Box Turtle Bulletin

The irony of opposing HPV vaccination

As we discussed earlier today, some conservative Christians find Rick Perry, a Southern Baptist politician, an unacceptable choice for president because he supported the vaccination of young Texas women to prevent their possible future infection with the human papillomavirus. Firmly believing that the wages of sin is death – and should damn well stay that way – they oppose any efforts to inoculate for a virus that is spread primarily through sexual behavior.

I believe that much of this opposition is based in a fear that their literalist faith might be losing relevancy. Should a moral code no longer provide an observable service – such as protection from disease and unhappiness – then it becomes an arbitrary set of rules imposed by a capricious deity at his whim. So it is important to them that HPV – and it’s correlation with cancer – remain associated with sinners.

You can sense the desperation in this comment on the American Family Association’s website from Sally in Pennsylvania:

Sorry… Christian or not, I cannot support any candidate who signed an executive order to mandate a series of painful vaccinations for 12 year old girls – FOR AN STD that’s preventable by BEHAVIOR! On top of that, there was no provision to allow parents to opt their child out until enough pressure was put on him and he gave in. That’s a pretty clear indication as to where he stands on the issue of parental authority versus state control on the raising of children. No thanks.

But what Sally hasn’t realized is that she may her way; HPV may well remain associated with a group.

Should sufficient numbers of people refuse vaccination, the virus will continue to have a distinct pool in which to replicate and a strong correlation will become detectable. Soon, should Sally’s thinking prevail, HPV and the correlating cervical cancer rates will come to be associated with conservative Christianity.

The HPV Vaccine Debate Today and Why Preventing Syphilis Was “Immoral” Then

On Monday’s Tea Party/CNN debate, Texas Gov. Rick Perry was blasted for signing an executive order requiring girls in Texas schools to be vaccinated for HPV, a virus which is the leading cause of cervical cancer in women (and, incidentally, the leading cause of anal cancer in men). The order included a parental op-out, but that did not mollify fellow conservatives who blasted him for trying to wipe out a sometimes sexually-transmitted cause of a horrible, painful death.

The argument is as old as the hills. Syphilis once played a similar role in public discourse at the turn of the last century. Untreated, syphilis leads to a slow breakdown of the body and nervous system that ultimately resulted in a premature dementia and death for its victims. And at the turn of the last century, it was not very curable — early cures were about as painful, time-consuming and deadly as the disease itself. In 1907, Dr. Elie Metchnikoff, of the Pasteur Institute in Paris, published what was later titled in English, The Prolongation of Life, in which he discussed a wide range of medical and moral issues facing society, including the debate about the morality of curing syphilis:

A large number of people, amongst them even men of science, regard as immoral any attempt to prevent to spread of venereal diseases. Recently, in connection with the investigations in the action mercurial ointment as a means of preventing syphilis, members of the Faculty of Medicine in France made a public protest, declaring that it would be “immoral to let people think that they could indulge in sexual vice without danger,” and that it was “wrong to give the public a means of protection in debauch.” None the less, other men of science, equally serious, were convinced that they were performing an absolutely moral work in attempting to find a prophylactic against syphilis which would preserve many people, including children and other innocent persons who, if no preventive measures existed, would suffer from the terrible disease.

…In the question of the prevention of syphilis, the moral problem is still more easy to settle. … The certainty of safety from this disease might render extra-conjugal relations more frequent, but if we compare the evil which might come from that with the immense benefit gained in preventing so many innocent persons from becoming diseased, it is easy to see which side the scale dips. The indignation of those who protest against the discovery of preventive measures can never either arrest the zeal of the investigators or hinder the use of the measures. This example again shows that reasoning is necessary in the solution of most moral questions. (Pages 302 and 304, American 1910 edition.)

Notice the debate taking place here, that it is a moral stand to withhold preventative treatment for a sexually transmitted disease, regardless of the consequences to those who do not undertake sexual activity of their own volition or who can acquire the disease non-sexually. HPV — and AIDS for that matter — also fit all of those characteristics. Little girls and women can acquire HPV through rape or molestation, and later develop cervical cancer. HPV, like syphilis and HIV, can also be transmitted prenatally from the mother. There are many routes of transmission, including casual skin contact, in addition to sexual transmission for HPV. But it’s that last aspect — remember how everyone on the debate panel, starting with moderator Wolf Blitzer, repeatedly called HPV a sexually transmitted disease? — which drove the debate on the morality of Rick Perry’s decision. There are similar mandates for vaccinations against measles, whooping cough and polio, but nobody was concerned about those mandates.

