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Policy provokes me to think and write. I currently work in ivory towers inspiring people to engage in their world. I am a student of the human condition and my classroom is the world. I don't need credentials to have an opinion but I've got paper to prove I know a few things about public health, social welfare and economics. I'm coming out of the tower and taking the words to the people and hope you will send some words back at me.

Monday, October 31, 2011

Preventing the health hazards of adolescent sex: Condoms, sex ed, and the HPV vaccine

Today, the topic of the day is HPV. I'll start with the facts, get them out of the way and get on with the rant.

According to the Centers for Disease Control and Prevention, HPV is the most common sexually transmitted disease in the USA with more than 50% of all sexually active people getting the virus at some time in their lives. Almost all cervical cancer is linked to HPV. Most of the time HPV goes away by itself within 2 years and does NOT cause health problems. Some strains of HPV cause cancer if they remain in the body for a long time and there is presently no way of knowing which people will develop cancer or other health problems. All women are at risk of cervical cancer and most cervical cancers occur after age 30. The National Cancer Institute estimates that in 2011, 12, 710 women will get cervical cancer and 4,290 will die of the disease. This works out to 8.1 cases and 2.4 deaths per 100,000 women per year - a fairly rare illness in the USA (but much more common and deadly in the economically developing world).

I have no qualms against preventing deaths and illness but the risk of cervical cancer is very low as is the risk of death from the disease. So we are immunizing a generation for a rare illness that already has a way of prevention (Yes. Condoms don't prevent 100% but neither does the vaccine). The HPV vaccine, with Gardasil (sold by Merck) being the most popular, has been widely marketed as a way of preventing cervical cancer by immunizing against four forms of HPV that cause the disease (as well as genital warts and vaginal cancer). Recommended age range for immunization is ages 9-26.

I have based much of a career on the belief that sex should be a safe and pleasurable activity that occurs between consensual partners. It shouldn't cost us our lives or our fertility or our social status.

But the politics of sex is why I have slowly gotten out of the sex business.

And nowhere is the politics of sex more volatile than in adolescence. (Well, the AIDS business has become less politicized but still a pit of snakes).

I get it. This is a country of prudes. People who like their sex on the sly instead of out in the open. (Thus the ever constant stream of 'scandals' that are just normal sexual behavior but conducted by famous people).

So when the chance to 'prevent cervical cancer' came along in the form of an injection, the pharmas (Merck in particular) were more than happy to talk about the prevention of HPV - a sexually transmitted disease - as a way to prevent cervical cancer. But not much talk of sex even though the early age of immunization - 11 - was closely tied to making sure a girl (and now boys) get their shot before they are exposed to HPV - through sex. (Age 11 is when many medical practitioners recommend it but on the website Gardasil is recommended for children as young as age 9).

So let's get this straight...... It is not okay to talk sexual health to children at age 11. We would not dare give children a condom at age 11, without societal outrage. However it is ok to give them an immunization at age 11 that prevents an STD (before sexual intercourse exposes them to HPV)

Call me paranoid but the safety record of drugs related to my reproductive parts is not the greatest and as these immunizations have not been around for 70+ years (the average length of time the children getting it now will live), perhaps we should use the opportunity (if you still want to be part of the medical experiment) to pass on some information while giving the shot. If we are going to give a shot related to a disease acquired through sexual behaviors then just maybe we could give a little spiel on behaviors that promote sexual health; like abstinence (yes, every sex ed volunteer preaches abstinence, not just religiously conservative ones), sexual pleasure from behaviors that do not require intercourse such as sexting (and whatever happened to hand jobs?), the use of a condom and monogamy (the holy grail of sexual relationships).

The focus on preventing cervical cancer and not a STD is really excellent marketing!!! In fact, it seems noone really wants to talk about the sexual behavior of adolescents. It appears that sooner or later we'll just give shots against gonnorhea, syphillis, chlamydia, and the lot, to spare us the necessary conversations or the necessary healthy behaviors. (Sorta like the stuff that makes you able to eat fat without it making you fat).

Abdicating a conversation for an immunization shows how far this country will go to avoid necessary conversations about sexual behavior. When I taught my 10 year old about condoms, everyone thought it was too young and yet they could not understand why I would not give her the HPV vaccine. Huh??? Isn't my condom talk and the immunization both based on the assumption that she may soon have sexual intercourse? When mothers told me that they do not want to imagine their daughter's having sex so they would not talk to them about sex and then packed them off for their Gardasil shot, my brain got a little fuzzy on the logic.

The shot separates us from the reality of adolescent sex. I live in a state (Washington) where the law says there should be comprehensive sexual education for young people. (But Washington has ex-state attorney and current senator who want to legalize marijuana and we have 2 female senators and 1 female governor - all democrats so it's not exactly the USA:). I find it interesting that elementary school children can learn about their stomachs when they learn about digestion but all the parts just below the stomach get ignored. As if they aren't there.

Here's the deal: almost everyone will have sex sooner or later. Let's acknowledge that, teach everyone how the sexual and reproductive health organs work (even married people need to know this), teach them how to take care of them and protect them and let's see how much the sexually transmitted disease rates would drop, unplanned pregnancy rates would drops (married people have this problem too), infertility would drop (often caused by undiagnosed STDs) and hey, even the abortion rate (lots of married people have these) would drop. And isn't that what everyone wants? (Yes. Lefties don't like abortions either).

So is it too much to ask that before the 11-year old gets the HPV vaccine, they get a sexual health class and some condoms, sign a form that says they understand what the immunization is for and that they received the class and the condoms, and then get their stab in the arm. Now that would be public health done the 'right' way instead of the 'easy' way.

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