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A group of four young, robust hikers stand atop a mountain cliff, looking at the spectacular view afforded them by their climb. They are fit and happy, triumphant even. The ad that features their photograph is not for Eddie Bauer or a vacation destination or even the SUV that helped them get there. Instead, it is an integral part of an advertising campaign for Merck Pharmaceuticals, the maker of the HIV-fighting protease inhibitor Crixivan. This year, as the AIDS epidemic in the United States enters its third decade, many people living with HIV are doing so thanks to drug combination therapies that have worked to increase their life expectancies. One effect of the (relative) success of combination therapy is that the paradigm for understanding life with HIV and its treatment has become similar to that of chronic illness management. This model of management, of “living with” rather than ‘dying of” HIV/AIDS has been accompanied, since the early 1990s, by a particularly American phenomena: the marketing of AIDS-related services and drug therapies to a new niche market, the HIV+ consumer. Some of these advertisements have been subject to criticism, particularly from California AIDS activists, because of their misleading, even dangerous, representations of HIV+ people and their lives. There is, for instance, concern that the recent crop of ads featuring athletic and handsome models has instilled a more carefree attitude toward the disease — that it is more an inconvenience than a killer. The ads are in magazines and plastered on bus shelters, billboards and other public spaces. On April 27, the Food and Drug Administration responded to the criticism and cracked down on the pharmaceutical companies, noting that certain direct-to-consumer drug ads falsely represent patients’ lifestyles (by featuring images of people climbing mountains, for example) and the drugs’ abilities to improve the health of HIV+ patients. The FDA ordered the ads changed within 90 days to include information about the dangers of transmitting the virus and its deadly nature. The ads targeted by the FDA are only the latest and most publicized episode in a history of problematic representations of people with HIV/AIDS in ad campaigns by two major corporate interests: pharmaceutical corporations and life insurance brokerage firms (otherwise known as viatical settlement firms). The ads have not only seduced the HIV+ viewer, but they have also shaped the American cultural imagination of who, exactly, people with HIV/AIDS are, as well as what life with HIV is like. Selling Peace of Mind
Back in the early 1990s, when HIV still constituted a death sentence, viatical settlement companies like Life Partners, Inc., and Estate Trust, Inc., played upon the fear of dying with financial obligations left unsettled or with dreams left unfulfilled. In a Life Partners ad published in The Advocate in 1995, a young white man with short dark hair and wire-rimmed glasses looks out at the reader, his head propped up with his left arm, which is balanced on his knee. He looks deep in thought, and his expression indicates that he’s pausing a moment before he speaks. The text (in quotes, to signal that he’s talking directly to us) reads: “Today my T-cell count fell below 500. And I feel fine. I’m still working. But I know eventually I’ll need long term medical care. My insurance won’t cover all the costs. And I want some cash now to put in savings, and for other expenses. So I shopped around and then sold my life insurance policy to Life Partners ” Now I have the peace of mind and some extra money to enjoy it.” This copy is similar to many other insurance ads; it emphasizes peace of mind and an awareness of one’s impending transition from HIV to AIDS to death. Selling a life insurance policy probably seems like a good idea if you’re not planning on needing it. Making that choice might seem like an even better idea if there are a bunch of good-looking men, like those featured in the ads, doing the same. This type of marketing worries Amy Rosenberg, senior public policy and legal specialist for the Boston branch of AIDS Action, a Washington, D.C.-based advocacy group. In an article about viatical settlements written by Sue Rochman in the February/March 2001 issue of hivplus magazine, Rosenberg discussed her fear that consumers are not fully informed about the financial consequences. “The advertisements for these companies are very deceptive,” Rosenberg said. “They picture this gorgeous guy sitting [around], and we were afraid people would be seduced by that image and not understand the potential impact of selling their policy on other parts of their financial life.” Rosenberg’s comment makes sense when you look at the back cover of the November 2000 issue of a&u: America’s AIDS Magazine, and see an ad for the Viatical Benefits Foundation featuring handsome HIV+ diver Greg Louganis as the company’s spokesmodel. The ad relies largely on Louganis’ calm, smiling face for its selling power. There are no disclaimers, and there is little substantial information in the ad copy. The implication is that Louganis’ testimony is enough information, and that he will provide a strong-enough means of identification for the ad’s audience. The HIV+ consumer being targeted through these ads is one who has a life insurance policy to sell (read: one who’s doing well enough financially to afford insurance), and who is white, gay and male. While the gay male population is one of the epidemic’s hardest hit, campaigns like this did not represent any of the epidemic’s other affected populations, including women and people of color, who by the early “90s made up significant parts of the HIV+ population in the United States. But this is, of course, an ad campaign, and it takes no small leap of the imagination to assume that these other populations might not have provided the same demographic appeal (particularly in terms of income level) that their gay male counterparts did. Expanding Options, Expanding Markets
With the introduction of direct-to-consumer HIV/AIDS drug ads the mid-90s, the strategies used by advertisers changed. While the ads for viatical settlement firms focused on impending death, those for drug companies focused on prolonging life — better living through science.
