides evidence of the benefits of
at times controversial needle and syringe
programs which are central to harm reduction
approach adopted nation since 1985”
• “Overseas experience showed a link between
needle distribution centres and an increase in
transmitted diseases such as hepatitis C”
Headlines:
Risk, blame and consequence
• “Hep C scare ignites review of blood
law” – The Australian
• “Women contract hep C after surgery” –
The Age
• “Hepatitis C fear at hospital” – Herald Sun
Risk, blame and consequence - text
Risk
• “Deadly virus in blood supplies, says churchman”
• “The women had surgery immediately after
intravenous drug users, who were later found to be
carrying hepatitis C”
‘Innocent victim’
• “People who have hepatitis C but never injected
drugs get tarred with the drug injecting brush”
• “The father of two got hepatitis C after 3 blood
transfusions in a Wollongong hospital after a
suffering serious car accident in 1986”
• “Many of these victims, through no fault of their own,
face a debilitating lifestyle and may have had to pay
for expensive medications for an illness they had no
part in contracting”
Risk, blame and consequence - text
Community needlestick injuries
• “My first fear was AIDS or hepatitis C. But I couldn’t do
anything about it.”
• “The plain facts are that people are not catching HIV
and hepatitis C viruses by such accidents. The health
risks to people spiked by discarded syringes were
minimal”
• “The lifesavers – all volunteers – will be encouraged to
obtain hepatitis A, B and C and tetanus inoculations,
according to the president of the Elwood Life Saving
Club”
• PM also says: “Retractable syringes would ease
concerns among parents who fear their children may
get HIV or hepatitis C from needlestick injuries when
playing in public areas.”
The lived experience - text
• “I was no longer taking drugs when
tested, in fact I was undergoing
rehabilitation but was made to feel like a
scumbag junkie”
• “An infectious virus that causes her no
end of shame and angst. Tears of bitter
regret slide down her face. “You can’t
ever forget the hurt and being made to
feel so contaminated”
Headlines: Social Control
• “Hepatitis C hope” – Herald Sun
• “Help with hep C” – Newcastle Herald
• “Good news on hep C” – The Australian
• “New hope for hepatitis sufferers” – Sydney
Morning Herald
• “Drug hope for hepatitis C sufferers” – The
Age
Social Control - text
Policy
• “The availability of appropriate support services
and provision of accurate information for
people with Hepatitis C as well as their
families, partners, carers and friends is
essential for physical and emotional wellbeing”
• Tensions re injecting drug use, harm reduction
and public health: “ANCHARD does not in
anyway condone the use of illicit drugs,
however as a public health committee we
cannot ignore the fact that people do inject”
Social Control - text
Treatment
• “While results were exciting they should be
treated with caution because interferon did not
suit everyone”
• “This study really impresses me. I’ve been
inclined to watch and wait. Now I’d be more
aggressive”
• “He advised against people gorging themselves
on Vegemite as there was no evidence that B12
was protective against the disease”
Passing, normalisation and normification
• “Many are reformed drug users, men and women
who are in responsible jobs, have young families and
mortgages”
• ‘Carmen’ “… seems to have it all. Alluring looks, a
three year old daughter on whom she dotes, a
terrace house in a fashionable suburb and a portfolio
of shrewd financial investments. She is trying to be a
good mother and hold down a job”
• “I have yet to meet a person who hasn’t acted