More than a hundred years ago, Dr. Metchnikoff found that “reasoning is necessary in the solution of most moral questions,” and that when one applies reasoning, the solution becomes obvious. But reasoning is non-existent among today’s GOP frontrunners. Dan Savage, like the good Dr. Metchnikoff more than 100 years before him, connects the dots:

Religious conservatives loved the HPV virus because it killed women. Here was a potentially fatal STI that condoms couldn’t protect you from. Abstinence educators pointed to HPV and jumped up and down—they loved to overstate HPV’s seriousness and its deadliness—in their efforts to scare kids into saving themselves for marriage. And they fought the introduction of the HPV vaccine tooth-and-nail because vaccinating women against HPV would “undermine” the abstinence message. Given a choice between your wife, daughter, sister, or mom dying of cervical cancer or no longer being to scream “HPV IS GOING TO KILL YOU!” at classrooms full of terrified teenagers, socially conservative abstinence “educators” preferred the former.

The state of scientific knowledge advances, but things never change for those of the earth-is-flat-and-God-is-on-his-throne mentality. If the day should ever come that the medical establishment is ready to role out a safe and effective vaccine against HIV, what you see today hints at the massive convulsion that will take place. If history is any guide (and why shouldn’t it be?) the apoplectic tantrums and scaremongering on the right will be epic, and you can guarantee that they will throw every roadblock imaginable to prevent its wide scale deployment.

“Over 28 times more likely to get anal cancer”

When traveling this year, consider the following:

• The second largest weather killer in the United States is a lightning strike.
• You are over 100 times more likely to be hit by lightning in Florida than California.

Makes ya think, doesn’t it? Perhaps vacation should be at Disneyland rather than Disney World.

But would it help you put things in perspective if you knew that the odds of getting struck by lightning in the US are about 1 in 500,000 and that only 40 to 50 people per year are killed here by a lightning strike? When you know the facts, then all of the above ceases to give you concern and instead you feel manipulated.

Keeping that in mind, look at the following condom awareness psa being aired by New York City:

When you get HIV, it’s never just HIV. You’re at a higher risk to get dozens of diseases, even if you take medications. Like osteoporosis, a disease that dissolves your bones; and dementia, a condition that causes permanent memory loss; and you’re over 28 times more likely to get anal cancer. It’s never just HIV. Stay HIV free. Always use a condom.

Scary!!

But is it true? And, as importantly, is it in perspective?

Osteoporosis is directly related to bone mineral density (BMD) and it is the measurement of BMD that is used to identify and – more or less – define who has or does not have osteoporosis and likely future fractures. And it is, indeed, true that HIV positive persons have higher rates of both osteoporosis and osteopenia (a similar but less sever condition). The reasons are, at present, undetermined.

So, yes it is fair and accurate to warn that HIV can, on average, increase one’s likelihood of osteoporosis (as can being a short white woman). And this condition is common enough that an increase in incidence is material and worthy of discussion.

But it’s not quite all of the story. The handsome young man whose bones were dissolving before our eyes is rather unlikely to have osteoporosis for decades, if ever. Osteoporosis (which primarily effects those over 50) is fairly easy to both treat and forestall, so this young man may need to take extra precautions (e.g. adequate calcium and vitamin D) but he is not going to wake up one morning and find that his skeleton has dissolved to soup.

Dementia is more common in people with HIV than without. Indeed, before HAART, dementia was a common consequence of HIV infection and was often the first qualification for an AIDS diagnosis. Currently it is less common, but still a major concern, especially as HIV infected persons age. (caregiver.org)

Before the arrival of highly active anti-retroviral therapy (HAART) in the second half of the 1990s, estimates of the percentage of people with AIDS who would develop HAD ranged as high as two-thirds. Many specialists, however, believed that the true figure was closer to 20 to 30 percent. More recently, experts have estimated that less than 10 percent of people on HAART develop HAD. However, because people with HIV are living longer than ever before, a greater number could ultimately develop the disorder, perhaps in its milder forms.

