Is HPV vaccination purely a women`s issue?
A simple question with a complex answer:
Is HPV vaccination only about women?
Although progress has been made in the past several decades across many countries, it's commonly been seen as “a woman`s issue”. Pap smears, concerns around women's sexual activity, and cervical cancer all tend to get a lot of press. You`ll find countless testimonials, videos on YouTube, TikTok, Instagram, and on every other social media site you can think of about cervical cancer. Of course, this is a positive. We certainly need to raise awareness around it. Especially in the light of movements around women's health, gender equality, and feminism in leadership. Rightly so; these are indeed important across the world.
However, here's the issue. That takes attention, funding, and resources away from the hundreds of thousands of cancer cases HPV causes in men every year. These include head, neck, oral, anal, penile, and oropharyngeal. This includes the base of the tongue and tonsils. Further, at the time of writing, there are no diagnostic tests for men, while there are PAP smears for women from the early twenties usually until their 60s. Therefore, it is crucial to emphasise the importance of the vaccine for men as it is their only preventative option.
As someone who has written a paper on HPV vaccination and cervical cancer, there is sufficient publicity and information around this. So, in this post, I`m going to address HPV and the diseases it causes from a slightly different angle.
I`m going to talk about HPV-linked disease, and why it isn't simply a female issue. I`m also going to discuss why we need to stop feminising it, and why it is indeed risky to keep doing so. I`ll also discuss common concerns men have around HPV vaccination, and how they can be addressed.
Nobody knows the importance of HPV vaccination for men better than men who have experienced HPV linked disease themselves.
Scott Vetter is one such individual.
In a video by the American Cancer Society, he states that his doctor told him "Scott, it's going to be tough, but just push through." He goes on to describe his experience of treatment. "She (the doctor) said that HPV-linked cancer is very responsive to chemo and radiation. Let's try that first. It was a 50-minute radiation treatment a day. The worst part, really, was the chemotherapy. I had 4,5 treatments, a treatment every 2 weeks. I ended up in the hospital. My last one I was in almost two weeks trying to recover and that was the hardest part. They joke about something called chemo brain. I couldn`t remember my wife`s name”
So, how do you build awareness around these devastating impacts HPV cancers can have on men`s lives? Well, you look at how it happened in the first place. That's exactly what I'm going to do next.
There are several reasons for this gender imbalance in HPV vaccine promotion. One reason is that HPV infection is more commonly associated with cervical cancer in women, which has historically been a more visible and stigmatised disease. As a result, there has been more public health messaging around the importance of cervical cancer screening and prevention.
For example, in her insightful book Vaccine Nation, Elena Conis begins chapter 10 by emphasising the impact media can have on people's perception of vaccination; particularly young people. On the television series Girls, it is stated that "All adventurous women do" (have HPV). This phrase circulated around social media hugely following the airing of the program.
Public health officials, however, were not so enthused, and stated that it reflected genuine confusion around how HPV is actually transmitted. As someone who studied Microbiology and has written a paper on HPV, I can say that;
You don't have to be sexually "adventurous" to contract HPV
You don't have to be promiscuous to contract HPV
You can have sex with one faithful partner and contract HPV
In fact, the vast majority of sexually active adults will contract HPV at least once in their lives. Over 90% clear it.
These nuances are not well understood by the public, and I believe that the program reflects this. However, I believe it reflects a broader issue than just understanding. It reflects connotations of female sexual liberation, gender roles, and so much more
Another reason is that the original HPV vaccine, Gardasil, was initially approved by the US Food and Drug Administration (FDA) for use in women aged 9 to 26. It was later approved for use in men, but the initial focus on women may have contributed to the perception that the vaccine was primarily for women.
So, that meant that discussions around HPV , and vaccination against it, were female-centred. Men weren't really in the public consciousness when it came to HPV. All the advocacy, policymaking, and research efforts were directed towards women. The research, however, shows that HPV causes a broad range of cancers in both men and women. However, cervical cancer was (and to an extent, still is) overrepresented in the public narrative. This signals a huge need for increasing awareness.
Cultural change takes time, however, and it has been only In recent years that there has been a growing recognition of the importance of promoting the HPV vaccine for both men and women. According to the CDC website, all boys and girls should receive the HPV vaccine at age 11 or 12, although it can be given as early as age 9 and up to age 26 for both sexes.
Increasing awareness of the importance of the HPV vaccine for both genders can help to reduce the gender imbalance in vaccine promotion and increase uptake among all populations.
Though progress has been made, how can we change the culture around it? How do we encourage men to take the HPV vaccine? The first thing that is key is understanding how diverse people`s reasons for being concerned or rejecting the vaccine are. That said, there are trends in why men reject or are concerned about the HPV vaccine. These include complacency (i.e going with the flow), lack of confidence in healthcare providers, institutions they are employed by, and convenience of vaccination which includes a framework of issues including lack of access, money, or time.
Therefore, encouraging men to get the HPV vaccine requires a multifaceted approach that involves education, awareness-raising, and targeted messaging. Here are some strategies that can be used to promote HPV vaccine uptake among men:
Increase awareness is key. If men aren`t aware of HPV, the cancers it can cause, and the vaccination, they won`t take action. Many men may not be aware of the risks associated with HPV infection, including the risk of developing cancers of the anus, penis, and oropharynx. Increasing awareness of these risks can help to motivate men to get vaccinated.
Telling stories like Scott`s above makes it highly relatable. Personal stories would emphasise to men that they should be conscious of HPV infection. Why? Someone who is in their age range, and thus someone they can relate to, has had consequences from it.
The emotion experienced by Scott resonates far more powerfully than statistics. It's vital to leverage that emotional component when advocating for vaccines. Or any healthcare intervention. Especially if it's about something as sensitive as reproductive health. I`ve said this many times before, and I'll continue to because it's so important. We are very vulnerable when we discuss healthcare.
Addressing questions and concerns is also key. There may be questions among men about the safety and efficacy of the HPV vaccine. Also, there are concerns about other aspects of HPV-linked disease and its prevention too.
So, let's break it down.
Once again, this is where men sharing their stories with other men can drive huge change. It's much easier to believe someone who you respect and can relate to, than abstract statistics. Again, we`re back to the culture around HPV. It's really only been promoted for women, (historically at least, there is change occurring around this). As a result, it's only being spoken about in female circles. Scale that tendency up to whole societies, countries, continents, and eventually the world - you start to get where the feminisation comes from. This is, of course, not a criticism, just an observation. Thus, why sharing experiences among men is critical to lead cultural change.
Here's something interesting I noted when reading through these. It's not so much that people want their partners to talk about HPV, in an intellectual way. They want their partners to accept HPV on an emotional level. There wouldn't be such intense discussion around it if there wasn't. It's a pain point. Judging by the number of such posts there are, it's a pain point for a lot of people. So (and I`ll say this again at the end), we don't just need HPV awareness, we need HPV acceptance.
Many people will have concerns around practicality .
When will I be able to get it?
Will I need to pay?
If so, how much?
Can I get time off work?.
Integrating vaccination into workplace programmes makes it easy and convenient to protect themselves and others. It reduces the confusion usually associated with the above questions, because the process of vaccination is centralised to their workplace.
I`m going to wrap up short and sweet. We don't just need HPV awareness, we need HPV acceptance. That leads to more empathy, better communication, and ultimately, better health for everyone. Thanks for reading.
Copyright @Irish Medical Times 2023