Just a pinprick

Are advertisements for home HIV tests selling false hope?

By Maia Szalavitz

Published November 4, 1996 12:18PM (EST)

the ad in Rolling Stone is certainly eye-catching — the words "Why Women Love a Small Prick," appearing opposite a bedroom-eyed model in lingerie. But read the fine print — it's a pitch for a home HIV test, and the prick in question is the kind made on a finger to get the blood sample.

The manufacturers of the Home Access HIV Test aren't afraid to be outrageous, but are their spots sending the right message? Though the copy proclaims that the test is "greater than 99.9% accurate" it neglects to mention what doctors have been cautioning for years — that someone can be positive and still test negative during the first six months of infection. This "window period" is the time when people with HIV disease are most infectious, and when most HIV transmission is believed to occur. The ads entice customers to plunk down fifty bucks for a test, with the implication that the outcome will be negative — and that this "small prick" is a license to get some bareback action. There is no mention of condoms or safer sex.

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.

Maia Szalavitz

Maia Szalavitz is the author of the forthcoming book "Tough Love America: How the 'Troubled Teen' Industry Cons Parents and Hurts Kids" (Riverhead, 2005). She has also written for the New York Times, Elle, Redbook and other publications.

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