Tackling Stigma Champion #2

We speak with Louise Hansford, a UK advocate for people who use drugs and those with hepatitis C. With more than a decade in the field, she’s seen the long-lasting harm caused when stigma overshadows care, and why mandatory training, peer voices, and compassion are needed to change the system.

In our second Tackling Stigma Champion Interview, Louise reflects on how stigma shows up in real life — from people walking away from healthcare after a single damaging comment, to patients being shamed in hospital wards, and even her own experience of a serious injury being dismissed as “drug-seeking behaviour.” She shares her vision for what needs to shift, from mandatory training to centring lived experience.

Louise’s tips at a glance

Make stigma training mandatory: Similar to the Oliver McGowan training for people with disabilities (more on that below), it should be mandatory for drug and alcohol awareness too
Start with peers: Real stories from lived experience can inspire action in ways professionals can’t match
Treat the first appointment as the test: If they’re not treated with unconditional positive regard, compassion, and care, why would they come back?
Challenge bias gently: Correct harmful language without shaming so people stay open to change
Check your policies in practice: Even well-intentioned systems, like opt-out testing, can cause harm if privacy and respect aren’t prioritised
Don’t assume “self-inflicted”: People’s health conditions have complex causes — alcohol or drug use is not the only story
Bring education earlier: Build empathy and awareness in schools to reach future healthcare workers before biases set in
Treat everyone like family: If you’d act differently with your own mother or father, it’s time to rethink your approach

Tell us a bit about yourself and your current work

I’m based in the UK and have been working in hepatitis C since 2012, when I set up a peer-led support and engagement project called Hep CU Later, for the NHS, in partnership with the Hepatitis C Trust. I now work as the Hepatitis C Elimination Coordinator South for the NHS APA (NHS Substance Addiction Providers Alliance). And I’m a board member for the International Network on Health and Hepatitis in Substance Users (INHSU). I also have lived experience of drug use and hepatitis C which has helped me connect with people as a peer and encourage them into treatment.

What are some examples of stigma you’ve witnessed – and experienced – firsthand?

Sadly, stigma is everywhere for people who use drugs. One woman I met recently had been diagnosed with hepatitis C over a decade ago. After a drug service worker told her he could disclose her status to her employer and to the driving licence authority (not true), she completely disengaged from healthcare. She missed every routine screening, never updated her GP, and only re-engaged when I contacted her and persuaded her to get tested and treated. That’s the kind of long-term damage a single comment can cause.

And those comments are still happening, a decade later. Recently, a friend went into a hospital where opt-out testing for blood-borne viruses is in place. It’s meant to reduce stigma, instead, a doctor told her she’d tested positive for hepatitis B and HIV — in a six-bed ward, with no privacy. As expected, my friend was devastated and went straight into shame and trauma response. Later, a nurse told her she shouldn’t kiss her son and suggested her husband must have been unfaithful. It turned out that the results weren’t even correct, but the damage was done.

As I’ve also experienced stigma and discrimination myself. Over 20 years ago, I had a motorbike accident and went to hospital in severe pain. I told the staff I used heroin so they could manage my pain appropriately. Instead, they assumed “drug-seeking behaviour.” I repeatedly reported thigh pain, but they focused on my ankle, sent me home, and left me with an undiagnosed broken hip which has had life-long effects.

What needs to shift — in people or in the system — to make sure moments like these stop happening?

We need national – even global – training programmes on stigma, bias, and discrimination against people who use drugs. In the UK, the death of a young man named Oliver McGowan, who was autistic, led to mandatory training on learning disabilities and autism. We need the same for drug and alcohol awareness.

Right now, my mandatory training covers fire safety, moving and handling, infection control – but nothing on drugs or stigma. Given how many people who use drugs or have BBVs die because of poor assumptions or inadequate care, it’s totally unacceptable.

One principle I share in my trauma-informed practice training is that the goal of a first appointment should be to make sure the patient comes back for the second. If they don’t, you need to ask why. If they weren’t treated with unconditional positive regard, compassion, and care, why would they?

Do you see positive change coming?

I’d like to think so, but not without earlier education. Most healthcare workers come from relatively stable, financially secure backgrounds and may not have had much exposure to health inequalities or substance use. Without empathy and self-awareness, biases go unchallenged.

How do you challenge stigma in real time?

I think one of the ways to challenge it is to focus on language. With drug and alcohol stigma, I encourage people to use people-first language, like “people who use drugs,” and to avoid shorthand like PWID in presentations. And of course, steer clear of words like junkie and other offensive words. That should be a given.

How can peers and personal stories make a difference?

A couple of years ago, I had a man called Stephen on my list. It took me about seven weeks to persuade him to walk the three minutes from his home to the GP surgery to see me. He’d been living with hepatitis C for 30 years but had avoided treatment because of stigma, and also fear linked to the old interferon-based therapies. Thanks to our outreach, he started the new direct-acting antivirals (DAAs) — and completed the course.

I asked him to make a short video about his journey, which I shared on my social media. That video proved powerful. Another man I knew had been holding onto his hepatitis C medication for 18 months without starting it. After watching Stephen’s story, he decided to take the treatment — and cleared the virus.

I found out recently that Stephen had passed away. His next of kin was listed in his medical records, yet the coroner’s office still issued a public appeal saying they couldn’t find them. It’s hard not to feel that, because his death was drug-related, not enough effort was made. But even in his absence, Stephen’s story continues to help others take that first step.

If you had five minutes with a healthcare leader or policy makers who didn’t think stigma was a problem, what would you say

I’d share stories – like Stephen’s and the others we’ve spoken about today – alongside my own. Then I’d ask them: if the same person in need was your mother or father, would you treat them the same way? If the answer is no, you need to give your head a wobble.

“If this was your mum or dad, would you treat them the same way?” Louise Hansford on stigma against people who use drugs