Friday, October 21, 2005

Attracting a Positive Market

Attracting a Positive Market
by Cristian Salazar

It wasn't the first time that an HIV treatment medication was advertised on a bus shelter. But it was remarkable that it appeared in Crown Heights, a neighborhood of solidly low-income African-Americans and immigrants. The message could hardly be clearer: marketing follows demographics. In 2004, the epidemic had hit people of color the hardest, with African-Americans and Latinos making up 71 percent of the 40,000 new cases of HIV/AIDS.

Bristol-Myers Squibb, which produces Reyataz, began placing ads in bus and transit shelters in 2004, to reach people who live in urban areas. "The challenge is to educate the HIV-positive African-American population," says Gary Patry, the company's manager of consumer marketing. "There aren't a lot of publications that speak to that population."

Reyataz is a protease inhibitor (PI), which works against the HIV virus by keeping it from using the protease enzyme, a protein, to replicate itself. Introduced in June 2003, last year it had worldwide sales of US$ 414 million.

The entire market for HIV treatment medications was about $6 billion in 2003, according to Gilead Securities. The market may be worth double that by 2007.

Today, ads for HIV treatment medications can be found throughout the urban landscape, decorating a phone booth here, a billboard there, adding to a general acceptance of medical information in the public sphere.

Besides Reyataz, there are currently 24 other anti-HIV drugs on the market, with names like Kaletra, Epzcom and Combivir. More complicated, these drugs belong to five different classes. Patients may take two, three or four different anti-HIV medications together as part of a daily regimen (called "combination therapy”). Patients often become resistant to certain regimens and their doctors will rotate them to new medications.

So how do companies position them in the market in contrast to competitors' products? How have the messages in the ads for HIV treatment medications changed, been refined and become what they are today? What are the unique challenges in branding these medications?

Marketing HIV treatment medications has almost always been contentious. In the late 1990s, ads showing men engaged in active lifestyles enraged AIDS activists.

"At first, such advertisements seemed necessary, to insure that people realized that the new treatments could help them return to a normal life," wrote Michael Specter in a recent New Yorker article. "Impossibly active men were shown climbing mountains or racing sailboats, and [...] played into the growing medicalization of America. Pharmaceuticals have become a basic part of the lives of millions of people in the United States [...]. The fact that tens of thousands of people were undertaking a battery of anti-HIV medications didn't seem unusual."


After the failed message of portraying virile young men, pharmaceutical companies seemed to refine their marketing to portray more solemn, if still optimistic, views of how the disease is experienced by people who are HIV-positive. For instance, in a recent ad for Kaletra, another PI produced by Abbott Laboratories, one man is shown embracing another, both smiling. In the background is the view of an apartment. The largest words on the page are "I Am L.U.," and below, "Long-term Undetectable."

Bristol-Myers Squibb has also tried to make its ads more realistic, but still, as Patry says, "inspirational." The latest ads for Reyataz are what he calls "slice-of-life" scenes where people are doing their laundry, enjoying a day at the beach or, as with the bus shelter ad, attending a party. Patry says the message is that people "can have HIV and still live a normal life" and that the disease doesn't have to be a "death sentence."

But a recent ad for Reyataz seemed to veer too far from inspirational, back to the fantastic. In the March 2005 issue of Out magazine, an ad for the anti-HIV drug caused angry letters to the editor. Opening the magazine made a pre-recorded message play from an embedded audio chip in the page; the man was calling on a cellphone, saying to his partner that he was having too much fun to worry about his chronic disease.

"Hey, HIV is still no day at the beach," says Bob Huff, who works at Gay Men's Health Crisis in New York, when asked about the ad. "It was a bad idea. A lot of people pick up the magazines at waiting rooms and it was setting off noise in the clinics."

Patry says that the intention of the ad was to "break through the clutter" but was perceived as trivializing the disease. After "intense dialogue" with AIDS activists, he says, the company pulled the ad and does not have any plans to do anything like it in the foreseeable future.

