STD Awareness: Gardasil and Gendered Double Standards

male female teens largeDespite the fact that it’s been approved for males for years, Gardasil is still largely seen as a vaccine for girls, and human papillomavirus (HPV) is still thought of by many as a virus that only impacts the female population. The fact of the matter is that HPV can have serious consequence for boys and men, and Gardasil is an important tool in protecting their sexual health. Why, then, does the association between girls and Gardasil persist?

Let’s stop thinking of Gardasil as the cervical cancer vaccine. Gardasil is a cancer vaccine, period.

Before Gardasil’s introduction, the pharmaceutical company Merck launched an HPV-awareness campaign to get a buzz going for their upcoming vaccine. Their talking points could be boiled down to one simple fact: HPV causes cervical cancer. Outside of the medical field, HPV was a little-known virus, and Merck strove to connect HPV and cervical cancer in the public’s mind so that, after it hit the market, Gardasil’s value would be easily recognized.

So the origins of the association between girls and Gardasil lie in its marketing — and the fact that the Food and Drug Administration (FDA) initially only approved its use in females. From its introduction in 2006 until 2009, Gardasil was only FDA-approved for use in girls and women, and its routine use in males was not recommended by the Advisory Committee on Immunization Practices until December 2011.

While Gardasil’s website is currently gender neutral, archives show that before FDA approval for males, it contained photos of young women and female-specific language. This initial focus on female recipients could have “feminized” Gardasil, entrenching its association with girls and women in the cultural imagination. Some scholars say that, by only recommending it for one sex, the FDA implicitly assigned liability for HPV transmission to females, and advertisers framed the woman as a disease vector in taglines targeting females, such as “spread the word, not the disease.” Although a male’s sexual history is a major predictor of a female partner’s HPV status, girls and women were assigned sole responsibility for their HPV status while boys and men were not similarly burdened. Such messages downplayed the male role in HPV transmission as well as HPV’s effect on males.

The focus on females might perpetuate stereotypes of the female body as vulnerable to attack and the male body as impervious to viral invasion. These stereotypes are not only misogynistic, they also place the burden for managing sexual and reproductive health on women. At the same time, they are harmful to men, as they allow us to underestimate their health risks and put less emphasis on men’s health. Framing HPV exclusively as a “woman’s disease” in female-focused, heterocentric terms ignores HPV’s effect on the male population and draws emphasis away from men’s sexual health. But men’s health is important, too — and disregarding it can have serious, even deadly, consequences.

Epidemiological studies that came out of Australia in 2013 show how unfair female-focused vaccination practices can be. Australia started vaccinating girls with Gardasil in 2007, and, thanks to their nationalized health care system, their vaccination rates were high enough to provide “herd immunity” — meaning that the virus had so few places to go, even people who weren’t vaccinated were at lower risk for HPV infection. Officials hoped that this herd immunity would extend to the male population, making it only necessary to vaccinate girls — after all, the reasoning went, if females don’t have HPV, how would males catch this sexually transmitted virus?

Thanks to Australia’s vaccination efforts, genital wart rates among females less than 21 years of age plummeted by 93 percent — which bodes well for a couple of decades from now, when we hope to see cervical cancer rates plummet as well. Amazingly, despite not being targeted for vaccination, males in the same age group saw an 82 percent decline in genital wart rates, which seems like evidence that boys don’t need to be vaccinated if enough girls have been immunized against HPV.

One problem, though: There wasn’t an 82 percent decline in genital wart rates among males, there was an 82 percent decline in genital wart rates among heterosexual males. Gay and bisexual males in the same age group saw no corresponding decline. Updated research published last year showed that gay and bisexual Australian males continued not to benefit from female-only HPV vaccination. This disparity shows that a female-focused vaccination policy marginalizes gay and bisexual males.

Let’s talk about HPV’s impact on gay and bisexual boys and men. HPV can be spread by any kind of sexual contact, including anal sex, which can transmit HPV that could eventually lead to anal cancer. Among men who have sex with men, anal cancer rates are on par with cervical cancer rates among women in the days before Pap testing became widespread. By vaccinating boys with Gardasil, we can make progress toward protecting the health of all males, not just heterosexuals.

But, speaking of heterosexuals, straight men are at increased risk for HPV-associated oropharyngeal cancer. In fact, Gardasil’s potential to reduce oropharyngeal cancer rates is one reason that vaccinating boys against HPV is predicted to be cost-effective.

Gardasil is a men’s health issue, too. Men who have sex with men are disproportionately affected by anal cancer, heterosexual males are disproportionately affected by HPV-associated oropharyngeal cancer, and all sexually active people are at risk for genital warts. Gardasil protects against the HPV strains that are responsible for the majority of anal cancers and genital warts, and a growing proportion of oropharyngeal cancers.

But to me, the most compelling reason to include boys in vaccination efforts is that to do otherwise marginalizes gay and bisexual men and boys, as well as transgender women who have sex with men. And I want to live in a society in which everyone’s health matters, and everyone’s lives are valued.

So let’s stop thinking of Gardasil as “the cervical cancer vaccine.” Gardasil is a cancer vaccine. And let’s stop thinking of HPV as a virus that only affects women. HPV affects everybody — and Gardasil is for everybody.