This would be tragic even if clean-needle programs saved only the lives of drug users, but they can have a far greater impact on the epidemic if instituted quickly enough. Contrary to popular stereotype, it’s far easier to get an addict to use a clean needle than it is to get a man to use a condom, so containing HIV among addicts also massively reduces risk of later sexual and mother-to-child transmission. I should know, because as a woman and a former I.V. drug user, I first wrote about this issue 15 years ago for the Village Voice, in an effort to debunk myths that were being used way back then to block needle exchange. My argument at the time was based on some suggestive data, my own experience and common sense, but now there is overwhelming scientific evidence to favor these programs. It breaks my heart that more than ever before, politics is overshadowing science at the cost of so many lives.

While some countries with large HIV epidemics among heterosexuals (most notably Uganda) have reduced its prevalence to 5-10 percent, the numbers infected are stabilizing, not declining. In such heterosexual epidemics, for each person who dies, someone else is newly infected to take his or her place. And in many nations, heterosexual infection rates are still climbing. In the United States there is some evidence of an unfortunate resurgence in HIV infections among gay men. Both heterosexually and homosexually transmitted infections continue to plague minority communities, with HIV rates among African-Americans doubling between 1988-1994 and 1999-2002.

In those cases, the opportunity to fight HIV with clean needles either was lost or never existed. In 1989, Congress, led by Sen. Jesse Helms, banned federal funding for needle exchange in this country, which essentially allowed HIV to get a foothold in our minority communities. But in many other parts of the world, particularly in the former Soviet Union and Asia, HIV is still mainly transmitted by drug use. For example, 75 percent of new infections in Russia and more than half of those in China result directly from I.V. drug use. In these epidemics, in which heterosexual and pediatric cases overwhelmingly begin with transmission from addicts, even a moderately effective intervention with addicts done early can have major effects.

Providing sterile syringes to addicts to fight HIV is not just moderately effective, however. In fact, it may be the best-supported intervention in all of public health. In 2004, the World Health Organization conducted a review of more than 200 studies on the issue, and concluded that “there is compelling evidence that increasing the availability and utilization of sterile injecting equipment by [I.V. drug users] reduces HIV infection substantially … There is no convincing evidence of any major, unintended negative consequences.”

Alex Wodak, director of the Drug and Alcohol Service at St. Vincent’s Hospital in Sydney, Australia, and the author of the WHO review, says, “I find it incredible that a major country was prepared to go to war on flimsy evidence that we now know was wrong but is not prepared to save the lives of its own citizens when the evidence is as strong as it gets in public health.”

In New York state, for example, which spends $1 million annually on syringe exchange and has also decriminalized pharmacy sales of needles, infection rates among I.V. drug users dropped from 50 percent or higher in the early ’90s to 10-20 percent in 2002. At the peak of the HIV epidemic in New York, at least two-thirds of heterosexual and pediatric infections resulted from sex with I.V. drug users.

In 2003, by contrast, there were just five HIV-infected babies born in New York, compared with 321 at the epidemic’s peak. While some of this success is due to medications used to prevent transmission from mother to child, infection rates among mothers are also down, having decreased by almost half between 1990 and 1999. In fact, the much publicized “down low” transmission from African-American bisexual men to women has become a larger factor in the epidemic in New York only because drug-related infections (outside prisons) have declined.

Incredibly, conservatives in Congress, led by Rep. Mark Souder, R-Ind., are considering a needle-exchange version of the abortion gag rule, which prevents U.S.-funded international aid organizations from mentioning abortion to pregnant women. This new move could stop American-funded groups from even telling intravenous drug users that they should use clean needles, let alone where to get them — at a stage in the epidemic when clean needles would be maximally effective in preventing indirect, as well as direct, transmission in many countries.

The United States is already alone among developed countries in refusing to fund syringe-swap programs here or abroad. And rather than recognize the success of states like New York that fund their own programs, the president wants to export its failed and disastrous policy overseas. In yet another example of its attempts to suppress science that does not support its ideology, the Bush administration recently threatened the U.N. Office on Drugs and Crime with loss of funding if it did not remove from its literature and Web site supportive information about needle exchange and other “harm reduction” programs for addicts that do not demand complete, immediate abstinence from drugs. The United States is the major financial supporter of UNODC.

