While in-home HIV tests promise 99.9 percent accuracy in detecting the AIDS virus, the prognosis for the companies marketing the kits is less clear-cut.
First developed a decade ago, home HIV tests have faced fierce opposition from the Food and Drug Administration as well as some AIDS organizations. Those groups have raised concerns about the accuracy of the tests, confidentiality, and whether counseling done over the phone would be adequate for people finding out they are HIV positive.
After intense lobbying from the companies looking to market the kits, the FDA, looking to encourage wider testing, relented.
Last June, Direct Access Diagnostics, a unit of Johnson & Johnson [JNJ], introduced the first of the kits, Confide. One month later, Home Access Health Corp., a fledgling start-up in Hoffman Estates, Ill., hit the market with its own test.
Sold nationally in chain drugstores for around $35 as well as through mail order (about $50), both the kits require users to prick a finger and then place blood droplets on a test card, which is shipped in a special envelope to the company. In three to seven days - depending on which kitis used - the consumer calls in with a code number to receive his or her results.
Despite the similarities in their products, each company took its own route when it came to marketing.
A Serious Tone
Direct Access Diagnostics keeps a very serious tone, right down to TV ads featuring a health professional in a white lab coat. Home Access has its share of serious ads but mixed some with a hip nature to attract the youth market.
Reaching those in the high-risk groups - adolescents and young adults, African-Americans (particularly women), Hispanics, and gay men - is considered vital to stemming the growth of AIDS.
Whether those will be the people actually buying the kits and just how big the market is has yet to be determined, with some speculating the companies will make the bulk of sales to the so-called "worried well."
"It's not a fair criticism. If anyone is unsure - whether it's the worried well or they're part of a risk group - we encourage them to be tested," said Kevin Johnson, marketing communications director at Home Access. "We hope that because the service is convenient and anonymous, they'll choose us, but all our ads encourage them to be tested no matter how. I don't know how anyone can argue with that."
He said the company hopes that pulling in some of the "worried well" will free up clinical services for the high-risk groups.
Johnson said the company is evaluating its marketing efforts and hopes to take a more targeted approach in its coming campaigns.
"We're still in the learning phase right now," he said. "The ads - both the broadcast and print - have been very effective in generating phone calls, but sometimes [the targeted consumers] bail out before they make the purchase. This is such a new product, and a lot of people have questions. It takes a long time to build any new product category."
The category is not only new, it treads on some highly volatile and emotional issues, as Home Access found out when one of the oldest and largest AIDS groups blasted one of the company's ads.
Directed at young straight males, the ad shows a voluptuous young woman leaning seductively into the camera. On the opposite page, the headline reads, "Why women find a little prick attractive."
The copy goes on to explain how the small puncture mark left on the finger from taking blood for the test can prove to be quite attractive, because "nothing arouses a woman like knowing you're responsible."
Johnson said the ad was designed to be a "little more provocative."
Overly Simplistic
But the Gay Men's Health Crisis in New York condemned the ad for being overly simplistic. "There's an important person missing from this campaign - the man or woman who will test positive," said Michael Isbell, the group's associate executive director. "We have nothing against creative and innovative approaches to raising awareness about testing, but the fact is that not everyone is going to be `aroused' by the result of their test, especially if they test positive."
Isbell said there's no question that home testing has the potential to reach people who wouldn't go to a clinic for a test. The Home Access ad, however, "is doing real damage by not preparing people for the fact that they may test positive" and "trivializing complicated issues of HIV disclosure."
Part of the challenge is that the companies are trying to target gay men, teens, hetersexual adults, and minorities all at the same time, but each group has different attitudes about the disease that will profoundly affect how it responds to the ads.
"If you look at these groups, they all have distinct takes on HIV and AIDS. Each audience is at a different place on the curve, and the advertising must be targeted appropriately," said Dave Mulryan, director of Mulryan/Nash, New York, which created the Home Access ads targeting the gay market.
One ad showed two crossed fingers with the headline, "If this is your idea of an HIV test... it's time you learned about ours."
Alternative Ways For Alternatives Lifestyles
"In a way, we had the easiest job because we knew gay men were interested in home testing," Mulryan said. "They've been around HIV for so long and been testing so much before. This was just an alternative way" so the emphasis was on the convenience and anonymity offered by the kit.
"When it comes to gay men and HIV, there's very little humor to it. In fact, it might be seen as somewhat inappropriate. But for a straight younger audience, you might have to be a little more leading edge," he said.
Arisa Cunningham, director of marketing at Direct Access, maintains the company is reaching the right mix.
"Our preliminary results indicate the individuals using the service are in the at-risk populations," she said, adding that the number of people testing positive with the Confide kit was "slightly higher" than the number of people tested in clinics.
Although the company felt it was important to target those groups at a higher isk, Cunningham said, the company has taken a general approach in its marketing efforts.
"We wanted to express an understanding of what it feels like for a person to have been exposed to the virus and to feel like they may be infected," she said. "Since the virus doesn't care if you're gay or straight, male or female, the message of understanding is universal." (Direct Access Diagnostics, 800/987-9120; HAH, 212/987-3411 Gay Men Health Crisis, 202/987-7812)