Can We Have the HPV Vaccine Without the Sexism and the Homophobia?

I respect that some of you are anti-vaccines–or just anti-Gardasil—but I hope that some Ms. readers will join me in cheering what I consider a better-late-than-never decision by the CDC’s Advisory Committee on Immunization Practices. It has officially recommended that boys and men ages 13-to-21 be vaccinated against the sexually transmitted disease HPV (human papillomavirus) to protect from anal and throat cancers.

There are many reasons this makes good sense. As I wrote in the Winter 2010 issue of Ms., there’s overwhelming evidence that HPV can lead to deadly oral, anal and penile cancers–all of which affect men and all of which are collectively responsible for twice as many deaths in the U.S. each year as cervical cancer. However, vaccines are a touchy topic, and I want to be clear that I’m not advocating in favor of or against anyone’s decision to get an HPV vaccination. I do strongly advocate for boys and girls, men and women, to have equal access to Gardasil and any other FDA-approved vaccine. Private insurers are required to cover HPV vaccines for girls and young women with no co-pay under the 2010 health reform legislation, and with this decision, that coverage requirement will extend to boys and young men, effective one year after the date of the recommendation. And, whether or not you or your loved ones get vaccinated against HPV, we will all benefit from more vaccinations, considering the extent of this sexually transmitted epidemic/pandemic, which affects as many as 75 percent of adult Americans and can be spread by skin-to-skin genital or oral contact (yes, that includes “French kissing”).

However, the media coverage of the recommendation includes a line of reasoning that I, as a sexual health educator and researcher, find offensive, ignorant, and inaccurate. The New York Times wrote: “Many of the cancers in men result from homosexual sex.” Really? What counts as “homosexual sex”? Most public health experts and HIV/AIDS researchers view “homosexuality” primarily as a sexual orientation, sometimes as a social or political identity, but not as a type of intercourse. Anyone who studies U.S. sexual norms knows that oral sex and anal sex–the behaviors cited as increasing risks of HPV-related oral and anal cancers–are not restricted to men who have sex with men. In fact, the NYT article itself asserts, “A growing body of evidence suggests that HPV also causes throat cancers in men and women as a result of oral sex” –so you don’t have to identify as a “homosexual” man to be at risk; you don’t even have to be a man.

Nevertheless, the New York Times goes on to muse that “vaccinating homosexual boys would be far more cost effective than vaccinating all boys, since the burden of disease is far higher in homosexuals.” Thankfully, the author also thought to check this idea with a member of the CDC committee, who seemed to grasp the ethical and practical challenges of making a recommendation based on a boy’s or man’s “homosexuality.” Kristen R. Ehresmann, Minnesota Department of Health and ACIP member, is quoted as cautioning, “But it’s not necessarily effective or perhaps even appropriate to be making those determinations at the 11- to 12-year-old age.”

Still stuck on the question of sexual orientation, that NYT author seeks to console potentially “uncomfortable” parents of boys by reassuring them that “vaccinating boys will also benefit female partners since cervical cancer in women results mostly from vaginal sex with infected males.” So, is the message, if you don’t want to imagine your son having oral or anal sex with a male partner, then you can focus on the public health service you are providing for girls and women who have male partners?

Instead of contributing to a homophobic panic, I thought it might be helpful to field a few frequently-asked-questions:

Q: Do you have to have a cervix to benefit from the “cervical cancer” vaccine? A: No. Despite its early branding, Gardasil has always been an HPV vaccine. Physiologically speaking, boys and men could have been benefiting from the vaccine since its initial FDA approval.

Q: Why are they recommending vaccinations for girls and boys as young as 11? A: Vaccines only work if given before contact with the virus. Reliable data on age of first “French” kiss is not available, but recent surveys show that about 25 percent of girls and boys in the U.S. have had penile-vaginal intercourse before their 15th birthdays.

Q: Are you too old to benefit? A: If you have not yet been exposed to all four of the HPV strains covered by Gardasil, then you can still gain protection. The more challenging question is: How would you know? The only ways to test for HPV (and then HPV type) is by tissue samples being sent to a lab. Most HPV infections are asymptomatic.

Q: What’s the risk of not getting vaccinated? A: We know that U.S. cervical cancer rates have dramatically decreased in recent decades due to improvements in screening, such as the Pap smear, and better treatment options. However, rates of HPV-related oral and anal cancers are reported to be increasing–and our screening options for these types of cancers are not as effective, affordable or accessible as those for cervical cancer.

Q: So, what can an unvaccinated person do to protect him/herself from a cancer-causing strain of HPV? A: Abstain from behaviors that can transmit the virus, such as deep/open-mouthed kissing, and use barrier methods when engaging in vaginal, anal or oral sex.

If this last answer strikes you as unreasonable, then mobilize your political energies to advocate for increased funding for HPV research. We need and deserve better ways to be tested and treated for the types of HPV that have been linked to serious and potentially fatal cancers. And, as my own research has shown, we have to get rid of the harmful stigma surrounding HPV and other sexually transmitted infections. We also need to stop inaccurately linking STDs to gender or sexual orientation. You can help by making sure your community supports medically accurate, age-appropriate sexuality education. And if you or a loved one wants more information about sexual health, then check out these free online resources.

Picture from Flickr user USACE Europe District under Creative Commons 2.0.