Press: You can always pop a pill
Authors: G. Yamey
Journal: BMJ (2001)

Gavin Yamey looks at direct to consumer advertising of HIV drugs

On billboards and bus stops in the Castro, San Francisco's gay district, advertisements for HIV drugs show beefy male models looking the picture of perfect health. Similar ads in the local gay press show beautiful men climbing mountains or sailing boats. These direct to consumer ads are perfectly legal in the Unites States, so is there anything wrong with these upbeat images? 

The city's daily newspapers certainly thought so. “Dubious message in bus shelters,” read the headline in the San Francisco Chronicle (15 March). The paper reported that a band of AIDS activists, together with the Department of Public Health, believe that the ads send out “too positive a message” about living with HIV.

“San Francisco to consider banning some ads for AIDS drugs,” said the Mercury News (15 March). Its story focused on the possibility that the city might become the first in the United States to outlaw these ads altogether.

Activists believe that the ads do not give an accurate picture of what it is like to live with HIV and to take HIV drugs, which can have serious and unpleasant side effects. In the ad that has caused the greatest outrage, for Crixivan (indinavir), four attractive men in hiking gear are shown on top of a rocky mountaintop, gazing into space. The headline reads, “Going the distance.”

“That's a phony and distorted image of what it's like to have AIDS,” said Jeff Getty of the activist organisation Survive Aids in an interview with the Chronicle. “On these drugs, you don't feel like climbing a mountain.”

Jeffrey Klausner, an epidemiologist in the city's health department, agrees. “Usually the ads have large, sexy models and fine print of what the side effects are,” he told the paper. “These medicines don't enable anyone with HIV to climb mountains. The side effects make it impossible.”

What's more, claims Klausner, the ads may have played a part in the recent rise in the HIV infection rate among the city's gay men (3 February, p 260). The ads, he believes, may fuel the idea that HIV is easily treatable and that safe sex is therefore unnecessary.

To back up his beliefs, Klausner has taken the unusual step of releasing preliminary data (available at www.surviveaids.org) from his survey of men attending the city's sexual health clinics. The data are incomplete—only 262 men, out of a target of 1000, have so far been interviewed. Nevertheless, Klausner told the press that 62% of men surveyed believed that the ads “affect a person's decision to have unprotected sex.” Gay men who saw the ads regularly, he said, were more likely to have unprotected sex than those who seldom noticed them.

“Because these preliminary data were so compelling,” he told the Chronicle, “I thought it necessary to bring it to public attention.”

Tom Ammiano, president of the city's Board of Supervisors, finds these preliminary data persuasive and has called a public hearing on 12 April to discuss a ban on the ads. He told the BMJ: “These ads are subliminally saying that the condition is not so serious—you can always pop a pill—which plays into why some young men are practising unsafe sex.”

If the city bans the ads, which it has the legal power to do, will the US Food and Drug Administration follow suit and impose a national ban?

Unlikely, says Richard Klein, from the administration's Office of Special Health Issues. “I'm not a fan of direct to consumer advertising,” he said, “but these ads are not in violation of the rules. The information about the side effects of the drugs is there in the ads, albeit buried in small type.” For the administration to take a regulatory position, he said, it would need “much better data” to support a link between the ads and unsafe sex. If the city does ban the ads, he believes, it could well be faced with a lawsuit from the advertisers. 

Klein agrees that the ads may not be representative of all gay men living with HIV, but he says there is no legal duty to represent all such patients in the images used. He agrees that it may be tasteless to show sexualised images of gay men in ads for HIV drugs, but the administration is “not the taste police,” he says.

Merck says that its ad for indinavir provides a useful educational function. Kyra Lindemann, spokeswoman for the company, said: “The visual of the ad was intentional—to describe the ability of individuals to overcome HIV. The purpose of the ad is to stimulate patients to go and discuss treatment options with their physicians.”

Back in the Castro, a gay man is about to have sex. He has seen the ads for HIV drugs, and perhaps these influence whether or not he puts on a condom. Such causality is of course difficult to prove. One thing that he did see in the ads was a mixed message: a sexy image being used to sell a drug for a sexually transmitted infection. And that, as Klausner says, “is like using Big Macs to sell drugs that lower your cholesterol.”