In 1999, AIDS Action reviewed the 15 largest pharmaceutical companies’ annual reports and concluded that drug makers spend $68.5 billion a year on marketing, advertising and administration while spending only $24.5 billion per year on research and development for new drugs to treat HIV/AIDS. Discuss the marketing The first direct-to-consumer pharmaceutical ad that appeared in The Advocate was an ad for Invirase, a protease inhibitor. The four-page ad, which appeared in the Oct. 1, 1996 issue of the magazine, featured an illustration of the HIV protease being inhibited by Roche Laboratories” drug. In the ad, a diagram shows exactly how the drug intervenes in the process of reverse transcription and integration of viral DNA; a pair of in vitro photographs, depicting cells with and without Invirase, provides a means of comparison for the viewer. While this strategy is educational and provides powerful “proof” of the drug’s efficacy, the selling power of scientific authority apparently wasn’t enough for Invirase marketers. Two months later, a new Invirase campaign appeared, one that was highly similar to the personal identification techniques used by viatical settlement firms. In the new ad, a relatively young, gay, white man stares out from the page. He appears, like the men in the insurance ads, deep in thought. In the ad copy, the clinical benefits of Invirase are explained, but the primary focus is the promise of “expanded options’ for treatment of HIV. The ad, which speaks to a patient at the end of his rope, states, “If you have advanced HIV, your options are limited. By what you can tolerate and what you can afford. You may be taking several drugs several times a day. Or you may have tried what’s out there and stopped cold, deciding it’s not for you. You may wonder: What’s next?” According to Roche Labs, that’s where Invirase comes in. The company is eager to help patients try out its drug therapy, offering to connect patients to the Roche HIV Therapy Assistance Program, which will help provide Invirase to those experiencing lapses in their insurance coverage and reimbursement. This ad seems closer to what the FDA may have in mind as an appropriate marketing campaign. While the ad’s rhetoric of “expanded options’ is hopeful, the ad copy points to several realities of life with HIV, such as difficulty staying on a drug regimen or frustration with various drugs’ side effects. Advertisement for Fortovase The suggestion of expanded options is a common selling strategy in AIDS drug advertising. While the Invirase ad makes this promise in its text, ads for drugs like Fortovase (another of Roche Laboratories’ products) and Crixivan communicate the same message by featuring subjects engaging in a variety of physical feats and recreational activities. The first ad for Fortovase, which appeared in The Advocate’s Dec. 23, 1997 issue, challenges the pessimistic assumptions of the disease upon which previous ads relied. To sell the drug’s potency, the ad features a full-page photo of a muscular, athletic-looking woman who has just released a javelin. In another Fortovase ad, an African American male runner is first shown poised on starting blocks (page one of the ad), then jumping a hurdle (second page of the ad). Nowhere does he look sick or fatigued. Merck pharmaceutical company has relied on a similar action-based strategy to sell its protease inhibitor, Crixivan. In a Crixivan ad published in the Sept. 16, 1997 issue of The Advocate, an African American man is shown climbing a mountain. Then he is seen standing on the summit, gazing at the view below. The ad’s headline reads, “In the battle against HIV, there’s a change in outlook.”
In other words, HIV is something you can live with, not an immediate death sentence. This is the new HIV paradigm the FDA and some AIDS activists are warning us about. While it’s undeniably good that many people living with HIV in the United States have increased life expectancies, it’s dangerous to assume that HIV is the same as other chronic illnesses, or, worse, that there is a cure. To the HIV+ consumer, ad campaigns like Merck’s and Roche Laboratories’ sell a vision of life with HIV that, while possible, is far from the reality most people living with HIV experience. I wonder, for example, how all of those mountain climbers deal with their drug regimens while on the trail, or how they manage to avoid side effects (like nausea or diarrhea) that often accompany protease inhibitor use. To those who have not contracted HIV, the ads present an image of HIV as something that doesn’t really have any significant consequences or drawbacks. There is yet another disturbing type of advertisement: Symbolic representations of mourning and rage and non-complacency have been co-opted for use by a corporation that will, if their research works, make even more money off of HIV+ consumers. In one of what I would consider the most insidious of AIDS-related ad campaigns, Vertex Pharmaceuticals appropriates personal and activist symbols — including the AIDS Quilt and ACT UP’s “Silence=Death” graphic — in their ads’ photomontages, encouraging viewers to invest in their research endeavors as a form of activism. The Vertex ads, which appeared in issues of The Advocate in June and July of 1998, seem to recognize their audience’s concerns. By using a slogan like “Selling Hope is Easy in an Epidemic,” Vertex appears to be sympathetic to HIV+ consumers and activists, but in another ad, the message is quite different. The featured slogan of Vertex’s AIDS Quilt ad — “Ambition will cure AIDS before compassion does’ — is the basis for the company’s innovative, ambitious research agenda. This slogan, however, is dismissive of the ads’ target audience. The message is that the time has come to move from grief to action, but the implied meaning is that personal responses to the epidemic have not been enough, and that Vertex Pharmaceutical’s researchers have the ambition necessary to go beyond the personal limitations of the activists, lovers, caretakers, families and friends whose work the Quilt represents. It seems as if HIV+ consumers, at least those with certain financial resources, can never do enough to ensure that they’re making the right decisions about their treatment or investments. And at the start of a third decade of the HIV/AIDS epidemic in the United States, this is what we are left with: an industry built upon the powerful suggestion that someone, some company, may have the key to better living with HIV, if we can pay the price. We’ll see in the next few months how drug companies respond to the FDA’s order to alter their marketing strategies, and how (or even if) HIV+ people will be represented in their new campaigns. The influence of these increasingly ubiquitous ads to shape our cultural view of the HIV+/AIDS community cannot be underestimated. Enter the Pop Forum Alana Kumbier lives and works in New Orleans. Her work has previously appeared in Bitch Magazine and Bust. Related Sites |
