Smoke, mirrors & the business of AIDS

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By now you’ve seen those ubiquitous One Life ads. Beautifully photographed, for months they appeared everywhere from transit shelters in queer villages to full-page spreads in many Canadian queer publications, including this one.

One ad features two muscled hotties, tattooed arms coiled around one another in heavenly embrace. “Isn’t it queer… to hide your emotions, to hide in the closet, to hide from your best friend, to hide your… to hide,” reads the ad.

There is also a similar, less sexual version showing two handsome gents about to marry. “Do you Stephen… take Peter for better or worse through sickness and health, for richer, poorer, till death do you part?”

Both ads urge readers to visit Luvu2.ca. There, they are strongly encouraged to get tested for HIV. There’s even a directory that will point them to the nearest clinic.

Luvu2.ca also includes a viral video encouraging everyone to get tested, set to musical heavyweights Mary J Blige and U2 singing U2’s hit “One.” To spread the message far and wide, the site promises rather vaguely that every time the video is shared, a dollar will be donated for “future AIDS-related programs.”

This One Life campaign is courtesy of the folks at pharmaceutical giant Bristol-Meyers Squibb (BMS) and BMS doesn’t hesitate to take credit for its perceived good deed: advocating that gay men and youth get tested for HIV, promoting being good to themselves, honouring themselves and taking care of one another. It’s the cool thing to do, rockstar cool.

But what might not be so obvious to many is the One Life campaign’s relation to another ubiquitous HIV/AIDS ad campaign that ran concurrently. It was the one featuring a cute guy with bangs and narrow eyes holding out a single pill. “1 with U,” the copy reads. “Living with HIV is complicated enough. Your treatment doesn’t have to be.”

No one claimed credit in the 1 with U ad, but it too was from the people at BMS. It’s a thinly veiled promotional ad for the company’s one-a-day HIV pill, Atripla. The drug isn’t mentioned in the ad because it’s illegal under Canada’s Food and Drugs Act to advertise prescription drugs direct-to-consumer.

Atripla is the result of a joint effort between BMS and the pharmaceutical company Gilead Sciences. It’s a combination of the BMS drug Sustiva with Gilead’s Emtriva and Viread. It’s the concoction they’ve called Atripla and BMS is marketing the bejeezus out of it.

The 1 with U ads were often found conspicuously close to the aforementioned One Life ads. It was done with such noticeable frequency that you couldn’t help but put the two messages side by side for a broader one: Get tested for HIV, it’s what you do if you really love yourself. Should it happen you are HIV positive, know that we have a convenient one-a-day pill waiting for you. Ask your doctor.

The dual ad campaigns — and their regular side-by-side placement — raise several issues gay men need to know about.

“It’s really nauseating,” says Toronto doctor John Goodhew, who provides care for many HIV-positive patients. “The One Life ads are incredibly maudlin and emotionally manipulative. It takes an important message — get tested — and turns it into a marketing ploy.”

Tough side effects

What BMS does not reveal in its 1 with U campaign is that its 10-year-old drug, Sustiva, in the Atripla concoction, is a black sheep among HIV drugs, its bad rap for side effects well documented both officially and anecdotally.

The product monograph — that folded document that comes with the prescription — states that in Clinical Study 006, “52.7 percent of patients receiving Sustiva reported central nervous system symptoms” of varying severity including dizziness, insomnia, impaired concentration, somnolence, abnormal dreaming, euphoria, confusion, agitation, amnesia, hallucinations, stupor, abnormal thinking and depersonalization.

Ken Monteith, the former executive director of AIDS Community Care Montreal, now the head of the Quebec coalition of AIDS organizations, COCQ-Sida, took Sustiva for three and a half years.

“I used to be a guy who would go to bed and wake up and my hair wouldn’t even be messy,” he recalls. Then he started taking Sustiva, which he acknowledges did reduce his viral load to undetectable levels, but “I would wake up with all my bed sheets in a ball because I tossed and turned so much.”

Like many people living with HIV, Monteith experienced depression, which he says Sustiva only made worse. Monteith finally stopped taking the drug in October, after going “four or five days where I really couldn’t string words together without crying. That was the point at which I decided to change.”

Brian Finch, who has been HIV positive for almost as long as the world has known about the disease, is no fan of Sustiva either. He has taken virtually every HIV drug there is and his tribulations with Sustiva are well documented in his darkly humorous blog, Acid-refluxweb.com.

“You can’t discount what it’s like to be suicidally depressed, to not be able to remember things to the point of not being able to work or take care of yourself,” says Finch, adding that while he was on Sustiva he “wanted to jump off a cliff.”

“I couldn’t even write a simple, comprehensible email,” he says. “These are no mere side effects.”

A Google search reveals scores of Sustiva side-effect horror stories. On Poz.com, the website adjunct to the popular US print magazine for HIV-positive people, user Leatherpoz writes, “The panic, depression, night terrors, anxiety, as well as digestive problems were literally driving me crazy.”

This past summer Finch went so far as to take a panel of researchers and doctors to task at the International AIDS Conference in Mexico City. Finch’s comments made headlines when he declared that too much attention was being paid to Atripla’s convenience and not enough to its side effects.

