While it's true that more and more HIV-positive people are responding to treatment with these anti-retroviral drugs, the Food and Drug Administration says the direct-to-consumer ads have crossed the line and are misleading the public about the realities of the disease. On April 27, the FDA ordered pharmaceutical companies to change the ads within 90 days.

In a strongly worded letter, FDA marketing division chief Thomas Abrams ordered pharmaceutical companies to create ads that are more "representative" of the realities of HIV, specifically citing lifestyle ads that feature "robust individuals engaged in strenuous activity" and "healthy-looking individuals." The agency stated: "We are hereby informing application holders that may be promoting their HIV drugs to consumers without prominently displaying the limitations ... or using images not generally representative of patients with HIV infection that such promotion is a violation of the Federal Food, Drug and Cosmetic Act." The decision followed an intense campaign by AIDS activists in San Francisco, who were calling for a ban on the ads by both the FDA and the city.

Among the most widely criticized ads are those for the drugs Crixivan and Combivir. The ad for Crixivan features three athletic men and one woman who have just scaled a dramatic mountain peak, an athletic feat that many perfectly healthy people probably couldn't do. Meanwhile, the ad for Combivir shows a muscular and attractive African-American with a towel over his shoulder, hinting that he has just completed a rugged workout. The text tells us he's "living proof" of the power of Combivir.

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Advances in treatment have led to a lot of good news for those infected with the HIV virus, which causes AIDS. But new problems are emerging too. Doctors and public health analysts say there is growing apathy toward preventing the disease. And this, they believe, is contributing to the current upsurge in HIV infection rates.

In San Francisco the rate of annual HIV infection has doubled since 1997, rising from 1.04 percent to 2.2 percent of the city's estimated 34,000 uninfected gay and bisexual men. And that increase has disproportionately affected young gay men. A recent preliminary study by the city's Public Health Department found that 62 percent of the heterosexual and gay male respondents stated that they believe HIV drug advertising leads to unsafe sex. But critics point out that the study asks respondents whether they believe the ads affect a person's decision to have unprotected sex, and not whether the ads actually affected the respondent's decision to engage in unsafe sex. In other words, it didn't establish a direct link between the ads and HIV infection; but it still provided ammunition for AIDS activists.

The controversy over advertising for HIV drugs comes at a time when there is increasing FDA scrutiny of direct-to-consumer advertising of prescription drugs. There has been an enormous increase in those ads since the FDA loosened its regulations in 1997. According to healthcare consulting group IMS Health, the pharmaceutical industry spends more than $2.6 billion on direct-to-consumer ads each year in the U.S. In some of the more recognizable examples, Bob Dole has served as a spokesman for Pfizer's erectile dysfunction drug Viagra. And ads for antihistamines like Allegra and Claritin show ethereal pictures of allergy sufferers blissfully romping through pollen-filled meadows -- a scene that might otherwise lead to an emergency room visit.

Unlike the ads for Viagra and Claritin, which pitch two very real prospects -- septuagenarian erections or a roll in the hay without fear of hay fever -- the HIV drug ads depict a lifestyle that is highly improbable for the vast majority undergoing HIV treatment. They fail to spell out the potentially deadly kidney and liver problems, diarrhea, nausea and other side effects that are endemic to anti-retroviral treatments. But others believe the ads portray the disease in a more mainstream and positive light.

Andrew Sullivan, a conservative writer who is HIV-positive, recently ranted about the FDA's decision to make drug companies change the images in their ads on his Web site. "I can see the point of having small-print in the ads explaining side-effects (as the ads now include by law) but what on earth is gained by re-stigmatizing the sick and undermining the self-esteem of people with HIV?" Sullivan wrote in a column. "Don't these people realize that a positive psychological outlook is critical to long-term survival?"

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