Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.

Reuters NewMedia - Friday December 21, 2001
Christopher Michaud

Some 20 years after the disease burst onto the scene, activists may have the opposite problem. They are now working furiously to stamp out the perception that AIDS patients, or those who test positive the virus that causes it, can live active, normal lives, thanks to a number of new drug therapies.

In recent years, pharmaceutical companies have introduced a range of treatments that have extended the lives and improved the well-being of patients. The ads they've used to market these new wonder drugs are hardly studies in helplessness. They show athletic men climbing mountains, renovating their homes or working out in the gym.

You would think the activists would be delighted. You would be wrong.

"People are obviously living longer and looking better, but the fact is the side effects are very severe, and we don't know what the long-term effects are going to be," said Marty Algaze, communications director for the nation's oldest AIDS support group Gay Men's Health Crisis.

Activists like Algaze argue that the ads may be convincing young people that they have nothing to fear from the once-deadly disease, which destroys the human immune system after a long incubation period. That may be encouraging the kind of risky behavior that might lead to more people being infected.

Alarmed by a rising HIV infection rate, affecting many young gay men -- the Centers for Disease Control estimates that Americans living with AIDS increased 33 percent from 1996 to 1999 -- activists have increasingly lashed out at the drug companies' sunny images of life with AIDS??? Even the U.S. Food and Drug Administration got into the act and began taking a look at the AIDS drug campaigns, finding them to be misleading. The FDA, which regulates the $145 billion annual U.S. prescription drugs business, made the finding after examining the small but growing portion of the $2.5 billion advertising targeted at AIDS and HIV drugs.

In late April the agency sent an "advisory letter" to eight or nine manufacturers of more than a dozen products, warning their ads "didn't include important limitations associated with the products," said Nancy Ostrove, the FDA's deputy director of the Division of Drug Marketing, Advertising and Communication.

Ostrove said of the offenders were warned against making claims or suggesting things the drugs can't really do.

This meant letting users know "that they don't cure HIV, they don't reduce the likelihood that it's going to be transmitted, and that they don't reinforce that the product has to be taken in combination with other products," Ostrove said.

"There are images in many of the ads that didn't seem to be representative of people who are being treated for HIV infection," she added.

Often cited was an ad for Merck & Co. Inc.'s Crixivan, one of the first protease inhibitors to hit the market, which depicted several robust hikers who seemingly had just scaled a towering mountain peak.

"If you're HIV positive, Crixivan may help you live a longer, healthier life," it said.

Typical of the activists' response was that from Jeff Getty of the San Francisco group Survive AIDS, who said "It's not about climbing mountains. It's about IV poles, wheelchairs and pain."

USING SEX TO SELL AIDS DRUGS

Others have accused the pharmaceutical companies of using sex to sell drugs, or called the ads the Joe Camel of HIV, referring to the widespread criticism of the animated character used to sell cigarettes which some felt was directed at children.

The San Francisco Board of Supervisors went as far as mulling a ban on HIV drug ads in the city.

What a difference a couple of decades can make. Such statements as Getty's mark a nearly 180-degree turn from the 1980s, when his predecessors routinely blasted the media for referring to someone as "dying of AIDS," even if they were. Rather, it was said, people were "living with AIDS."

Since the FDA letter, a move that Ostrove characterized as "relatively unusual," the ads have largely vanished, thinning out the gay magazines they once peppered and with only the occasional torn, faded, graffitied poster haunting subway stations.

Newer ads, such as one for Viracept, manufactured by Pfizer Inc.'s Agouron division, now contain caveats including that the drugs do not cure HIV or prevent its transmission and can have serious side effects.

"From what I've seen, it appears they're certainly trying to comply," Ostrove said of the more recent ads. Advertising in gay publications has started to disappear entirely.

But not everyone is happy with the shift, even within the gay community.

"The fact that people are blaming the pharmaceutical advertisers for the rise in unsafe sex is ludicrous," said Joe Landry, publisher The Advocate and Out as well as hiv plus, a newer publication.

Landry said it was "really offensive" to blame Crixivan for promoting unsafe sex because its maker Merck was "the first company to portray a positive image of an HIV-positive person."

"When I first saw ads for Crixivan I thought, "all right, there's hope.' And now, five years later, the activists are blaming the drug companies -- again," Landry said.

For their part the pharmaceutical firms are mostly reluctant to criticize the activists or comment on the political minefield that the relatively recent phenomenon of direct-to-consumer drug advertising can be in a sensitive arena like AIDS.

"There's a line, and the line is kind of fuzzy, politically," said the FDA's Ostrove.

A BUSINESS DECISION TO CHANGE MARKETING STRATEGY

The drug companies note that in any event the campaigns had outlived their useful lives and were already being phased out even before the FDA sent its critical letter.

"It was a business decision that we had made to change our strategy regarding the promotion of Crixivan," said Merck spokesman Chris Loder.

Crixivan, Loder said, has been out since 1996 and is "well known in the community, to doctors and health care workers, and we wanted to target our promotional pieces in a patient-focused manner. That's the reason you won't see mass marketing of Crixivan," he said.

The direct-to-consumer ads Merck runs now "are fully in compliance with the FDA," Loder added.

But he declined to comment on whether the dearth of recent ads in the gay press stemmed from the flap or the flagging economy.

Publisher Landry, however, had some thoughts on that.

"Companies don't like controversy," he said, "and if they can avoid it, they will."

"No one likes people yelling and screaming at them, so maybe they're taking a wait-and-see approach."

The irony, he noted, was that the drug companies had pulled back "just when they need to advertise -- because of the rise in seroconversion."
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