So far, I don’t necessarily quibble with accuracy of the psa, though the imagery suggests that these possible consequences are likely to be onset in early life, a false implication. But now let’s turn to one of my pet peeves, the ooky-spooky (and mostly bogus) anal cancer scare.

Yes, anal cancer exists. And yes it has higher rates in gay men than straight and even higher in HIV positive men. But the inclusion of anal cancer as a “higher risk” and the “28 times more likely” language tells me that this psa has no credibility whatsoever. It is not designed to inform, but to frighten.

The anal cancer scare is a favorite tactic of anti-gay activists. And it is irresponsible and immoral behavior when they seek to demonize gay men by claims that “”homosexuality is by its very nature dangerous to those who practice it.” It is no less irresponsible and immoral to use this scare tactic in the advance of a noble cause like encouraging condom use.

Anal cancer is very rare. In the US, about 5,260 people per year get this disease, of which about 40% are men (so, as you can see, women are 50% more likely to get anal cancer. Beware!!). About 720 patients die. Anal cancer is highly associated with HPV infection (though the vast majority of those infected with the HPV virus never develop anal cancer) and a vaccine is available which eliminates this risk factor.

Gay men, who are more likely to have become infected with HPV in their anus than are heterosexuals, experience anal cancer incidence of about 35 in 100,000. HIV infected persons, as are other persons with a suppressed immune system, are more likely to develop this cancer, but we still are talking tiny tiny numbers, maybe around one tenth of one percent.

Yes, HIV seroconversion is a life-changing experience. While most HIV positive people live relatively the same life as HIV negative people, there are more risks, rules, and precautions. Drug regimens must be adhered to, lifestyle choices have to be made, and health complications of some sort are almost unavoidable.

There are, indeed, many many good reasons to avoid infection with HIV. But fear of anal cancer is not one of them.

I support the dissemination of information that clarifies and warns about avoidable health risks. But I do not support bogus fear tactics that seek to deceive and manipulate, even if the goal is admirable. And this psa is one of the most deceptive manipulation tactics that I’ve seen.

And we cannot blithely suggest that the end justifies the means, when there are real victims of this false impression of HIV. This psa stigmatizes HIV positive persons in ways that are unnecessary and cruel. Viewers leave with the impression that HIV positive persons are about to fall over dead or go stark-raving mad.

And, in the mind of many, the ails of HIV positive people reflect on gay people as a whole. Psa’s that warn of dementia or anal cancer in HIV infected persons translate to many viewers that gay people are diseased and insane. We all, HIV positive and HIV negative alike suffer the consequences of such presentation.

And, besides, they are wrong. Yes, most people with the virus will also have other issues that result. But it is not true that “It’s never just HIV.” For some few, an HIV infection will not result in any medical consequences. I can’t say exactly how many, but it may be more than those who get anal cancer.

GLAAD and Gay Men’s Health Crisis have joined forces to ask the city to pull the ad. I wholeheartedly agree.

HPV Vaccine OKed for Males

Hardly an anti-gay activist can keep the excitement from their voice when they breathlessly declare that Gay Men Die From Anal Cancer!! And, indeed, gay men do die from anal cancer. In fact, about 0.35% of gay men do get anal cancer (a higher rate than non-gay men) and, if not treated, some of them die.

The primary contributor to anal cancer is infection with the HPV virus, the same virus that contributes to cervical cancer in women, causes genital warts, and is linked to some rare oral cancers in straight men. HPV is very common and most sexually active adults will be infected at some point in their life.

But some day that may no longer be true.

As we told you in June, a vaccine for the virus – which the CDC has been urging to be provided to all girls – is also effective in preventing infection in boys. And now the FDA has approved the vaccine for such use. (NYTimes)

The vaccine was approved last week by the Food and Drug Administration for use in boys and men ages 9 to 26. Wednesday\’s action, by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, is intended to guide national policy on use of the vaccine; its recommendations are typically adopted by professional medical associations and set the standards of practice for physicians.

But it probably won’t lead to universal vaccination. After all, it would be mostly appropriate to boys who may some day engage in sex with someone of the same sex, and we aren’t so foolish as to assume that public health policy will be directed by what is beneficial to future gay citizens.

