[ public health ]
Powered by millions of dollars in big-pharma marketing in recent years, HPV — the human papillomavirus, most commonly associated with causing cervical cancer — has jumped to the forefront of public-health concerns for young women. Vaccines are distributed at doctors’ offices and at little or no cost at community health centers and Planned Parenthood, and women under 27 are urged to partake.
For young men, though, it’s a different story. Access to the vaccine has been relatively limited — as I found out the hard way — and its importance has been under-recognized. But the city of Philadelphia is taking steps to change that with “3 for Me,” a recently launched city vaccine program for teens. It could be a game-changer, especially for men — if only anyone knew about it.
One of the challenges facing such programs is the widespread misconception that HPV is only a women’s disease. After all, working against it is a powerful target-marketing effort. It doesn’t help that one of the two vaccines, Cervarix, has a very pointed name, and is, in fact, approved only for women.
Yet HPV can cause, among other ailments, anal and oral cancers in people of both genders; according to the Centers for Disease Control, men are more than four times as likely to contract the latter. It can also cause genital warts and, more rarely, penile cancer.
You can see why I would want the three-shot vaccine. But my doctor, like many others in the area, doesn’t offer it to men. Neither, I learned, did Planned Parenthood in Center City. (They do now, and Planned Parenthood Southeastern Pennsylvania plans to offer HPV vaccinations for men at all of their locations soon.) My lengthy search eventually took me to the LGBT-oriented Mazzoni Center, where I finally got my shots.
All that is more research than most people are likely willing to do, says Donna L. Brian, clinical director for Health Connection, one of five health centers the Public Health Management Corporation (PHMC) runs in the city. “It’s probably only been two or three men who actually come in asking for it,” she says. “Much more often we have to tell them about it.”
The city, to its credit, seems to recognize the universality of HPV’s threat. “3 for Me” aims to get young people ages 13 to 18 vaccinated. Neither doctor nor parental approval is required; insurance is also not necessary. All a teen has to do is go to 3formephilly.org and sign up for an appointment at Health Center One (1400 Lombard St.) or Health Center 10 (2230 Cottman Ave.). Once there, a “3 for Me” project manager explains HPV and the vaccine to the teen and administers the first of three shots to be given over a six-month period. Easy.
The “3 for Me” website discusses all the dangers of HPV, not just cervical cancer. It prominently features images of young men as well as women, as does the literature on display at Health Center One.
If only the pharma companies had started this way: Merck’s early campaigns for Gardasil focused entirely on the cervical-cancer threat, and barely mentioned men at all.
While there are more than 130 strains of HPV, only a handful pose a real risk if contracted. Most people’s immune systems defeat even the most noxious strains before they can do any damage. The initial lack of interest in marketing HPV vaccines to half the population stems in part from America’s long-standing awkwardness about all things coital. In a study published in 2007, CDC researchers warned of “STD-associated stigma” and advised against focusing on HPV’s mode of transmission in the interest of promoting vaccination.
One way to play down the sexually transmitted nature of HPV was to market the vaccine solely to women as a “cervical-cancer vaccine.” (That’s Cervarix’s technically inaccurate slogan: There is no vaccination against cancer.)
Many men still don’t realize the vaccine could protect them. “My girlfriend got [the vaccine], but I didn’t think it was available for men,” says Andrew, a 26-year-old Philadelphia resident who preferred that his last name not be used. “I thought HPV was just one thing and people told me, you know, casually, at parties, that I probably already had it because I’m 26 and I’ve been sexually active for a while. And I thought there was no point in getting vaccinated against something I already have.”
While HPV vaccinations are FDA-approved for people between the ages of 9 and 26, research suggests effectiveness at any age, even for those who have been previously infected. If your body fights off HPV, you can still contract it again, and if you are currently infected by one strain, Gardasil still protects against the others, including four of the virus’ nastiest varieties.
The vaccines are available at many of Philadelphia’s 30 nonprofit health clinics, including all of those run by PHMC. And community health centers offer the shots for free, thanks to two federal programs: Vaccines for Adults at Risk (VFAAR) and Vaccines for Children (VFC), which “3 for Me” branches off from. But VFAAR’s free HPV vaccines aren’t available for those older than 26, and most insurance will not cover the shots past that age, either. The earlier someone gets the shots the better, and that’s where the outreach to teenagers in the “3 for Me” campaign comes in.
These vaccines are available to insured and uninsured alike. But those patients covered by Medicaid and private insurance who do not already use a health center as a primary care provider should check if their doctor offers the HPV vaccine for men. If not, the patient will have to make the health center their primary provider to get the vaccine.
Hopefully, “3 for Me” will attract attention, but it hasn’t been promoted much outside of some doctors’ offices. So far, just 54 patients have been immunized through the program. “The campaign is a small grass-roots campaign aimed at at-risk teens. It is not a media campaign of any scale,” says Jeff Moran, spokesman for the Philadelphia Department of Health. But promotion is critical: As of now, only 1 percent of American males are vaccinated.