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The Tally Ho

Tuesday, May 24, 2005

HPV: "honor killing on the installment plan"

NOTE: This post discusses genital warts, cancer, and the latest antics of the Religious Wrong. I think you should read about all these topics. If you have a particularly weak stomach, though, consider yourself warned.


The glorious thing about the Internet is watching the memes rise and fall--not those hideous magazine-style quizzes, but the random facts and ideas that show up within the same week from such disparate soruces. This week, everyone's talking about HPV, or human papillomavirus. There are more than 100 types of this virus, and they cause everything from the wart on your foot to genital cancers. Some types are sexually transmitted. Most types are not. Don't wrinkle your nose like that; chances are startlingly good that you, dear reader, have one of those HPV types floating around in your skin. About 50% of sexually active men and women acquire genital HPV at some point, though I wouldn't presume to make any comments about your sex life. The prevalence (total number of cases) in the U.S. is 20 million. The incidence (number of new cases each year) is 6 million, or more than 16,000 new cases each day, in the U.S. Now that you know all that...

The Kaiser Daily Reproductive Health Report on May 20th announced that "Merck's HPV Vaccine Produces Stronger Immune Response in Girls, Boys Ages 10-15 Than Women Ages 16-23." ("Wait, there's a vaccine?" you say. "How can I get this vaccine? Oh, frabjoyus day!" Keep reading.) Merck has a vaccine. GSK has a vaccine. They have both proven the efficacy of these drugs, and they're just about to hit the market. I'm cautious of Merck's Phase III results, because they are based on follow-up antibody tests and do not represent actual rates of infection. However, the Phase II results are stunning: "A study of the Phase II trials published in the April issue of the journal Lancet Oncology showed that Merck's vaccine was 89% effective at preventing infection with the four HPV strains and 100% effective at preventing cervical cancer, precancerous lesions or genital warts." (emphasis mine, quote from previous link) Because they are vaccines, these drugs are only effective for people who don't yet have any of these types of virus (of course). This report gives a good reason to target younger groups: the vaccine seems to work better on children under 15. Is that because of their young immune systems, or because this group is less likely to be sexually active and more of them will benefit from vaccination? I don't know. Neither do they.

People are worried about this disease. Dan Savage recently addressed this topic in his "Savage Love" column, and went on the record as saying "HPV is not a big deal," before documenting the prevalance and incidence of the infection, as well as its possible long term consequences, over his next two responses. Condom use only cuts the transmission of HPV infection by about 50%, since the virus spreads by skin-to-skin contact.* Savage rightly points out that the majority of folks with HPV will never get cancer or have a single wart, and that many healthy people are able to clear the HPV infection on their own within a couple years. According to my clinical sources, most of the persistant cases of HPV or warts occur in patients who are over 30 and/or smokers. We knew that smoking raised your risk of lung cancer, but did you know that it raises your risk of cervical or penile cancer, too, if you have a persistant high-risk strain of HPV? More good facts from the clinic: a "high risk" type of HPV is a type that is more likely to be associated with cancer or precancerous lesions (that's "abnormal Pap" to you, ladies). The "high risk" types are not the same types that are likely to manifest as genital warts. Let go of the ick factor. If you do have a wart on your body, that is not the type of HPV that gives people cancer. The only types that will kill you are the ones you will never see.
*And no, you cannot spread genital HPV if you have a wart on your hand, no matter where you may be putting those hands on your own or anyone else's body. Stop worrying. We haven't gotten to the frightening part yet.

Cervical cancer, however, is frightening. "About 250,000 women worldwide die annually from cervical cancer, and the American Cancer Society estimates that about 3,700 women die of the disease each year in the United States." (from Kaiser DRHR) If we could cut the rate of HPV infection, we would also be dramatically dropping the rate of cervical cancer--and HPV-associated penile and anal cancers, which occur at much lower rates but are still horrifying to the folks who contract them each year. Katha Pollitt, in her article "Virginity or Death!" summarizes the opposing viewpoint well:

Wonderful, you are probably thinking, all we need to do is vaccinate girls (and boys too for good measure) before they become sexually active, around puberty, and HPV--and, in thirty or forty years, seven in ten cases of cervical cancer--goes poof. Not so fast: We're living in God's country now. The Christian right doesn't like the sound of this vaccine at all. "Giving the HPV vaccine to young women could be potentially harmful," Bridget Maher of the Family Research Council told the British magazine New Scientist, "because they may see it as a license to engage in premarital sex." Raise your hand if you think that what is keeping girls virgins now is the threat of getting cervical cancer when they are 60 from a disease they've probably never heard of.

I remember when people rolled their eyeballs if you suggested that opposition to abortion was less about "life" than about sex, especially sex for women. You have to admit that thesis is looking pretty solid these days. No matter what the consequences of sex--pregnancy, disease, death--abstinence for singles is the only answer. Just as it's better for gays to get AIDS than use condoms, it's better for a woman to get cancer than have sex before marriage. It's honor killing on the installment plan.

There's a flaw in this logic. Maher seems to be concerned about young women engaging in premarital sex. Pollitt restates her attitude as saying, "it's better for a woman to get cancer than have sex before marriage." Maher doesn't say anything about young men, however. If "good" women are abstinent until marriage, and men aren't required to be, then we won't cut the rates of HPV--or any other sexually transmitted infection--at all. The most heartbreaking stories I hear from my friends in the Local Health Clinic (which serves a primarily Catholic Latina population) are about the women who come in to the clinic because they are too ashamed to go to their regular doctors, even though they know something is wrong with their bodies. They test positive for chlamydia or herpes or genital warts, and they cry and can't figure out how they got these diseases because they are good girls and have only slept with their husbands, and my friends at LHC get to explain to them that if that's true, they must have gotten the diseases from their husbands. The clinicians suggest (for bacterial stuff) that their husbands come in as well to get tested/treated, and the women refuse to tell their husbands because THEY will get accused of cheating. These women can't negotiate condom use, or don't believe in condoms anyway, so they will continue to get reinfected with these STIs. These are the women that Maher and the Family Research Council would fail to protect from cervical cancer: the women who have followed their religious institution's silly abstinence rules and who have never been educated about what risks they're taking by choosing a mate who hasn't followed those rules. It's not just the women who sleep around who will die from cancer. As long as this disease is allowed to spread, every woman--and many men--are still at risk. It's imperative that we vaccinate as many healthy people as we can, as soon as we can. If the Religious Wrong is gearing up for a "Plan B"-style fight in the FDA, they may be able to hold off government recommendations for this vaccine for months or possibly years. EVERY DAY they fight, they will have failed to protect our citizens from 16,438 new cases of this virus.

Frightened now?


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