Buff Bodies in AIDS Ads Are Misleading, Critics Say
They scale rock faces, they ride fat-tire bikes, they look fit and fabulous and fun. The men appearing in public advertisements for prescription AIDS drugs are so attractive, critics have charged, that their images glamorize life as a patient, contributing to false confidence in the gay community about what is still an incurable, deadly disease.
Last week, San Francisco became the first city to publicly join the backlash. Officials announced plans to hold hearings on whether to ban the advertisements in their current form from public places. Recent studies have shown an increase in new HIV infections in San Francisco, and some believe the ads may have contributed to the problem.
“You see all these handsome, robust, buff men on billboards and bus shelters, and I think it creates a cavalier attitude” about the disease, says Tom Ammiano, president of the city’s board of supervisors, who has called the hearing for April 12. “You think, ‘If I get sick, I can just take a pill and get better. I can climb mountains and sing like Maria in “The Sound of Music.” ’ “
The city leases some of the spaces where the ads appear, he says, and it should have some say in what goes up there.
No one disputes the drugs’ overall effectiveness. Since the mid-1990s, when several types of new antiretroviral agents became available, doctors have mixed and matched them to create powerful anti-AIDS “cocktails.” Average survival time of AIDS patients has quadrupled since 1996, from 11 months to almost four years, according to a study just released by the federal Centers for Disease Control and Prevention. During that same period, the number of people living with AIDS has increased 33%, from 240,000 to 320,000. “There’s general agreement that it’s the improvements in antiretroviral therapy that are responsible for that,” says Lisa Lee, an epidemiologist at the CDC and the study’s lead author. “We have estimates that as many as three-quarters of newly diagnosed patients are now getting the therapies.”
One reason the drugs have had such quick impact: direct consumer advertising, manufacturers say. “The ads have always been meant to raise awareness about the drugs, and I think they’ve done that very well,” says Mary Faye Dark, a spokeswoman for Glaxo Wellcome, maker of Combivir, a leading antiretroviral agent. “The reality is that we’re 20 years into this disease, and people are living longer and in better health with the drugs than without them.” As evidence that the advertising may have a downside, Ammiano says, he will present preliminary results from an ongoing survey among men visiting city clinics treating sexually transmitted diseases, or STDs. Dr. Jeffrey Klausner, director of the city’s STD prevention program, has interviewed 262 men, and almost three-quarters agree that the AIDS drug advertisements portray men who are “healthy, handsome and strong.” More than 60% said these ads “affect a person’s decision to have unprotected sex.”
By itself, this evidence is not strong enough to prompt any action by the Food and Drug Administration, says Richard Klein, the HIV-AIDS program coordinator at the FDA, which regulates claims made in drug advertising. For that to happen, Klein says, the ad would have to be demonstrably false. “For example, if a drug was approved for cholesterol lowering in men, and they put a woman on the ad,” he says. “We could do something about that.”
Do the poster boys on phone kiosks and billboards constitute false advertising, in themselves? Many AIDS activists think so. After all, young, healthy 20-somethings represent only a fraction of a larger group of AIDS patients on drug cocktails, many of whom are very sick, says Martin Delaney, founding director of Project Inform, an AIDS information and advocacy bureau in San Francisco. Not to mention that many of the men on these drug cocktails suffer awful side effects, from headaches to diarrhea to lipodystrophy, a condition that can account for the sunken features and odd body contours of many men with AIDS.
Still, Delaney acknowledges that plenty of people on antiretroviral therapy do look very healthy. “With all the drugs they have to take, it’s surprising to me how good some people look,” he says. One young man in a current ad for Combivir, identified as Shon G., was on the drug at the time the ad was produced, according to Glaxo’s Dark. The same goes for the people pictured in all Combivir ads, she says.
Delaney says part of the tension over the ads is the result of AIDS activists and drug companies simply having conflicting agendas. During the last several years, for example, some drug makers have actually convened panels of AIDS activists to screen ads before distribution.
But the process is far from ideal, says Delaney. “I’ve sat in on all sorts of focus groups and panels, and usually they present you with four ads and ask you to choose--and they’re all offensive. So the best we can do is rank them, and we end up seeing those ads come out anyway.”
The complaint that the people pictured in ads create a misleading impression adds a new dimension to the ongoing debate over direct-to-consumer marketing of prescription drugs, health officials say. Since the FDA first allowed the practice more than a decade ago, doctors have said that the ads often confuse consumers. Sometimes side effects aren’t adequately reported, they say, and the ad copy can convince people to demand a drug that’s not ideal for their condition and who they are.
But images are much harder to regulate than words--and the pharmaceutical companies know it, says UC Davis’ Dr. Richard Kravitz, who studies drug advertising. “There’s no question the companies use visual images to sell their products, and they’re smart about it,” he says. “They know that showing someone with AIDS scaling a mountain is not so different from showing someone with hay fever, sitting in a field of poppies with their shaggy dog in an ad for allergy medication.”
For his part, Ammiano says he is willing to negotiate some kind of compromise. “I’d be willing to broker something,” he says. “At the very minimum, we’d like the ads to devote some space to a prevention message,” discussing condom use and regular STD checkups.
