The controversial vaccination for the most common sexually transmitted virus, human papilloma virus (HPV) — which has been available for girls' use since 2006 — is once again becoming contentious as the Centers for Disease Control and Prevention (CDC) debates whether it should recommend that boys receive the vaccine as well.
Last year the Food and Drug Administration (FDA) — which approves drugs for use in humans but does not issue recommendations — cleared the way for Merck & Co.'s Gardasil, one of two competing HPV vaccines, to be used for boys and men ages nine through 26, pointing to its ability to prevent genital warts.
HPV can lead to cervical cancer in women and anal cancer in men, among other ailments. The FDA last year approved GlaxoSmithKline's Cervarix for use by girls and women ages 10 to 25, but not for boys or men.
Gardasil has been found to be highly effective in preventing anal lesions and cancer in men — men who have sex with other men are approximately 20-times more likely to develop anal cancer in their lifetime than men who only have sex with women. The CDC, which does make recommendations, is now deliberating whether to recommend the vaccine for all males, homosexual males or just for females, as it currently does.
The CDC currently recommends that all girls aged 11 or 12 be vaccinated with either Gardasil or Cervarix.
The vaccine has been met with significant opposition, particularly from parents, who have complained that the addition of these drugs to the existing regimen of childhood vaccinations has cornered them into discussing sex with their children earlier than they would prefer. Some have expressed concern that administering the shot encourages young girls to experiment with sexual behavior prematurely.
"It's ... highly politically and culturally charged," Tufts University's Medical Director of Health Services Margaret Higham said of the ongoing debate.
Community Health Lecturer Alissa Spielberg explained that while targeting gay boys raises issues for many people, it is often helpful to focus on the group of patients that will be most affected by a procedure of medication.
"If you're going to recommend something, you like to recommend it to the right group of people," she said.
Many, however, see ethical problems in targeting the drug's use.
Junior Ryan Rifkin, an active member of Tufts' Lesbian Gay Transgender Bisexual (LGBT) community, said that he thinks universal vaccination is the best way to reap the most medical benefits while remaining unbiased.
"The big concern with HPV is cervical cancer. Given this, I don't think it should be encouraged particularly within the Lesbian Gay Bisexual Transgender community," Rifkin said. "I think just vaccinating as many people as possible is the goal at this point — focusing of course on straight women, those with the greatest risk."
But universal vaccination is not straightforward either. While various states have attempted, and some succeeded, to pass legislation requiring girls of a certain age to receive the HPV vaccine before they enter school, issues of compliance and funding still remain, especially when controversial topics like sex, gender and homosexuality are brought into the mix.
Freshman Sascha Strand, who is not related to this reporter, said that his family's health insurance does not cover many standard sexual health procedures, so he empathizes with people with similar plans would not be in favor of a costly vaccine that might not be necessary.
"Insurance companies can be challenging on issues of LGBT health. Some are more reasonable than others, I'm sure, but my small health insurance company back home, for example, doesn't even cover STD testing," Strand said. "And it's difficult to justify preventative medicine when you're paying for it out of pocket."
Targeting particular preteen boys proves problematic on a practical level as well; often, little can be gleaned about a boy's sexual preference before he becomes sexually active.
"To single out certain kinds of boys is difficult," Spielberg said. "And probably ridiculous."
Still, the HPV vaccination has been proven to yield significant health benefits, and whether or not its use in males is recommended by the CDC, Tufts' Health Service is in favor of students becoming inoculated, according to Higham. The drug, taken as a shot and administered in a series of three doses, reduces the risk of contracting, transmitting and exhibiting the symptoms of HPV. In addition to keeping genital warts at bay, studies have shown the inoculation protects against cervical as well as penile and anal cancers.
"[Health Service is] very keen on the HPV vaccine. We think it's great," Higham said. "75 to 95 percent of young adults who have more than three partners will contract HPV, but some will show no symptoms."
