HPV: The Case for Gender- and Sexuality-Neutral STI Coverage

by Julia Barr

Human papillomavirus (HPV) is the name for a group of viruses (over one hundred) that are extremely common but present no symptoms--you’ve likely encountered them without knowing. HPV is not your typical STI: while it is sexually transmitted, it can’t be entirely prevented by wearing a condom, as the bacteria that cause HPV lives on the skin. While most strains are harmless and become undetectable in the body after a few years, some particularly harmful strains can remain, leading to genital warts and cell abnormalities that can result in cervical cancer, mouth and throat cancer, or anal cancer.

Luckily, there’s a vaccine for that. 

If, at this point, you are wondering whether you should get vaccinated against HPV, the answer is almost certainly yes. There are, though, some valid reasons why you might not get vaccinated, such as: 

  1. You’re pregnant

  2. You’ve had an allergic reaction to a previous vaccination dose

  3. You’re currently unwell 

But there are also many unfounded reasons for avoiding the vaccine, including: 

  1. Your partner(s) have had it

  2. Your sex/sexuality does not put you at risk

  3. Getting vaccinated against an STI leads to more promiscuous behavior

These unfounded reasons for opting out of safe sexual health practices don’t just apply to HPV. But the recent history of the HPV vaccine in the UK provides an ideal example as to why we need a broader change in mentality when it comes to sexual health care.

Beginning in 2008, it was recommended that all girls in England aged 12-13 years receive the HPV vaccine. In part, this was an effort to protect girls against cervical cancer that has, overall, proven successful: since the 1990s the rate of cervical cancer has decreased by 25%. Yet it was also a strategy based on the idea that vaccinating girls would provide enough herd immunity  to protect the entire population. With this approach, some issues immediately became evident. First, it put the burden of safe sex precautions in heterosexual relations on women, excusing men from having similarly to think proactively about protecting themselves against STI transmission. Second, it was only a strategy for women and individuals having sex with women, leaving men who have sex with men (MSM) particularly vulnerable. And indeed, even as the HPV vaccination campaign has contributed to lower rates of cervical cancer, there remain high rates of anal cancer due to HPV among MSM (20 times higher than among heterosexual men).

The way that sexual health care is delivered is not only a question of access; it’s also a question of messaging and emphasis. In the case of the HPV vaccination program, the implicit message was that HPV was primarily a concern for women (namely, heterosexual women). Recent studies have confirmed that this was the message many absorbed: HPV indeed comes up more frequently in conversations about heterosexual sex; a study of MSM confirmed that many believed the HPV vaccine was only meant for women, or didn’t perceive any threat from HPV to themselves. Consequently, in a community generally commendable for its emphasis on STI prevention, there remains lower HPV vaccination rates among LGBTQ+ individuals.

It was not until a decade later (in 2018) that the English Government updated its policy to recommend that boys of the same age should also receive the HPV vaccine, and initiated another vaccination programme specifically focused on MSM. While this is a resounding step in the right direction, it isn’t a complete solution in itself: this improvement in access needs to be accompanied by an improvement in messaging. Sexual health care and education should be available to all, and equally should be the responsibility of all. The onus to uphold safe sexual practice shouldn’t fall on just one partner--so split the price of condoms and ensure you’re each up to date with vaccinations and STI testing. 

Unfortunately, like many other health services, the HPV vaccination programme has suffered under COVID-19. The vaccine is usually administered in school to Year 8 students, but with school closures, these vaccination programmes were halted. Whereas in the 2018/2019 school year, 88% of female Year 8 students received the vaccine, in the 2019/2020 school year only 59.2% of Year 8 females and 54.4% of Year 8 males were vaccinated. But even as our ability to vaccinate is limited, our ability to approach sexual health more equitably is not. We can all assume responsibility for getting tested for STIs; we can all speak openly with our partners about our sexual practices  and history.

The bottom line? Sexually transmitted infections don’t distinguish between sexes or sexualities; so neither should sexual health care.

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Julia Barr is a recent graduate of the University of Cambridge where she studied postcolonial British history. She currently serves as grant writer with Kar Geno, a Kenyan-based non-profit that assists HIV/AIDS-affected women and provides sexual health education to school-aged children.

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