Misleading Ads About HIV-Prevention Meds Limit Their Uptake

By Tamara Mathias

March 04, 2020

(Reuters Health) - Targeted advertisements on Facebook and television that overstate side effects of preventive medicines for HIV might be the greatest threat to protecting people at high risk of contracting the disease, HIV-prevention experts say.

The ads, sponsored by law firms, call for participation in class action lawsuits against Gilead Sciences, a California-based drugmaker that sells the only two U.S.-approved regimens of pre-exposure prophylaxis (PrEP).

In the journal Lancet HIV, Amy Nunn and colleagues say the ads target people who already take the drugs to safeguard against HIV and dissuade them from continuing to do so by making false claims about their safety.

"The Lancet article is an empirical response to what so many frontline PrEP providers have been saying for months," Rich Ferraro, Chief Communications Officer at LGBTQ media advocacy organization GLAAD, said in a phone interview.

"The fact that these are not just broad ads but that they're targeting at-risk people who do not in general come across accurate information about HIV prevention is why they need to be removed."

Nunn, an associate professor of public health and medicine at Brown University in Providence, Rhode Island, says that the advertisements "grossly overstate" the occurrence of side effects like renal failure and substantial bone loss.

Peter Staley, co-founder of New York-based advocacy organization PrEP4All, which lobbies for expanded access to PrEP medication notes that scientists have not been able to find any harm when TDF (tenofovir disoproxil fumarate), one of the medicines in Gilead's PrEP regimen, is used to prevent HIV.

"There really isn't much gray area here," he said.

The authors also note the advertisements seem to be tailored toward communities that are disproportionately affected by HIV in the United States: people of color, people in the South and gay and bisexual men.

"It's not just the text of the ads that's so problematic, it's the visuals as well, because they use LGBTQ couples, they use very relatable looking young men of color in these ads and those are among the communities who should largely be on PrEP," Ferraro agreed.

GLAAD, along with nearly 70 organizations, has submitted an open letter to Facebook, urging quick action against the misinformation being spread on its social media sites.

In November, the organization flagged problematic advertisements to Facebook's independent fact-checking partners, following due process in accordance with the social media giant's policy to deal with misinformation in advertising.

A Facebook spokesperson confirmed that its fact-checking partners determined some ads misled people about the effects of Truvada (Gilead's combination of emtricitabine with TDF).

"We rejected the ads and they can no longer run on Facebook," the company said.

However, several other ads continue to be displayed on the social media site.

"That was welcome news, but Facebook still has to take this over the finish line by creating a new policy that stops these ads from the get go, because waiting a month and a half for a fact-checking agency to get back to us on one ad is a bandaid solution," Ferraro said.

The U.S. Centers for Disease Control and Prevention (CDC) recommends Truvada, often featured as a little blue pill in the ads, to prevent HIV for all people at risk through sex or injection drug use.

"Although these (adverse) responses to PrEP medication are exceedingly rare, CDC has advised clinicians to monitor kidney function regularly in patients who use PrEP, and not to prescribe PrEP to patients with abnormally low kidney function, or to patients with pre-existing bone conditions, such as osteoporosis," a CDC spokeswoman said.

Nunn believes the ads are the single biggest obstacle to PrEP uptake.

"Patients are coming in and quoting the ads because they're so commonplace," she said.

"I have sent this to public health officials at the highest levels of government. They're aware about this issue and many have responded that they are also very concerned."

Gilead reiterated that its medicines are "safe and effective for use."

"We have joined calls from GLAAD and leading organizations to have any misleading advertisements related to our HIV medications removed from Facebook," a spokesman said.

The authors say the ads, which reach millions, are seriously undermining the nation's fight against HIV.

"By decreasing public confidence in PrEP as a safe and effective HIV prevention method, these advertisements are having detrimental effects on the nation's first-ever comprehensive federal effort to eradicate HIV," Nunn and colleagues write.

SOURCE: https://bit.ly/2w7hvby The Lancet HIV, online February 4, 2020.