After a meeting with a U.S. State Department official last November, UNODC director Antonio Maria Costa promised to “review” its statements on the subject, saying the organization would now “neither endorse needle exchange as a solution for drug abuse nor support public statements advocating such practices.”

Only months earlier, Costa had made the opposite pronouncement: “The HIV/AIDS epidemic among injecting drug users can be stopped — and even reversed — if drug users are provided, at an early stage and on a large scale, with comprehensive services such as outreach, provision of clean injecting equipment and a variety of treatment modalities, including substitution treatment [like methadone].”

He added that fewer than 5 percent of the world’s I.V. drug users have access to such help, and he went on to criticize countries that incarcerate large numbers of addicts because this increases HIV rates. That last bit likely was a sensitive point, since America has the largest documented prison population in the world.

It’s enough to make a former I.V. drug user like me think about shooting up again.

At a meeting of the 48th Session of the Commission on Narcotic Drugs in Vienna, Austria, in early March, Costa did make at least a modest attempt to stand up to American pressure, saying that needle exchanges are “appropriate as long as they are part of a comprehensive strategy to battle the overall drug problem.”

Nonetheless, American drug czar John Walters reiterated U.S. opposition to needle exchange in his speech to the group. Japan was our only public ally — with all of Europe, Latin America (led by Brazil), and even Iran favoring needle exchange. While China did not explicitly speak up for needle exchange, with 70 percent of its HIV infections linked to I.V. drug use, it is experimenting with such programs and argued passionately for other harm-reduction measures like methadone maintenance.

Though support of needle exchange by human rights groups, who raised the issue before the meeting started, may have blunted the impact of the U.S. attack, the American grandstanding did manage to kill a resolution that would have stated UNODC’s support for needle access and human rights for addicts.

Public health experts worry that the Bush administration’s stance will undermine still shaky political support in countries that need to expand needle-exchange programs if they are to successfully ward off HIV. A gag rule on needle exchange would force AIDS groups to drop their programs or lose funds, seriously undermining access to clean needles for millions around the world.

Even if the administration supports a death penalty by AIDS for I.V. drug users, you’d think the innocent lives of their children or unwitting spouses might count for something. Or perhaps, being fiscal conservatives, opponents might worry about the thousandfold greater expense of HIV/AIDS treatment, compared with pennies for sterile needles.

Although the Clinton administration declined to overturn the 1989 Helms amendment banning federal funding for needle-exchange programs, at least it was honest that it was making a political, rather than a scientific or fiscal, decision, as science writer Chris Mooney noted in the American Prospect.

But the Bush administration is trying to deny the science, too, which means the harm of its stance won’t be limited to the current debate. One administration official even suggested that the Washington Post contact several AIDS researchers who’d done studies on needle exchange, claiming that their work supported its contentions that such programs are ineffective and dangerous. When the Post called the researchers, however, they denied the administration’s charge, stating that their data demonstrated the opposite.

It’s worth looking more closely at one of these studies, which is in the small minority of the hundreds now published to even suggest any kind of negative result. In 1997 in the journal AIDS, Stephanie Strathdee and her colleagues reported that despite having North America’s largest needle-exchange program, instituted in the late ’80s, Vancouver’s rate of HIV infections had increased dramatically during the early to mid-’90s. Worse, needle exchange users were more likely than other addicts to be HIV positive.

But as Strathdee and others have noted repeatedly, this does not mean that needle exchange caused participants to become infected. In fact, during the period of the study, Vancouver began to be flooded with cocaine. Injectors, who had previously used primarily heroin, started shooting coke as well. Since cocaine is injected far more frequently than heroin because of its shorter-lasting high, the number of daily injections is often greater by a factor of 10 or more, increasing the odds of being exposed to HIV.

Syringe exchanges tend to attract only the poorest, highest-risk users in Canada because needles can be legally purchased at pharmacies there, which might have confounded the data, but the program also had a variety of limitations that contributed to its initial failure. As Vancouver improved its program, however, and even opened safe-injection rooms, infection levels among I.V. drug users stabilized and then began to drop, according to Canadian government statistics. New HIV infections among I.V. drug users fell by more than 70 percent between 1995 and 2000, though part of this drop may represent saturation of the I.V. user population. (A study on the injection rooms published this week in the Lancet found that addicts who used the facility were 70 percent less likely to share needles than those who didn’t visit it.)

