By Stuart Elliott

New York Times 10 May 2001

A leading maker of drugs that fight AIDS, the Agouron Pharmaceuticals division of Pfizer, and its agency, CCA Advertising in New York, are changing a consumer campaign they recently introduced for the drug Viracept. They are adding cautionary words that such drugs are not a cure for AIDS nor do they prevent the spread of H.I.V., the virus that causes AIDS.

The change is coming two weeks after the Food and Drug Administration sent letters to eight makers of anti-AIDS drugs, including Agouron, warning that those products could no longer be advertised without noting their limitations. The letters also warned against running ads with images that are "not generally representative" of patients with H.I.V., particularly photographs of "robust individuals engaged in strenuous physical activity" like climbing mountains.

The warning letters and the advisory being added to the Viracept campaign coincide with a growing debate about whether ads for H.I.V. drugs are too optimistic in their portrayals of patients "living with AIDS." Critics contend the ads may contribute to a rise in the rate of H.I.V. infections among impressionable people who perceive AIDS as no more debilitating than a cold or other minor ailment.

That debate has intensified since March, when preliminary results of a survey by the San Francisco health department found that gay men who had frequently seen AIDS drug ads featuring buff models in glamorous poses were more likely to engage in unsafe sex.

The dissension over ads for AIDS drugs is part of a larger dispute centered on the appropriateness of all advertising for prescription drugs aimed at consumers rather than doctors and health care professionals. Such campaigns, called direct-to- consumer advertising, have proliferated in recent years as the F.D.A. relaxed strictures against them.

But a backlash has been building over the decision to apply the tactics of consumer advertising like images of attractive, active people with H.I.V. in ads for AIDS drugs to the selling of prescription drugs, especially as the drug makers pour billions of dollars into direct-to-consumer campaigns.

The benefits that Viracept can "bring to people's lives" warrant advertising it directly to them, said Catherine O'Connor, manager for consumer marketing at Agouron in LaJolla, Calif. "We knew there was an emotional connection we could make with people with H.I.V., the same type of emotional connection we could make with physicians."

However, since hiring CCA last fall to produce a new campaign for Viracept, with annual spending estimated at $5 million, Agouron has sought ads with a "real, humanistic approach" that were "not like what was already out there," she added.

"From a marketing point of view, you could understand what they were trying to do, asking people to relate the powerful activities to the power of the drug," Ms. O'Connor said. "I don't think they were saying `If you take this drug, you can climb mountains.' "

"But people want to see themselves in the advertising," she added. "If you see someone mountain- climbing, you want to relate that to yourself." The campaign for Viracept by CCA, carrying the theme "Plan your future with Viracept," features portrait-style photographs of H.I.V. patients. They are seen standing as if in caught in a moment or thought or reflection rather than engaged in strenuous pursuits.

There are words next to the portraits that Ms. O'Connor described as "affirmations," like "Because where I go from here is up to me" and "Because I may be scared but I'm not alone." And while generally healthy looking, none could be described as Adonises or Venuses.

"We've focused on the efficacy of the drug and not on beautiful, buff people," said Mike Devlin, creative director at CCA.

"This is a tough disease, with tough choices," he added, and the campaign is intended to offer Viracept as "a choice, not the answer." Mr. Devlin compared the debate over the role the attractive images may play in encouraging risky sexual behavior to the debate over the role that video games and violent television programs may play in "making kids shoot up high schools."

"There's a level of personal responsibility, regardless of the images around you," Mr. Devlin said. "Reminding people about prevention is not a bad measure; maybe they'll say they should take the extra step and not be unsafe."

The decision to add the advisory was in the works before Agouron received the warning letter from the F.D.A., Mr. Devlin and Ms. O'Connor said, adding that the line to be included in all future Viracept ads will read "H.I.V. drugs do not cure H.I.V. infection or prevent you from spreading the disease."

The images in the ads are not being changed, they said, because the photographs of the models, all H.I.V.-positive, were already generally representative of H.I.V. patients and not unrealistically glossy.

The Viracept campaign replaces ads centered on images of animals, intended as visual metaphors for the drug's effectiveness. Those ads were created by Mulryan/Nash in New York, which closed. The new campaign is starting to appear in May issues of more than 100 magazines and newspapers read primarily by gay men, lesbians and H.I.V. patients; they range from national publications like The Advocate, Out and Poz to local publications for resort communities including Fire Island and Rehoboth Beach, Del.

"There's something to be said" for the argument that many ads for AIDS drugs are "maybe a little too glamorous," said Todd Evans, president and chief executive at Rivendell Marketing in Westfield, N.J., which sells ad space for publications read by gay men and lesbians and is handling the media services for the Viracept account.

"But it's advertising," he added, and glamorous imagery is often "what advertising is all about."

Since the warning letters were sent, Mr. Evans said, he was told by executives at one maker of AIDS drugs that they "are going to sit it out for a couple of months" and stop advertising "to see where this goes." "I'm concerned as a gay person that if you take the profitability from H.I.V. drugs, the companies will go on to larger markets with greater profits," he added.

Mr. Evans said one benefit of the "glamorized ads" for AIDS drugs that have come under fire has been "they took away some of the horrendous stigma" attached to being H.I.V.-positive.

"I won't say maybe they did too good a job," he added, but perhaps adding cautions to the campaigns "is not such a bad thing."