  
Survey results suggest HIV drug ads may encourage unsafe sex
Last Updated: 2001-04-17 11:54:51 EDT (Reuters Health)
By Kate Fodor
NEW YORK (Reuters Health) - Preliminary data from a large-scale survey being conducted by the San Francisco Department of Public Health suggest a link between exposure to HIV drug advertising and risky behavior among men who have homosexual sex.
Dr. Jeffrey S. Klausner, who directs the department's prevention and control services for sexually transmitted diseases, presented the data in testimony delivered late last week to the San Francisco Board of Supervisors. The board is considering a proposal to ban HIV drug advertising that has been cited as trivializing the deadly disease.
The advertisements, including those for Merck's Crixivan and Bristol-Myers Squibb's Zerit, are displayed on billboards across the city and feature pictures of robust, smiling models--some at the end of an uphill hike.
The US Food and Drug Administration, prompted by complaints from San Francisco officials, has also said that it will investigate the ads.
Klausner told the Board of Supervisors that data from the first 422 participants in the Department of Health's survey "provide compelling evidence" that the ads "influence individuals' perceptions of HIV disease and...adversely affect men's sexual lives."
The department plans to survey 1,000 men in all--half of whom have sex with men and half of whom have sex with women--and will present an analysis of the final data at a Centers for Disease Control and Prevention (CDC) conference this summer.
Initiated in early February, the anonymous survey enrolls men attending San Francisco's municipal sexually transmitted disease clinic, asking them about their sexual behavior and HIV status as well as their exposure to HIV drug advertising and whether they believe such advertising affects decisions about acceptable risk.
The effort is being conducted as part of the Department of Health's "ongoing efforts to understand recent increases in sexual risk behavior, STDs and HIV among men who have sex with men in San Francisco," Klausner noted.
According to Klausner, for the 215 men surveyed so far who said that they have homosexual sex, "increasing exposure to HIV drug advertisements was associated with [an] increasing percentage of self-reported unsafe sexual behavior." For the purpose of the research, unsafe sexual behavior is defined as unprotected anal sex with a partner whose HIV status is unknown or different from the survey participant's own.
The survey found that 12% of those who said that they never or rarely see the ads had engaged in unsafe sexual behavior in the past month, while 19% of those who reported seeing the ads on a daily or weekly basis had had unsafe sex during the month.
In addition, the survey found that men who have homosexual sex are more frequently exposed to advertising portraying HIV patients who are "healthy, handsome and strong," Klausner said. Twenty-nine percent of that group reported seeing the ads daily and 47% said that they see the ads at least weekly. The figures were 12% and 27%, respectively, for men who have heterosexual sex.
Among men who have sex with men, frequent exposure to HIV advertising nearly doubled the chance that a participant would say drugs have made the disease "less serious," Klausner reported. Nineteen percent of those with monthly, weekly or daily exposure to the ads believe that HIV is less serious because of new medications. Among those who rarely or never see the ads, the figure was 12%.
Participants' exposure to the ads also was linked to whether they believed the promotions affect decisions about sex. Of men who have homosexual sex and see the ads on a daily or weekly basis, 64% said that the promotions affect people's decisions about whether to have unprotected sex, compared with 40% of those who saw the ads rarely or never.
Of the total 422 men surveyed, including those who have homosexual sex and those who have heterosexual sex, 61% said that they believe the ads influence people's decisions about whether to have unprotected sex, Klausner noted.
In response to the San Francisco Board of Supervisors' original announcement that it would consider banning the ads, spokespeople from both Merck and Bristol-Myers Squibb maintained that the campaigns are a positive force in the fight against HIV because they provide education and encourage patients to talk with their doctors.
A spokesperson for Merck told Reuters Health on Monday that the company hopes to engage in dialogue about the survey with San Francisco officials. "There's clearly a concern overall about rising incidence rates of HIV in San Francisco, and we recognize and share that concern," she said.
However, she stressed that the company believes there are "a lot of different factors" that need to be examined as possible causes of the problem.
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