The new recommendation means, in effect, that doctors and clinics may now administer the vaccine at their discretion to boys and men ages 9 to 26, but they are not expected to offer it. Parents may consider the vaccine as an option for their sons, but some health insurers may choose not to cover the shots.

Yet this is good news. And it is important that we spread the news to gay-straight alliances and gay youth groups and to parents of kids that are a bit gender-nonconforming and even those parents who put their kids’ health above their dreams of a daughter-in-law. This simple step could possibly save a life.

And in the process remove one more bullet from the arsenal of those who attack our lives and freedoms.

Vaccine for HPV Effective in Men

Just ask any anti-gay activist and they’ll tell you: the gays get anal cancer!! In 1997 the anti-gay group Concerned Women for America, in support for their claim that “homosexuality is by its very nature dangerous to those who practice it”, declared

Homosexual men’s practice of anal sex has left many of them victims of anal cancer. One article in the New England Journal of Medicine commented, “Our study lends strong support to the hypothesis that homosexual behavior in men increases the risk of anal cancer: 21 of the 57 men with anal cancer (37 percent) reported that they were homosexual or bisexual, in contrast to only one of 64 controls.”

And even the CDC warns

Gay and bisexual men are 17 times more likely to develop anal cancer than heterosexual men.

You may find this surprising. Looking at your friends you may wonder, “Who has anal cancer here? Why are they keeping this a secret from me?”

Well fear not. Your friends aren’t lying to you. While anal cancer is far more frequent in gay men than heterosexuals (and even more common to HIV politive men), it is still very very rare – and about to become rarer still.

HPV, the human papillomavirus, is sexually transmitted and very common. According to the CDC, “Most sexually active people in the United States (U.S.) will have HPV at some time in their lives.”

Although the virus may never present symptoms, it’s most known for causing genital warts. At any given time 1% of sexually active men in the US have genital warts.

More seriously, a number of cancers have been shown to be associated with HPV including cervical cancer, penile cancer, and anal cancer. Each of these are fairly rare.

The rate of anal cancer in men is 9 out of 100,000. In gay men that rate soars to 35 out of 100,000.

Although 0.035% is hardly the sort of occurrance rathat argues that “homosexuality is by its very nature dangerous”, we should not dismiss or treat lightly the pain and misery brought about by this disease.

Fortunatly there is a vaccine for the type of HPV that causes cancers. It is nearly 100% effective in reducing infection in women. However, the vaccine has not yet been approved for use on men.

A new study may lend support to the vaccination of men as well. (xtra)

“The numbers right now look not quite as good as the girls\’ but still very, very good,” says Palefsky. “The vaccine was nearly 100 percent effective [in women] so you obviously can\’t do better than that.”

Palefsky says the vaccine would still make an effective preventative health tool for everyone because the same strains of HPV that cause most cervical cancers in women also cause a majority of anal cancers in men.

“They\’re entirely the same,” he says. “That\’s why we\’re optimistic that if boys do get vaccinated with the same vaccine that girls are using, it should prevent a substantial number of anal cancers.”

Conservatives have opposed the application of this vaccine for girls under the logic that it presumes that their little Suzy is going to be a promiscuous slut. And since they are good Christians kids wearing their purity ring they will never be exposed to a sexually transmitted virus. (In my experience, Christian kids tend to experience miracle babies – those who show up fully devoloped and health about seven months after a rapidly planned wedding.)

We can expect an even higher level of objection to vaccinating little Johnny who is undoubtedly going to give up his desire to be church organist when he grows up, develops an interest in sports, and marries a nice Christian girl.

But as a matter of policy, every child in the country should be vaccinated, regardless of sex. I care about Suzy and Johnny’s heath even if their parents do not.

Study Links Virus to Rare Cancer In Heterosexual Men

There’s a headline you don’t see every day. This is almost the mirror image of the study which sparked the MRSA panic last January: A virus that had been causing cancer in women and gay men has been found in straight men in pretty high numbers. It’s just one small study though, just like the one that inspired worldwide headlines of a new killer superbug threatening homosexual men. So where’s the panic this time? After all, HPV is one of the most common sexually transmitted diseases out there.

Paging Peter LaBarbera and Matt Barber…