A 1997 study that compared cities around the world with and without needle-exchange programs found that those with programs had an average annual decrease in the prevalence of HIV of 5.8 percent, while those without programs had an increase of 5.7 percent. No study has ever found that the existence of needle exchange motivates addicts to keep taking drugs — in fact, most find that syringe-exchange users are more likely than other addicts to seek treatment. It’s no surprise, therefore, that every major public health body that has looked at the issue — from the World Health Organization to the American Medical Association to the Institute on Medicine to the International Federation of Red Cross and Red Crescent Societies — has strongly endorsed making sterile injection equipment available to addicts.

The policies that the Bush administration endorses as alternatives to needle exchange — attempts to reduce the supply of illegal drugs, for example — have not been shown to affect drug-use rates, let alone reduce HIV. Despite U.S. drug-control budgets that have increased almost exponentially since the 1980s, the purity of cocaine and heroin has at least quadrupled, the prices of both drugs have dropped by at least half, and neither addicts nor teenagers report difficulty purchasing most drugs.

It profoundly saddens me that I must still cite studies to defend needle exchange nearly 20 years after activists first began to fight for it. It also disturbs me that needle-exchange programs rarely get the credit they deserve. A Jan. 30 New York Times story on the virtual end of HIV infection in newborns in the United States didn’t even mention the role of clean needle programs in this accomplishment.

And the articles about bisexual black men infecting heterosexual female sex partners have largely neglected the critical role that I.V. drug use in minority communities has played in the epidemic. One can make a good case, in fact, that there wouldn’t even have been such an epidemic in black and Latino heterosexual populations if the United States had provided clean needles earlier and hadn’t insisted on locking up (without access to condoms or needles) so many minority drug users.

The U.K. dodged this bullet: Under the conservative government of Margaret Thatcher, it rapidly implemented clean-needle measures in response to the outbreak of AIDS, starting in 1986. HIV prevalence has rarely reached more than 1 percent among intravenous drug users there, compared with over 50 percent at the epidemic’s peak in New York. Heterosexual AIDS in the U.K., consequently, is almost entirely limited to immigrants who were infected in Africa. Says Neil Hunt, a director of the U.K. Harm Reduction Alliance and an honorary research fellow at Imperial College London, “It’s a largely unheralded, astonishing success.”

So why is it so hard for U.S. policymakers to accept that needle provision works? A large part of it is surely prejudice related to drug-war propaganda — for instance, the belief that addicts are out of control and thus unwilling to protect themselves even when protection is offered. And some of it may even reflect a desire to simply let addicts die. But I also think some people believe that addicts like to share needles, the same way many people prefer to have sex without condoms, and that changing such behavior would take too much effort.

And for those who suggest that needle exchange encourages drug use and keeps addicts using longer, I would argue that it is not the presence or absence of needles that determines one’s desire to get high. For many, drug use stems from deep unhappiness and an inability to handle distress, not from an effort to obtain extra pleasure in their lives. Compassion is the appropriate response to such suffering, and for many addicts, the first place they ever experience such grace is at a needle-exchange program. It’s the one place that accepts them just as they are.

Contrary to critics’ claims, needle-exchange programs offer a message of hope, not a “counsel of despair,” as U.S. officials recently claimed. They do not tell addicts that they are forever doomed to addiction and might as well kill themselves. Instead, they say, “We want you to live; we believe you are valuable.” And that message is often the spark that starts recovery. It’s far from all that is needed, but without it, many are too demoralized to try.

I can’t abide the idea that my country is still fighting against HIV prevention. But what’s most infuriating is that such action is not only unnecessary but also inhumane. It’s throwing a symbolic sop to the religious right (which isn’t even especially focused on the issue) at the demonstrable cost of human lives.

But even at its height, the drug that President Ronald Reagan and Nancy Reagan said was killing “a whole generation of children” was never sampled by many people outside the world of adults who were already heavy drug users. There never was a new generation caught in the web of a brand new drug.

