"Herpes Awareness Project Divides Health Officials"

"Drugmaker's Campaign Targets Blacks"

By David Brown
Washington Post Staff Writer
Tuesday, July 24, 2007; A03

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."

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