The Promise of Disease Prevention
If the vaccine works, why not use it
By Erin Lebacqz
A young student told me recently that she had been diagnosed with Human Papillomavirus (HPV), the virus that causes cervical cancer in women. In her case, cancerous cells had already developed, and she had undergone two surgeries to remove this tissue. As she knew HPV is sexually transmitted, I told her not to feel guilty, that it was a virus like any other, and there was nothing wrong with the way she happened to contract it. I told her HPV affects 80 percent of sexually active people at some point in their lives, that it was common and normal. She said she had felt ashamed of having the virus at first, and I wondered whether embarrassment and shame had hindered her quest for health care in any way.
Though we now understand how this virus works, and while we have relative sexual openness compared to some periods of history, the stigma associated with sexually transmitted diseases (STDs) like HPV is still strong. This stigma causes guilt, embarrassment and silence. Even more dangerously, it often prevents people from seeking information and help. In the case of HPV, a new form of help may soon be on the horizon, in the form of a vaccine. My hope is that the vaccine will not only be ready, but available. In the current political climate, I worry that young women like my student will still not be able to receive this vaccine, either because of their age, or because of silence, or because we are unable to face the realities of sex and STDs.
HPV is the primary reason women have Pap smear exams each year. Because of this test, cervical cancer has become the eighth leading cause of cancer-related deaths in American women, rather than the second. However, this test still catches HPV after it has already been contracted, and often, as in the case of my student, discovers cancerous growth after it has already occurred. To completely prevent the spread of this virus, and thus to almost completely prevent cervical cancer, we would need a vaccine against HPV.
Fortunately, doctors at UNMH are testing such a vaccine right now, which may be ready for distribution in 2006. The UNMH team, led by Dr. Cosette Wheeler, has studied 768 women, with 100 percent success so far: none of the women taking the actual vaccine have contracted the virus. To Dr. Wheeler, these results are "probably the most effective that have ever been shown for any agent."
However, we can only hope that our political climate will be as progressive as our science. Like most states, New Mexico faces restrictions on reproductive health education and access. School district policies, public education obstacles, financial constraints and a resistance to talking about sex all threaten to prevent the vaccine from becoming widely available, even after the study is complete. The real shame about HPV would be a successful vaccine development without the popular access to match it.
Albuquerque Public Schools' district policy includes the provision that "birth control devices and medication will not be dispensed at school sites," indicating a general unwillingness to discuss or distribute reproductive health materials. The question of whether to offer the vaccine on school campuses cannot easily be avoided, however: Girls between the ages of 10 and 15 will likely be the target for these vaccines, even though they will most likely not require such protection for years to come.
Outside of Albuquerque, the political trend is also moving away from providing reproductive health care. International gag rules and refusals to fund organizations that mention abortion are having a devastating effect on countries dealing with an explosion of AIDS in their population; many of the same organizations that counsel women about abortion also provide health care for people with AIDS. In both the local and international cases, it seems like a fear of discussing reality is cutting people off from health care and other forms of help--a pattern we've seen before.
The reality of the situation is, of course, that while viruses like HPV and AIDS are contracted sexually, they are nonetheless viruses that deserve our attention and care. People that contract these viruses may have been unlucky, just as I was unlucky enough to catch a cold last fall. If the stigma surrounding HPV persists, and if a vaccine for this virus is not made available to everyone, people like my student—people who are sincerely trying to better their lives and the lives of those around them—will continue to risk battling cancer in their future. It is our responsibility to welcome the advances of science when these advances promise protection. It is equally our responsibility to see past our own ideals and fears to consider the health of others above the opinions of ourselves. For this reason, we should start considering how to make health care products like an HPV vaccine available to everyone, under any circumstance.
Lebacqz is a freelance science writer and instructor at TVI and UNM.
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