In fact, illicit drug use had reached its peak in 1979 to 1981 and then begun falling before the crack hysteria began. Crack-use rates also began to decline — almost as soon as they could be measured. As early as 1986, survey data showed that more than three out of four people who tried the drug that newspapers and television shows had said caused “instant addiction” never used it again.

Though the crack threat to the nation was oversold, the trade in the drug and the chaos it caused certainly did severely damage communities where it was sold on the streets. Crime rose dramatically and the suffering of families whose members became involved in using and selling was profound. At its peak, the number of young arrestees who tested positive for crack use reached 70 percent in New York City, and the murder rate in the city doubled between 1985 and 1990, driven largely by turf wars among crack dealers.

By 1991, however, a few reporters and survey researchers began to notice that the media-fed fears that crack and crime would rise forever were unwarranted. In 1993 and 1994, the Washington Post ran two major stories detailing what has come to be called the “younger sibling” effect: Kids who saw their older siblings and parents get in trouble with crack use and sales didn’t want to try it themselves. Rappers began to glorify reefer and “chillin’” rather than dealing and the “gangsta” life.

By the early ’90s, many crackheads of the ’80s had simply aged out. Meanwhile, researchers discovered that crack babies weren’t doomed — in fact, fetal alcohol syndrome does far more lasting damage. And younger siblings of the crack generation, chastened by the family destruction wrought by the drug, turned the word “crackhead” into a devastating insult. They certainly didn’t aspire to smoke or sell it. In many cities, falling teen birth rates and infant mortality rates are seen as evidence of the end of the crack epidemic.

Crack “epidemic” stories disappeared almost as suddenly as they had appeared. In 1989, 64 percent of the public had said that drugs were the most serious problem facing the nation. But by 1990, when media focus shifted to the economic problems and layoffs related to a major recession, only 10 percent found drugs to be the No. 1 problem.

The next time we heard about crack it was in the context of police officers and politicians taking credit for having solved the crime problem with their “zero tolerance” on low-level offenders and tougher sentences. The media bought it for the most part, particularly in New York, giving Mayor Rudy Giuliani the lion’s share of the political credit for crack and crime reduction.

The problem is, once again, this analysis does not tell the whole story. Crime dropped almost as much in cities where there were no police changes (like Washington) as it did in Mayor Giuliani’s New York. New Haven, Conn., and later Boston police took a “kinder, gentler” tack than Giuliani’s force did — and saw the same results. And New York had adopted uncommonly harsh narcotics laws 10 years before crack. If these were effective, the city should have been less affected by the drug’s rise, rather than being the epicenter of the crack and crime wave. Says James Alan Fox, dean of the college of criminal justice at Northeastern University, “Probably the most important factor [in the drop in crime] was the change in drug markets” — that is, dealers no longer needed to fight over turf for selling the new product, because the boundary lines were now established.

Alfred Blumstein, a criminologist at Carnegie Mellon University, agrees with Fox. “There are four major factors in the drop in crime,” he says. “No. 1 has been getting guns out of the hands of kids, No. 2 has been the shrinking of the crack markets and their institutionalization. Third is the robustness of the economy. There are jobs for kids now who might otherwise be attracted to dealing.” In last place, Blumstein says, is the criminal justice response, or as he puts it, “incapacitation related to the growth of incarceration.”

Blumstein believes the connection between crack markets and the popularity of guns among youth drove the crime epidemic of the late ’80s and early ’90s. “All of the growth in homicide between 1985 and ’91 was among young men with handguns,” says Blumstein. “The homicide rate in that group doubled — while it fell 20 percent among people over 30 … Regular kids started getting guns and using them, partially for protection, partially because it was trendy. It diffused out from the nuclei of dealers and worked its way into the broader community.” Just as beepers started out as icons of drug-dealing cool and spread to other teens, so did guns, with far worse results.

Why did the media get it so wrong? Why did nearly every single news organization overplay crack’s threat and rise — and underplay its fall? Why didn’t reporters realize that a drug like crack was unlikely to ever spread far beyond its ghetto roots?