“I don’t want HIV to be convenient,” Finch told them. “I want to be treated with safe, effective drugs that don’t make me want to hurl myself off my balcony.”

As Goodhew notes, however, “Sustiva is still useful,” saying he frequently prescribes it to patients. “But it has developed a reputation in the community because a lot of people who take it have a strong adverse reaction to it.”

But the 1 with U ads avoid those details, playing up dosing simplification instead, which admittedly can help some people stick to their treatment regimes.

“There is a convenience element to the ad, but there is still also a concealment element,” says Goodhew.

BMS wouldn’t allow any of its employees to be interviewed for this article, except media spokesperson Marc Osborne.

“This one pill was an unbranded campaign,” says Osborne. “The novelty is there is a daily one-pill available now.”

Still, as Monteith points out on his AIDS Community Care Montreal blog, Accmpositiveoutlook.blogspot.com,”It would be naive to think that people can’t figure out what drug is being advertised in the 1 with U ads.

“There is only one combination available in the format of one pill once per day, so this campaign is treading rather close to the line.” On his blog Monteith calls the campaigns and the ad placement, “a violation of the spirit of the ban on direct-to-consumer advertising.”

Not so new

The three drugs in Atripla have been on the market for some time. Health Canada approved Sustiva in 1999, Viread in 2004 and Emtriva in 2006. The combination of the three into Atripla was approved just last year.

Another pharmaceutical company, Tibotec, received approval in April for another HIV drug, Intelence. It’s one of the drugs Finch takes.

Intelence is noted as the first new medication in more than a decade from the same class of HIV drugs as Sustiva. But the side effects associated with Intelence are far less severe.

When you’re a company like BMS selling a drug like Sustiva and a competitor gets approval for something that does the same thing with fewer side effects, what else do you do but repackage and market your now-obsolete drug as something new?

Jose Sousa has been involved in HIV/AIDS activism since 1989 and sits on the board of the Canadian Treatment Action Council (CTAC) as its Quebec representative. He balks at the marketed newness of Atripla.

“It’s being hailed like it’s a new molecule,” he says. “People don’t realize it’s three drugs already readily available.”

“This is not to debate one’s opinion on drug innovation,” says Osborne, steadfast on message that the 1 with U campaign was to promote the one-pill option and not a rebranded Sustiva. “If you go back many years ago, there’s a point where you needed to take many pills,” he says.

But that was many years ago. “People with HIV these days can be on a regimen of two or three pills anyway,” says Sousa. “One pill really isn’t a big deal.”

Certainly not for Monteith. After stopping Sustiva he switched to a multi-pill regimen to avoid side effects.

“It doesn’t matter to me that I take one pill,” he says. “I’ve been taking them for 11 years, I just gulp them back all at once.”

Is awareness prevention?

Does BMS’s advertising hocus pocus at least help to prevent the spread of HIV?

“From a prevention perspective the way this has been done doesn’t make people, especially younger people, scared of HIV,” says Sousa.

A point worth taking, considering that in Toronto HIV rates are on the rise among 15- to 24-year-olds — the very market targeted through the use of Blige and U2.

Goodhew, however, says he doesn’t fault BMS, pointing out that it is in the business of making money.

“They are shareholder-driven,” he says, blaming instead the Pharmaceutical Advertising Advisory Board (PAAB).

“The PAAB are the ones who police the no direct-to-consumer advertising…. Either a bureaucrat fell asleep at the switch by allowing these campaigns or they’ve lowered their standards and are beginning to open the door to direct-to-consumer advertising.”

Osborne admits he can understand how people drew the link between the two campaigns.

He also insists the One Life ads were no more than the pharmaceutical company asking, “What could we do to talk to people about the need to get tested?”

Clearly, though, there is an argument to be made that coming from a company hawking an older, unpopular HIV/AIDS drug, the BMS advertising is transparently self-serving.

“It’s not because you are running a campaign that you are necessarily going to sell drugs,” Osborne counters. “It’s about being careful and being tested so you know you carry the virus.”

But if the ad urging readers to get tested runs right next to the ad for a one-a-day pill and the same company bought and paid for both ads but only identified itself in one, does that not seem remotely suspicious?

“It could have been done better,” says Osborne. “We’re going back to the ad agency.”

Sousa isn’t buying the BMS company line, especially because BMS has billions at stake and employs only the best marketing experts money can buy.

“Companies like BMS don’t make mistakes like this,” he says.

“We apologize and we would do it differently,” Osborne assures. “We’ll make sure in the future we can do better.”

Some might say it’s a little too late to do the right thing now, given that the campaign has come and gone and the messaging is now in the psyches of countless people who are now asking their doctors about Atripla.

“Now if someone comes in and wants to talk about the one-a-day ad it’s more work because I have to address what Atripla is and isn’t,” explains Goodhew.

“I address the benefits of one-a-day, that it’s not actually new and that it tends to have a significant side-effect profile. You have to undo the slick messaging. Decisions about treating HIV are complex and don’t fit on billboards.”