Sunday, March 18, 2007

Things I Don't Want to Hear Again (on the HPV Vaccine)

Okay, people, you really have to stop it with the "HPV vaccines will turn girls into sluts" argument. I'm serious. My brain might just explode. Today's Tennessean (Nashville's newspaper of dubious quality) has an article, "State official doesn't back mandated HPV vaccine." As you may know, mandating the vaccine for school entry (with generous opt-out provisions) is under consideration or has been enacted in several locales. Tennessee's Commissioner of Health, Susan Cooper, reportedly stated, "Do I think every female child should be protected against cervical cancer? If there's a way to do it, yes. Do I think we know enough about the long-term outcomes of this vaccine to say we ought to mandate it today? Maybe not." This is a common concern about the vaccine (see my concerns about Texas's mandatory vaccination proposal). You want to further examine the science and the money and the implications, fine, good idea.

However, Bishop George W. Price Jr., pastor of Bethesda Original Church of God in Nashville trotted out a already tired old line not based in science - "I'm not for it because it does encourage young girls to have sex outside of marriage, and that's now what it's all about."

Let's be absolutely clear:
  • Most girls are probably not avoiding sex solely because of HPV and/or cervical cancer. A recent CNN article profiled a doctor who indicated that few of her patients are even aware of HPV. I would go out on a limb and say that pregnancy is the number one fear about sex for young girls.
  • Existing data suggests that 9% of high school students report having been forced to have sexual intercourse, and 20-25% of women in college report being victims of completed or attempted rape. This suggests that there are an awful lot of women who may or may not choose premarital sex, but could nonetheless use some STD protection.
  • Additional reports suggest that by age 44, 96% of males and 94% of females have had premarital sex. 70+% have had premarital sex by age 20. If these data are correct, 3/4 of people are having sex despite their parents' exhortations and wishes, and could also potentially benefit from this protection.
  • Spouses cheat, and get divorced. The CDC reported a divorced rate of 3.6 divorces for every 1,000 people in 2005. Additionally, some marriages may include an abstinent-until-marriage woman, but a less abstinent husband.
  • The vaccine is most effective before sexual activity begins (such as before age 20 for about 3/4 of people). This does not require tremendous understanding - we generally understand that we give vaccines for chicken pox, measles, the flu, etc. before people contract the infection, in order to prevent it.

Essentially, there are a number of factors outside an individual woman's control that may mean, even if she intends to be pure as the driven snow until marriage, she may end up with an HPV infection, and possibly resulting cervical cancer.

One anti-vaccination activist previously stated that, “What they are proposing is vaccinating a bunch of healthy girls that are responsible and that do come from good homes for the benefit of irresponsible people.” However, according to the CDC, “Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year.” I suppose 80% of women just come from bad homes and are irresponsible.

Planned Parenthood's Mark Huffman responded to such concerns with, "For those parents who are concerned about what kind of effect this will have on their daughter's behavior, we can assure them that related studies suggest very strongly that vaccinating or providing young people with protection around sexuality does not increase the likelihood that they will engage in sexual behavior." Even the notoriously conservative Family Research Council has gotten with the program and realized that encouraging sex is an unlikely outcome - the organization once stated that it might be seen as a license to have sex, but later released a statement in support of the vaccine. One commenter on the story's discussion thread gets it just right - "Let's be clear on this: I got chlamidia[sic] from my husband. Young girls need to be protected, not so that they can go out and do whatever, but so that they will not be victimized in yet another way."

If you're going to oppose HPV vaccination, you can do it for any number of evidence-based reasons. Let's not use "it'll turn the girls into sluts!" Reefer Madness-style propaganda, given the number of holes in that particular argument. If you'll excuse me, I'm off to stick myself with rusty nails and roll around in a blood spill, because I've been vaccinated against tetanus and hepatitis.


Blogger Lynne Eldridge M.D. said...

Thank you for your note! I love your analogy to feeling free to play with rusty nails!

When I was in private practice, the majority of my patients had no idea what HPV was. The did, however, understand the risk of pregnancy, AIDS, and a host of other concerns related to sex.

Since I have not heard the HPV vaccine advertised as a method to prevent pregnancy or HIV, I fail to see how this would motivate girls to feel they are protected against their greatest concerns.


Lynne Eldridge M.D.
Author, "Avoiding Cancer One Day At A Time"

12:22 PM  

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