Sociologist Craig Reinarman, author of “Crack in America: Demon Drugs and Social Justice,” notes that the crack scare was useful to politicians, police and the media. “At a minimum, the media accelerated its spread,” he says. “When crack first appeared, it was after a good long gestation period of widespread use of freebase cocaine [crack is just another name for this drug, marketed ready-made]. Within a few months of crack’s appearance in L.A., New York and Miami, there were hundreds of hours of network news coverage, and by the end of the first six months, there wasn’t a 14-year-old in Iowa who didn’t know what it was.”

“There is no major corporation which could have afforded the coverage and exposure that crack got for free,” he adds. You might say it was a very successful product launch. And the first network special devoted to it, CBS News’ “48 Hours on Crack Street,” got the best ratings of any news show in the previous five years.

Reinarman describes the crack mania as an old-fashioned “moral panic,” of the sort that led to alcohol prohibition earlier in the century. In the years before alcohol was banned, reporters credulously accepted claims that prohibition could end poverty and domestic violence. Coverage focused on extreme examples of drunks who committed crimes and implied that this could happen to anyone who imbibed. Alcohol was also linked with scorned minorities — mainly the Irish and Germans at the time, although the Women’s Christian Temperance Union hailed sobriety as “the white life,” and linked drunkenness with African-Americans as well. The media and prohibitionists eventually spoke almost as one.

When it came to crack, the media escalated the panic and propelled a political arms race, in which Democrats and Republicans fought to outdo each other as anti-drug crusaders. The result was sentences for dealers and users that are longer than for rapists and even killers.

In the end, crack did prove to be a long-term disaster for the inner city — not because of unending violence, but because of the resulting criminalization of young black men. Now almost a third of black men are in prison or on parole, and many cities are coping with the political ramifications of having large numbers of black men ineligible to vote because of felony convictions. The war on crack may prove to be the true shame of the cities, especially for African-Americans — much more devastating than crack itself.

Although the experiments were done in the ’60s and ’70s, White says that the time is now right to offer what he calls a “full-body transplant” to humans. He has been featured on ABC News and in the New York Times discussing the possibility. With present technology, nerves could not be reconnected, so a new body wouldn’t offer feeling or movement; but it could prolong the lives of quadriplegics, most of whom presently die of organ rather than brain failure.

White is not just some mad scientist with crazy ideas. The monkey research was originally published in the prestigious journals Science and Nature. In addition to his post at Case Western, he is director of neurosurgery and the Brain Research Laboratory at MetroHealth Medical Center in Cleveland.

“Christopher Reeve, Steven Hawking, these people are sustained by their hearts and other organs, but they can’t move, they can’t feel,” he says. “Right now, they are the equivalent of a head. And Mr. Hawking’s body might fail, it might become susceptible to infections, which could kill him. The issue comes up, is he entitled to a transplant? We say it’s OK for a liver, why not a whole body?”

Like many medical techniques that start being used for the sickest and most desperate patients, this one has frightening implications. For example, eventually some scientists believe they will be able to reconnect the nerves and offer feeling and motion.

Could full-body transplants become a macabre fountain of youth, offering people a chance at near immortality as they continually replace old bodies with new, younger ones? Will headless bodies be cloned as replacements, or would people need other sources of donors? Could this offer a bizarre new way to get a sex change? And what does it say about identity, humanity and the soul?

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Tia Powell, assistant professor of psychiatry at Columbia University and an expert on medical ethics, does not believe that such transplants are inherently unethical.

“Ever since ‘Frankenstein’ was written, which captured the questions of the modern era — what are the ends of science, where is it taking us? — these questions come up. They came up with egg donation, with cloning, and we never do answer them,” she says. “One response is to say that technology in itself doesn’t have a moral cast. It can be used morally or immorally. If you transplant Christopher Reeve’s head onto another body, it might work well; people might say, ‘Well, that’s great.’ If it’s Bill Gates or some evil wealthy person who has more money than God and who is unable to deal with death and buys the body of a pauper … It isn’t the science that changes, it’s whether or not we approve of the people or their goals.”

Other ethicists are more queasy. Tom Murray, the current director of the Center for Biomedical Ethics at Case Western Reserve, says, “Thirty-three years ago, we didn’t have the understanding about primates that we do now; I won’t criticize it 33 years ago. But now there would be some very hard questions, and it’s not clear that the study would pass muster today.”

