A double standard for the HPV drug

When the Centers for Disease Control recommended preteen girls get the HPV vaccine, parents lamented the sexualization of their little girls. Where was the outrage when the CDC then recommended it for boys?

Illustration by Koren Shadmi

With 6 million new cases each year, the human papillomavirus (HPV) – best known as the primary cause of cervical cancer in females – is the most rampant sexually transmitted infection in America, practically as common as the cold. The US Centers for Disease Control estimates that more than 50 percent of sexually active men and women will eventually contract HPV, though most won’t ever know it. It can be symptom-free and frighteningly easy to transmit, through intercourse, oral sex, and, some doctors say, even aggressive French kissing, which anyone who’s chaperoned a school dance knows kids are sort of into these days.

Kids are, of course, the issue. There’s a HPV vaccine, but in order to be most effective, it must be administered far in advance of any sort of sexual contact – the CDC recommends starting the series at age 11 or 12. The uptake’s been slow, to say the least: Four years after the Food and Drug Administration approved the vaccine, fewer than 11 percent of girls in the United States have received all three shots.

Though the anti-vaccine movement has something to do with the underwhelming turnout, the lack of interest is also a result of the conflation of public health and morality –  recalling, scarily, the notion of HIV as a disease for drug addicts and libidinous gay men.

Even the most liberal parents have struggled with the idea of inoculating their often pre-pubescent daughters against a virus that can be contracted only through a sex act; some worry it will give girls a license to be promiscuous. And many parents resent the government’s involvement, with a recent National Journal poll indicating that 57 percent of US voters surveyed oppose Texas’s mandated HPV injections. As presidential hopeful Michele Bachmann declared at a recent debate: “To have innocent little 12-year-old girls be forced to have a government injection through an executive order is just flat-out wrong.”

Yet the government obviously requires innocent little girls to get injections all the time. And for that, your kid doesn’t get rubella, for instance. The darker implication, however, is that STDs happen only to those whose behavior asks for it. For people like Bachmann, cervical cancer isn’t a disease. It’s a punishment.

But when the CDC issued a recommendation that 11- and 12-year-old boys also receive the HPV vaccine, the backlash was surprisingly muted. Objections to this fall’s announcement focused not on morality or emotion, but on money. “Does it make sense to vaccinate all boys against a sexually transmitted virus that causes a common cancer they are physically incapable of developing?” staffer Marie McCullough wrote in the Philadelphia Inquirer, despite the fact that the new recommendation was based on findings that the virus can also lead to throat and anal cancers, which are on the rise in both straight and gay men. (Vaccinating boys will also help reduce the incidence of HPV in girls.) In the same piece, University of Missouri cancer researcher Diane Harper said the new recommendation arose because drug companies “didn’t make the money they hoped to make with girls.” Staff writer Mary Elizabeth Williams said on Salon.com that “the sudden push to give the vaccine to boys will significantly boost the profits of Merck, the drug’s producer.”

Left unsaid in all of that? Protecting boys from their own sexuality might not be the worst idea. After all, boys are going to have sex. They’re boys.

In many ways, the HPV vaccine has always been about the money. The two versions available in the US are expensive. At the same time, that money seems to be the only issue surrounding the recommendation for boys is evidence that the sexual double standard is alive and well – sex is natural for boys, not for girls.

It’s not all backward steps for female health. Barely two months after the recommendations for boys, the controversy has already subsided, even leading toward a new sort of acceptance. Public health officials hope that now that the vaccine is OK for boys, well, maybe parents will agree it’s OK for girls, too. “In many ways, the recommendation for boys could help change the public perception of the vaccine in general,” says Alina Salganicoff, vice president of women’s health policy for the Kaiser Family Foundation. “When you involve both genders, there’s an increased receptivity. There’s something about targeting preadolescent girls that had some sensitivity. Now it’s a neutral issue.”

That’s good news for girls. Better news, though, would be removing the shame factor from female sexuality, something that won’t come from a government mandate, but from an essential, and very personal, shift in values. In the end, politics is the easy part.

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Alyssa Giacobbe is a regular

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Globe Magazine

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