Newsday - March 13, 2001
Laurie Garrett, Staff Writer

The federal Food and Drug Administration is also scrutinizing claims that ads promoting the sale of antiretroviral drugs may contribute to unsafe sexual activities in the gay community, thereby spreading HIV. Studies in recent months have noted an increase in new HIV infections among gay men in several cities, including New York and San Francisco.

In New York City, where such ads appear on the walls of subways and buses, health officials worry the images of sexy, athletic men scaling mountains, going to parties and having fun may be masking the fact that HIV poses a fatal danger.

AIDS activist Jeff Getty of Survive AIDS, based in San Francisco, is one who says the advertisements, which depict handsome men getting married and partying, give an incorrect impression. "Three-quarters of our [Survive AIDS] group has died in the last 10 years." he said. "We don't think it's a sexy disease. It's not about climbing mountains. It's about IV poles, wheelchairs and pain."

The number of Americans living with AIDS increased 33 percent between 1996 and 1999, from 240,184 to 320,282, according to a report released yesterday by the Centers for Disease Control and Prevention. And since the anti-HIV drug cocktails were introduced in 1996, the CDC report says, survival time following AIDS diagnosis has jumped from 11 months to nearly four years. The bad news, Getty and fellow critics charge, is that it has become easier to forget that AIDS remains a terrible and lethal disease.

Last month the CDC issued new HIV treatment guidelines, calling for postponing use of the drug cocktails until a patient's immune system shows clear signs of deterioration, or the individuals progress to full AIDS. "If they [the ads] followed the new guidelines, they wouldn't say, 'I'm young, I'm sexy, I take these drugs.' They would say, 'I'm sick, I'm ill, I take them,'" Getty said in an interview.

Jeffrey Klausner,an epidemiologist with the San Francisco Department of Public Health, has been conducting opinion surveys of gay and straight men who visit city clinics for treatment of sexually transmitted diseases. So far he has questioned 262 men, 72 percent of whom agreed with the statement that, "HIV drug advertisements... portray men who are healthy, handsome and strong." And 62 percent of Klausner's respondents said yes, they felt that, "these types of advertisements affect a person's decision to have unprotected sex."

Though his study will not be completed until he has surveyed 1,000 men, Klausner said that he is already convinced that "the drug companies are using sex to sell drugs... This strategy sells sex to a very vulnerable and sexually identified population... resulting in perhaps unexpected increases in sexual activity."

Word of the survey's preliminary findings has spread in San Francisco. This week Tom Amiano, chair of the city's Board of Supervisors, called for the survey's findings to be made public, followed by local government hearings. Amiano says he'll push fellow supervisors to ban all such ads from San Francisco buses, subways and city property unless the drug companies agree to devote half their ad space to promoting protective use of condoms.

"The visuals are always young, buff bodies," Amiano explained, "neglecting, of course, their heavy side effects and the emotional toll... that these medicines are taking."

The list of toxic side effects of the various anti-HIV drugs is long, and growing as patients stay on the therapies for years on end. They include abnormalities in lipid metabolism that lead to heart disease, changes in immune function that spark autoimmune diseases, bone erosion , kidney failure, pancreatic disorders and diabetes, nausea, memory loss and other brain effects, diarrhea and bowel dysfunctions, depression, changes in libido and marked alterations in the body's ability to metabolize many drugs.

Drug companies increasingly pitch all of their prescription products directly to would-be consumers.

For example, Merck's drug, Crixivan, depicts a quartet of attractive young men, all wearing shorts, standing atop a mountain. The ad copy reads, "Going the distance. If you're HIV-positive Crixivan may help you live a longer, healthier life." The ad does note that Crixivan is not a cure, but the promise of longer, healthy life is the thrust of the pitch.

And Bristol-Myers Squibb has two large campaigns. One promotes Videx with the slogan "Mission Accomplished!" The nature of the "mission" isn't defined, but it is implied -- life without fear of HIV.

The company's other anti-HIV drug, Zerit, depicts handsome young men, grinning and saying, "I'm positive." The word "positive'" in the ad can be construed to mean both HIV-positive, and positive -- or certain -- that "Zerit can work for me."

Bristol-Myers Squibb declined to comment specifically on concerns about the advertising, offering only this statement: "Direct-to-consumer advertising of prescription drugs improves public health by prompting people to see their doctors and become more involved in their health. DTC advertising enhances the potential for dialogue between doctor and patient."

Merck spokeswoman Kyra Lindeman, also declining to respond to specific allegations about her company's ads, noted that the marketplace for anti-HIV drugs has become highly competitive, and all of the companies now conduct direct-to-consumer campaigns.

"Merck has had a DTC campaign for Crixivan since 1996," Lindeman said, "and we have found that, like all our DTC campaigns, these advertisements do motivate consumers to go and talk about their disease conditions with their physicians."

In New York City, Associate Commissioner of Health Isaac Weisfuse says that "in some ways public health messages are in competition in the marketplace," with the optimistic drug pitches.

Weisfuse adds, "We're clearly very concerned. HIV prevention fatigue is clearly a very real phenomenon in New York City."

On a national level Dr. Richard Klein oversees much of the FDA's antiviral drugs activities. He, too, is troubled by Klausner's findings.

Klausner said it's important to consider the impact of the advertising. "But I'm not sure if FDA is an agency that has any meaty jurisdiction over" drug advertising. Though this week Klein asked the FDA's general counsel to make a determination, it's probable, he said, that the agency will be unable to act. That's because under congressional limits on FDA activities the agency can stop only ads that are "misleading" in demonstrable ways. If the agency acts over vaguer questions, "we will be in court in a microsecond," Klein insisted.

And that vagueness, Eric Altman says, is the problem. Altman, who is assistant director of Gay Men's Health Crisis in Manhattan, says that his agency's clients don't come to HIV clinics saying, " 'I saw this ad, and the ad makes me want to have unsafe sex.' But you know what is real? These drugs affect the perception of the disease, of the consequences of the disease."

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