A recent innovation in HIV medication treatment ads is the use of people who actually have the disease instead of models. "For other drugs, people may not think about what anyone looks like who is in an ad," says Mary Faye Dark, spokesperson for GlaxoSmithKline, which has the most HIV antiretrovirals on the market. "With HIV, making sure we are not misrepresenting someone who is taking the HIV medication is very important."

Companies have also refined the messages of their marketing, positioning them alongside competitors' products. For instance, Kaletra was shown in studies to suppress the HIV virus considerably. Its marketers wanted to market that—thus the "long-term undetectable" message of its ads.

Similarly, Sustiva, from the makers of Reyataz, had proven to be one of the more reliable HIV treatment medications; patients who used it would have a fairly good chance of living without full-blown AIDS for the long-term. Patry says "efficacy" was the message of the most recent ads for Sustiva. The ads revolve around the theme of goals: "An HIV medication with as many goals as you," the pamphlet for the drug reads, which is stapled to or included with magazines that HIV-positive patients are likely to read.

The company is also sponsoring a contest for the second year, called the "Street to Success Program," which promises three grand prizes, including a "Home Makeover," a "Wardrobe Makeover," a "Community Makeover" or a "Whatever You Want Makeover." Entrants in the contest must submit two short essays about their goals.

Patry says the ads attempt to communicate that it's possible for people on Sustiva to have goals and plan their lives because Sustiva helps them live longer. The ads also feature photographs of HIV-positive people who continue to achieve their goals: Drew Mercer, "World Traveler," Dyon Martin, "Co-owner, Handbag Company," and Orlando Reyes, "Interior Design Student."

Tolerability is another important theme that marketers of HIV treatment medications use to brand their products. Side effects from these treatments can range from inconvenient (nausea) to possibly deadly (pneumonia), so tolerability is extremely important to patients. Lexiva, also produced by GlaxoSmithKline, features probably the most somber ads. Black and white portraits are accompanied by text that gives a no-nonsense description of why HIV patients would ask their doctors about it: "Significantly less diarrhea than another PI [...]. Convenience of eating what you want, when you want—no food/fluid requirements."

New ads from Invirase, from Roche Pharmaceuticals, also feature tolerability front-and-center, but combine this message with one of personal strength in the individual's fight against HIV/AIDS. In one recent ad, the main text reads, "Because I will not give in—Boosted Invirase. Power and tolerability in fewer pills." Invirase was the first PI introduced, and its safety and tolerability "have been well characterized through clinical trials and ten years of marketed use," according to company spokesperson Maureen Byrne.


In the first quarter of this year, the company introduced Boosted Invirase, a new 500-mg film-coated tablet formulation of the original medication. The new formula reduces the number of pills a person would have to take. Now, instead of taking five pills of Invirase, patients can take two, twice-daily, a message that is emphasized in its branding.

For people who live with the disease, the ads also serve another purpose: educating them on treatments, giving them the intellectual tools they need to help themselves more effectively. "People have clamored for information," Dark, of GlaxoSmithKline, says. "And they've been learning the information at the same time that health care providers and pharmaceuticals are learning them."

Shirlene Cooper takes six pills a day. She refers to them by their brand names: Invirase, Norvir and Combivir. What they do would demand hundreds of lines of fine print. But, essentially, their goal is the same: to keep her alive.

Eight years ago, Cooper, a community organizer for the New York HIV/AIDS Housing Network, learned she had the virus that causes AIDS. "When I became HIV-positive, I didn't know what this illness was," Cooper says. "I just knew that I was dying."

She turned to doctors who could inform her, books that could teach her and websites that could enlighten her about this disease. Essential to that diet was the fine print that accompanied advertisements for HIV treatment medications. "Whatever info anyone has, I want to know," Cooper says.

She says that ads such as those for Invirase and Reyataz speak effectively to HIV-positive people, especially since they put the emphasis on strength and life. "I think folks are maintaining today," she says. "Yesterday it was a death sentence. Today it's not."

But other members of her organization didn't agree with her entirely. Tom Reynolds, 59, is a 16-year survivor of HIV and said recently that the marketing is "almost an idolization of what the products can produce." He says, "It's not what it's about. It's about keeping you alive."

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