foolishly or even recklessly at times”
• “Michelle” a heroin user with hepatitis C, tells
readers, “she would use a safe injecting room
because she has nowhere else to shoot up. I’ll never
forgive myself if a kid stood on my syringe”
Chart 7: Hepatitis C article themes
14%
Epidemiology
12%
Names for Hep C
Abominations of the
body
Association with HIV
Transmission
10%
About Hep C
IDU
NSP
Tattooing
8%
Blemishes of
individual
character
Deviance
6%
Lived
experience
Deviance other
Social
control
Risk
Blood products
Risk, blame &consequence
Blame
Hospitals
Needle stick
4%
Passing
Cost
Compensation
Discrimination
2%
Ignorance
Support
Policy
0%
NS
P
T
De atto
oin
via
g
nc
e
ot
he
r
Bl
oo
Ri
d
sk
pr
od
uc
ts
Bl
am
Ho
e
sp
ita
Ne
ls
ed
le
st
ick
Co
C
m
pe ost
n
Di
sa
sc
t
rim ion
ina
tio
Ig
no n
ra
nc
Su e
pp
or
t
Po
l
ic
Tr
ea y
tm
en
t
Va
cc
Ed ine
uc
at
io
Pa n
ss
ing
ID
U
Ep
Na idem
m
iol
e
As
og
so s fo
rH y
cia
ep
tio
n
C
wi
th
Tr
H
an
sm I V
i
ss
Ab
ou ion
tH
ep
C
Treatment
Vaccine
Education
Passing
Chart 8: Non-hepatitis C article themes
18%
16%
14%
Blemishes of
individual
character
12%
10%
Abominations of the
body
8%
Risk, blame & consequence
6%
Lived
experience
4%
Social control
Passing
2%
ID
U
NS
P
Ta
De
tto
oin
via
g
nc
e
ot
he
r
Bl
oo
Ri
sk
d
pr
od
uc
ts
Bl
am
e
Ho
sp
ita
Ne
ls
ed
le
sti
ck
Co
C
m
pe ost
ns
Di
at
sc
rim ion
ina
tio
Ig
no n
ra
nc
e
Su
pp
or
t
Po
lic
Tr
y
ea
tm
en
t
Va
cc
Ed ine
uc
at
io
Pa n
ss
ing
Na
Ep
ide
m
m
iol
es
As
og
fo
so
rH y
cia
ep
tio
n
C
wi
t
h
Tr
HI
an
sm V
Ab issi
on
ou
tH
ep
C
0%
Epidemiology
Names for Hep C
Association with HIV
Transmission
About Hep C
IDU
NSP
Tattooing
Deviance other
Risk
Blood products
Blame
Hospitals
Needle stick
Cost
Compensation
Discrimination
Ignorance
Support
Policy
Treatment
Vaccine
Education
Passing
Chart 10: Thematic references percentages, hepatitis C and non-hepatitis C articles
18%
16%
14%
Abominations of the
body
12%
Blemishes of
individual
character
10%
First column hep C articles
Social control
8%
Risk, blame &
consequence
Second column non hep C articles
Lived
experience
6%
Passing
4%
2%
Ep
Na ide
m
io
As me
so s fo log
y
cia
r
tio He
p
n
C
wi
t
Tr
h
an
H
sm IV
Ab iss
ou ion
tH
ep
C
ID
U
NS
T
De att P
via ooi
nc ng
e
ot
he
r
Bl
oo
Ri
d
sk
pr
od
uc
ts
Bl
a
Ho me
Ne spit
ed als
le
st
ick
Co
Co
m
p
s
Di ens t
at
sc
rim ion
ina
Ig tion
no
ra
nc
Su e
pp
or
t
Po
l
i
Tr
ea cy
tm
e
Va nt
c
Ed cine
uc
at
io
Pa n
ss
ing
0%
Hepatitis C; stigma and the media
• Each theme or reference in isolation does not
necessarily denote stigma
• However, attributes which conform to negative
stereotypes, such as notions of plague and
contagion, injecting drug use, other descriptions
of deviance, burden on society in terms of cost
and the adverse effect of hepatitis C on
‘innocent victims’ are repeatedly portrayed.
• These issues sometimes presented
dispassionately as facts or information but are
often described with emotive and discrediting
language.
Challenges for the sector
• Low reporting rates assist to create low
community awareness of hepatitis C.
• Hepatitis C is caught in a difficult and
paradoxical situation.
• In the articles hepatitis C is systematically
defined within a stigma narrative.
• Danger that this narrative will continue to
proliferate.
• Need for staff training and resource allocation
• How to frame hepatitis C?
• Using the media to advance a cause or
message involves taking risks.
Just as Goffman describes that it is
relationships between people which
confirm stigma it is also relationships
that will help to break it down.
Using the daily print media, with media
training, care and consideration, is a
good place to start.