Herpes awareness ads divide officials
Drug company's campaign raises race, sex issues
WASHINGTON -- "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
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, of 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 specialists 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 1 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 specialists 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 (Valtrex) cut the odds of transmitting the virus in half -- from 4 percent to 2 percent -- over a period of eight months.
Few specialists, however, recommend testing all adults for herpes. Both the US 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 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."
For their part, Glaxo officials describe the campaign as largely an educational experiment.
