The Problem With “Not an Actual Patient”

“Not an actual patient.” In every print advertisement I’ve ever seen for an HIV drug that includes an image of a real human being, this small caption has appeared, clarifying that the person seen does not actually have HIV. I don’t see this sort of clarification in any other drug ad I’ve come across—and as a doctor, I see a lot of them. Diabetes medications, blood thinners, cancer drugs—no disclaimer. Apparently the drug company or the actors—most of whom surely don’t suffer from the maladies in question—don’t feel that this statement needs to be made for other conditions. So why the nervousness around HIV?

I remember an early episode of Friends where Joey stars in a print ad for a city clinic and finds himself—much to his horror—the face of “VD” (venereal disease). No disclaimer on that poster, and it cost him a date with a pretty girl and Thanksgiving dinner with his family. More recently Charlie Sheen found himself the victim of blackmail while he tried to keep his HIV diagnosis quiet. With what other diagnosis would someone pay out millions of dollars to keep it secret?

This is a prime example of what I call “diagnosis discrimination.” It’s the reason that obituaries of non-smokers who died of lung cancer feel the need to clarify that the deceased never had a nicotine habit. It’s the reason we specify when someone has cirrhosis without having been an alcoholic. There is a bias when people have a disease that we feel they brought on themselves. You’ve got lung cancer because you smoked four packs per day? Boo hoo. Your two-a-day fast food diet has left you with a fatal heart attack? We saw that coming. But, for the “innocent,” the ones with breast cancer, prostate cancer, lupus—those diseases that we did nothing to bring on ourselves—those are the ones we can proudly, and publicly, fight. HIV doesn’t fall into that category for most people, especially not in America in 2015. Children born to HIV-positive mothers are exempt, of course, from criticism. But the rest of those who are positive earn an unfair helping of contempt from the larger society.

This goes back to the beginning of the AIDS crisis, in 1981, when the CDC published a report on a few previously healthy gay men who had developed a rare form of pneumonia then known as Pneumocystic carinii pneumonia. Thus began the epidemic that has claimed about 34 million lives so far and infects nearly 37 million more globally. Over half of those worldwide and over one-third of those in the U.S. living with HIV are heterosexual, which is a big change from the early epidemic. I don’t think many people who are not heavily involved in HIV care know this. Many still believe HIV is a “gay disease,” specifically a gay man’s disease. So what is it about HIV that makes those four little words—“not an actual patient”—so important for drug advertising? Is it because an actor on the page doesn’t want to be assumed to be both gay and HIV-positive? Is it because the actor fears losing further jobs or, as in the like Friends’ episode noted above, relationships due to this assumption?

Perhaps the drug companies, actors, and agents behind them think the American public is mindless enough to actually believe that an actor really is what they are playing in an ad. It’s sad, but I could buy that argument. In fact, I would prefer that argument, that Americans are dumb and gullible. It would make me feel a whole lot better than if they felt HIV was a shameful disease, worthy of special stigma and disclaimers. Because that would imply that Americans were bigoted and hateful, possessing of a unique disdain for those stricken with HIV—even those who are just pretending. And that would make me sadder.