Bay Area Reporter - April 20, 2001
David Fraser

Against increasing controversy over upbeat outdoor advertising for HIV/AIDS drugs on city property, San Francisco Board of Supervisors President Tom Ammiano is turning up the heat on pharmaceutical companies to tone down their ads.

One way to get their attention: a possible ban on such advertisements on city property.

Ammiano told the Bay Area Reporter on Monday, April 16, that given the serious issues involved, he is prepared to move in that direction.

Many prevention advocates and experts argue that drug companies are using ads that paint a rosy face on the ravages to the body from HIV/AIDS. In effect, they say, the firms are selling the disease to sell drugs.

Ammiano, who chaired a hearing on direct-to-consumer HIV/AIDS drug advertisements last Thursday, April 12, said he was moving to get a quick response from pharmaceutical firms.

"I haven't gotten any direct responses," Ammiano said. "I've heard from a New York contact, a doctor who works with the drug firms, and he thinks it would be in their best interest to sit down [with city officials] and he is willing to act as an intermediary."

But, said Ammiano, sounding far less conciliatory than at the hearing, "if they don't respond in a timely manner, the city attorney is ready to draft legislation banning such advertisements.

"We are definitely committed to going there," Ammiano added. "I think this is brokerable. But the pharmaceutical companies are so autonomous and have so much money that if mediation fails à"

At the hearing the board president had said he was seeking mediation, not litigation.

In an ongoing effort spurred by recent proliferation of 'glam' lifestyle HIV ads on billboards and city bus shelters, local health officials and HIV prevention activists are tackling what they see as sexually provocative and misleading advertisements. They argue that the images of physically healthy and attractive men û some shown mountain climbing û betrays the horrors of AIDS.

Other ads have drawn fire for featuring handsome men, some "scantily clad" with bedroom eyes or come-hither looks. Critics say the ads may lull people into believing AIDS is not so devastating, and thus promote unsafe sexual practices, especially for youths who haven't dealt with the disease.

At the hearing, prevention activists and health officials spelled out their problems with the advertising. One major objection: young people who may get the message that HIV isn't such a big deal.

In a letter read to the committee members, Stop AIDS Project board members said: "We also hear from men, both HIV-positive and -negative, who put it much simpler with statements such as 'Climbing mountains, my ass! Where's the Porta-Potty?'

"And, perhaps the most troubling story we have heard occurred at a seminar held in March for people who have recently tested positive. Participants were discussing the pharmaceutical ads and one 25-year-old man summarized the conversation by saying that the ads made him feel that getting HIV was 'no big deal.' He is now learning what it truly means to try and manage being HIV-positive."

The writers, board members Chris Cowen and Rafael Rosario, said they did not support an outright ban on the advertisements in question, but wanted pharmaceutical firms to take responsibility for possible unintended harm to the community.

Such advertising "gives the wrong signal to the non-infected or to kids," said Rosario, who is HIV-positive.

Regimen for life

HIV drugs have improved his life, Rosario said, "but I still have to deal with neuropathy and daily diarrhea. This is a reality. People need to know: this is going to be your regimen for the rest of your life. The pharmaceutical companies should address this."

No one from the pharmaceutical industry addressed the hearing.

Many speakers argued that the drug firms were essentially cynical in their appropriation of positive images.

Survive AIDS' Jeff Getty told the committee that he was concerned about the prominent appearances of ads that are "sexual in nature" on city billboards and bus shelters, and raised the question of whether such images "could lead to unsafe sex."

In actuality, he said, when taking powerful drugs for HIV/AIDS, "you get to the point where you're not out climbing mountains, you're not out sailing."

Some ads "are telling children, 'I'm positive, but with the drugs I'm going to feel more like myself again.' The pharmaceutical firms are selling the disease with drugs," he added.

Bus stop

Lew Lillian, general manager of Infinity Outdoor Advertising, handles advertising for San Francisco's 1,100 bus shelters, as well as billboards.

"I'll make every effort to support what we do [at the hearing]," Lillian said. "But we should be cautious in talking about a ban. We can tell the pharmaceutical companies to modify their ads, to not make them provocative. The bottom line is, they cannot make people think they can just take a pill à"

Lillian, who was en route to an industry meeting this week, told the B.A.R. on Monday that some industry contacts were listening, but some were "sort of blas ."

An effort to ban advertising would be "kind of a litigious thing," Lillian said in his presentation. "It would be trouble, it would be biting off an awful lot."

He said there were limits to how much image and content could be regulated.

Infinity donates to the city about $1 million annually in advertising space; of that about $225,000 goes for HIV education, Lillian said. His firm often donates space to the San Francisco AIDS Foundation.

He added that a number of prevention warnings, "especially from the San Francisco health department, are provocative, some have used a relatively sexy approach."

Most LGBT media outlets, including the B.A.R., rely on revenues from pharmaceutical advertising. Some of the ads being challenged in the hearing also appear in magazines such as POZ and other media. Crixivan's mountain climbing ad tops the Crixivan Web site. The drug, also called indinavir, is made by Merck & Co.

A number of critics have also noted that outdoor advertising, unlike print ads, leaves little room for complex disclaimers and warnings. What there is usually is printed in very small type.

Dr. Jeff Klausner, director of STD Prevention and Control Services for the Department of Public Health, told the hearing a preliminary study of 442 men showed that 61 percent believed that HIV advertisements "affect a person's decision" to have unprotected sex.

Kyra Lindemann, a spokeswoman for Merck & Co., which makes Crixivan (indinavir), told the B.A.R. in a telephone interview that the pharmaceutical firm had done no outdoor advertising since September 2000. She said the firm's strategic objectives had changed to emphasize print media, adding that "all our ads are consistent" with federal Food and Drug Administration guidelines.

Asked about the drug's advertising messages, Lindemann said, "Crixivan's imagery has been consistent over five years, with the mountain climbing. The image intentionally demonstrates the ability of people who have HIV to lead active lives. There's a lot of anecdotal evidence from people on treatment saying they feel better, more energized."

Merck's advertising is "not just about pictures," Lindemann said. It's designed to encourage dialogue between patients and doctors. "There's a lot of information about benefits and risks."

Notably in print ads, Lindemann added, where an image page is usually followed by a medical details and disclaimer page, "we talk about side effects. We say Crixivan is not a cure."

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