Herpes Awareness Project Divides Health Officials
Tuesday, July 24, 2007
Nearly one in two African American adults has genital herpes. Could it be you? Could it be your partner? . . . A simple blood test is the best way to know if you have it.
That's the language of an advertisement that has begun running in publications and on radio stations with largely black audiences in cities including Baltimore, Detroit and Atlanta.
The ad is part of a campaign by drugmaker GlaxoSmithKline to educate blacks about genital herpes, a sexually transmitted disease that is far more common among African Americans than other racial or ethnic groups. The effort has divided public health authorities and raised complicated questions about race, sex, disease and commerce.
As a pharmaceutical marketing tool, it may set a new standard for candor -- and controversy.
The "Say Yes to Knowing" campaign partners Glaxo with the National Medical Association, the country's main society of black physicians, and the American Social Health Association (ASHA), a nearly century-old organization devoted to fighting what used to be called "venereal disease." Each has received money from Glaxo in the past, although no donations were made in connection with this effort.
The campaign was introduced last month in Detroit, where it had the support of the local health department. In Baltimore the health commissioner has declined to endorse it.
Glaxo makes one of three drugs for genital herpes, which is caused by herpes simplex virus types 1 or 2. The infection cannot be cured, but it can be suppressed with daily medication.
Some experts worry that the campaign may lead to widespread testing and large-scale treatment of people who do not have symptoms -- a strategy not recommended by federal health authorities. Even Glaxo's supporters think the effort is likely to be controversial.
"My sense is that this is probably a high-risk campaign for GSK," said Edward Hook, an infectious disease specialist at the University of Alabama at Birmingham and chairman of the board of ASHA. He believes that the campaign "will raise awareness across the country." He added, "I don't think even many doctors know how common genital herpes is."
A federal survey in the early 1990s found that 21 percent of American adults had the infection. Among blacks, the rate was 48 percent. A follow-up survey this decade found that the national prevalence had fallen to 17 percent, but in blacks it had not gone down significantly.
In about 40 percent of newly infected people, the virus causes painful, pimple-like sores on the genitals. Although they eventually go away even without treatment, they can reappear every few months. In most people, recurrences are less frequent as time passes. In the survey, only one in 10 people who tested positive knew they were infected. A person without symptoms can transmit the virus to a sexual partner.
Genital herpes poses two chief hazards, apart from pain and embarrassment. Active infection in late pregnancy can cause devastating illness in a newborn. Infection also triples the risk of acquiring the AIDS virus from an HIV-infected person.
Medical authorities advise testing anyone with herpes-like sores and treating those who have active or painful infections. Many experts also support long-term treatment of an infected person whose regular partner is uninfected. A study several years ago showed that a daily dose of Glaxo's drug valacyclovir (sold as Valtrex) cut the odds of transmitting the virus in half -- from 4 percent to 2 percent -- over a period of eight months.
Few experts, however, recommend testing all adults for herpes. Both the U.S. Preventive Services Task Force, which advises the Department of Health and Human Services, and the American College of Obstetricians and Gynecologists reject routine screening.
There are several reasons.
Telling people they have an incurable, sexually transmitted disease can have serious social and emotional consequences. And there is no evidence that long-term treatment of tens of millions of asymptomatic people is worth the time, effort and anguish.
And treatment can be expensive. While generic acyclovir, the oldest anti-herpes drug, costs as little as $9.96 for a month's supply, Glaxo's Valtrex costs $192.88.
Whether testing and treatment of a subpopulation, such as black adults, are useful and cost-effective has not been studied. A mathematical model published in March concluded that "suppressive coverage" would reduce the overall prevalence of genital herpes, especially if drugs were started right after people acquire the virus.
Baltimore's health commissioner, Joshua M. Sharfstein, said his department turned down Glaxo's request to become a local partner in its campaign "because of the lack of evidence to support, as a public health strategy, screening for herpes in people without symptoms." He added that "the racial targeting was not an issue that we needed to address to make a decision."
For their part, Glaxo officials describe the campaign as largely an educational experiment. The company is surveying about 100 people in each city before and after the campaign to see if they learned anything about genital herpes.
"The first step is to see if we are able to move the needle and increase awareness," said Marc Meachem, a company official. The survey is not a formal epidemiological study, and there are no plans to publish the results.
Glaxo Senior Vice President Lynn Marks said, "We haven't said that we should screen any populations."
Nevertheless, on 100,000 brochures and a Web site, Herpes411.com, from the company, a message says, "A simple blood test is the best way to know if you have the virus." It goes on to say that people who think they may have been exposed "should ask your healthcare provider about being tested."
The campaign material does not mention Glaxo's drug, but a Web page devoted to it can be reached through the herpes site with two clicks.
Georges Benjamin, head of the American Public Health Association, said more research is needed to determine whether widespread testing and chronic treatment for herpes are worthwhile.
"While it is nice to educate people with a campaign like this, at the end of the day it tells us more about what we don't know than about what we do know," he said.
But Anita Moncrease is convinced. A physician and consultant who works part time for the Detroit health department, Moncrease urged Glaxo to engage other city health departments and is negotiating with the company for help in paying for blood tests for uninsured people in Detroit's public clinics.
She admits there is a risk of stigma and stereotype with a message aimed at one racial group. "I am concerned about the negative connotations because this is a sexually transmitted disease," she said. "But I am concerned about the public health of the citizens of the city of Detroit more."
Glaxo has previously targeted blacks for messages about diseases especially prevalent among them. It promoted the diabetes drug Avandia by direct mail, hired basketball star Magic Johnson for advertisements about AIDS treatment and engaged football player Jerome Bettis for an "asthma awareness" project.
"We need to reach out increasingly to these populations, not decreasingly," Marks said.