James Nelson, professor of philosophy at the University of Tennessee, agrees. He explains that many people like to believe there’s a clear line separating us from other species, but that line is remarkably hard to pin down.

“We think there’s a magic moral bubble around members of our own species,” he says, “and that it is wrong to treat humans as ends to some other goal. But why humans alone? Because we have complex intelligence, deep emotional and social connections, high-level communicative abilities? This isn’t true for all human beings. What about the severely retarded? What about babies?”

Nelson believes that whatever the monkeys felt, “It must have been terrifying,” and adds: “If he had taken mentally handicapped human orphans and done this, it wouldn’t be a creepy-making interesting experiment, but it would be Nazi-like and we would drag him away in chains.”

Nelson is intrigued, however, by the intellectual issues inherent in the possibility of body transplantation. “The questions it raises about immortality and identity are interesting,” he says. “In ‘The Iliad’ and ‘The Odyssey,’ the gods’ lives were trivial and dull. It was the mortals who had lives where things mattered. Our way of valuing and thinking about life is not unaffected by the fact that we are mortal beings.”

Of course, body transplants couldn’t help you if you got Alzheimer’s or brain disease — or if your head got crushed in some accident. But they could remarkably reduce death from many causes.

“If you extend life by three, four, five times our current span, one would have cause to wonder how is that related to our [actual] mortality?” asks Nelson. “Is that really our future, or is it the future of some other being that replaces us? One could imagine, even now in my mid-40s, my childhood memories seem almost like they happened to another person. What kind of sense of connection would I have to them if I was 200 years old? And if I’d switched bodies — are we really extending life or are we dying and being resurrected in some sense?”

He adds, “You might be being slowly effaced by someone who is not you.”

Nelson cites a “thought experiment” published by Stanford philosopher John Perry in which a philosopher has an accident that destroys her body but not her head, and is offered the chance to have her brain transplanted into another body. She claims that even if she woke up after the operation and said, “Hey, it’s me, my boyfriend’s name is Jack, etc.,” we wouldn’t necessarily be able to believe her — because who we are is determined by both our bodies and our brains, and that identity would be unable to survive the transplant.

In his book “Descartes’ Error,” neurosurgeon Antonio Damasio also explores these questions — concluding, along with Perry, that without a particular body a self cannot really exist. Damasio’s argument is that our emotions are intimately linked with bodily sensations; even intellectual decisions, according to Damasio, at some point rely on emotion. We are embodied creatures, shaped by evolution to experience the world through our senses — and our identities lie not just in what we feel, but in how we feel it via our unique bodies.

The technical capability required to wire one head to another body so that the head could have control and sensation is also far from trivial. There are literally billions of nerves involved, and as White concedes, “They aren’t color-coded.” It’s also conceivable that individual differences might actually make such connections impossible, because people’s bodies might be wired in completely unique ways.

Talking to the philosophers and ethicists, reading the consciousness books and inquiries related to this research and thinking about the possibilities can be dizzying. Despite the potential for extending life, the prospect of switching bodies is one many are likely to find revolting. If the price of longer life is this great, both in discomfort and in animal suffering, perhaps it’s not worth paying. The alternative is almost literally becoming a vampire — relying on the death of others for one’s own immortality.

White himself is a devout Catholic who has 10 children and has advised the pope on bioethics issues. He has little time for animal-rights concerns, believing that “God gave us dominion over the animals.”

He says, “I think there’s a soul and a spirit in the Judeo-Christian sense” — one that is unique to human beings. When pressed about whether the soul could be trapped and prevented from going to heaven, hell or some other afterlife if a brain were kept alive outside the body, he said simply, “At some point, it just comes down to faith.”

A frustrating answer from a neurosurgeon! And it begs the big questions: If we did succeed in achieving bodily immortality, would that be the end of the idea of the soul? If we could switch bodies, would we really know what it’s like to walk in someone else’s shoes — or would we simply become some odd combination of us and them, unable to relate to either?

Although I appreciate the use of humor in advertising, the smarmy tone and lack of complete information in the ad make me uneasy. What if people did as the ad suggested — using their “nearly 100% accurate” test results to convince their partners to have unprotected sex, ignoring the prevailing advice to wait six months and take another test to confirm the result? Trading on high hopes and misinformation, tests could actually lead to more, rather than less, spread of HIV.
The debate on home testing has so far focused on whether or not telephone counseling provides enough support for those who are getting potentially devastating news. It has not examined the potential public health effects of the way the tests are sold. And since the CDC is not devoting any of its budget to promoting or explaining HIV testing in public service announcements this year, these ads could define how the mass media depicts the tests. Two manufacturers, Home Access and Direct Access (a subsidiary of Johnson & Johnson), are currently competing to sell home HIV tests, and each plans to spend at least $18-20 million annually on advertising, according to the Washington Post.

Kevin Johnson, Director of Communications for Home Access, doesn’t see any problem with leaving information about the window period out of their ads. “We can’t put everything in an ad,” he says, “It would be boring.” He goes on to explain that telephone counselors fully inform customers about the limitations of the test. “That’s part of our service,” he notes. If customers use the ads and their test results to mislead their partners about the certainty of their status, he maintains, the manufacturer should not be held responsible. After all, most products can be misused by those who are determined to do so.

Although the makers of drugs and other medical devices are required to put all qualifications and potential side effects into their advertising, home HIV tests needn’t do so. The FDA doesn’t mandate it because HIV tests are sold over the counter and thus are not in the agency’s jurisdiction.

Dr. Robert Fullilove, an associate dean at the Columbia School of Public Health and an AIDS prevention researcher believes that the Home Access ads are “irresponsible,” labeling them “fundamentally extremely problematic and potentially very dangerous.”

Daniel Wolfe, Director of Communications for Gay Men’s Health Crisis, is less disturbed by the ads’ failure to mention the window period, but has a more general complaint. “It’s not fair to burden an ad with portraying all those complex issues, but you don’t want to lead someone down the garden path. I think the whole tone of the ads both in print and on TV is ‘just find out you’re all right.’ What if you’re positive? You aren’t going to be rushing up and showing the girl your puncture. They’re assuming a HIV negative result and that’s an assumption that people taking the test shouldn’t make.”

Karen King, a professor of advertising at the University of Georgia who has done work with the CDC on AIDS prevention campaigns, points out that the effect of the ads is entirely dependent on the amount of knowledge the reader already has. “I could see the possibility that the ads might lead people to feel more secure than in fact they should,” she said, “But consumers might be sophisticated enough to know the test’s limitations. It really depends on their level of sophistication and knowledge about HIV.”

Research by Direct Access, manufacturer of the Confide Home HIV Test, suggests, however, that the audience is less worldly than one might hope. “Most people are aware of AIDS but there isn’t a great deal of depth to their knowledge,” says Arisa
Cunningham, the company’s marketing director. “There may be awareness of the window period, but people may have misconceptions that it is the period between getting infected and developing AIDS.” Direct Access research also found that those who take the test are more likely to be young, and black or Hispanic than the general population, and that the positive test rate is above average, indicating that the test is reaching people at risk, not just the worried well. This makes ads like the “Small Prick” campaign particularly risky, if they lead to a false sense of security and a decrease in condom use.

Ads for Confide don’t include window period information either, but because they don’t invite readers to use the test to prove their status to their partners, they don’t seem to have as great a potential to cause harm. On the other hand, they certainly don’t grab your attention the way the Home Access ads do.

Should the government require full disclosure in these ads, and crack down on the way some of them seem to promise a negative result? Arisa Cunningham believes that the Home Access ads are “harmful to the category” because they “trivialize a serious condition” and “give the impression that the test will be negative.” Of course, she’s hardly an unbiased commentator on her competitors’ marketing. Since Johnson & Johnson is a huge conglomerate with marketing power much greater than that of the smaller Home Access, it is not surprising that they haven’t chosen to attract attention with controversy: they don’t have to.

But just last week, a New Jersey judge decided that Johnson & Johnson had acted wrongly when they fired the inventor of the home test as chief executive of the division which now makes it. The division will now return to its prior, smaller owner, and the competition may well heat up.

And concerns about how best to fight the spread of AIDS will play second fiddle to the more mercenary matter of making more sales.