November 07, 2010

HPV and the Bigots of AVN

Jane J Kim, PhD, an assistant professor of health decision science in the department of health policy and management at the Harvard School of Public Health in Boston, constructed models to assess the cost-effectiveness of the HPV shot across a range of potential scenarios involving men who have sex with men. The scenarios were based on age, previous exposure to the types of warts that are targeted by the vaccine, and HIV status. Men who test positive for HIV, the virus that causes AIDS, are at higher risk for HPV and anal cancer.

Researchers used measurements called “QALY.” QALY -- which stands for “quality adjusted life year” -- is a measurement of both quality and length of life. In the study, a cost-effectiveness ratio of less than $50,000 per QALY gained is considered a "good value for money."

Vaccinating men who have sex with other men against HPV between the ages of 12 to 26 is a cost-effective strategy, Kim concludes. If further study shows that this vaccine is also effective against HPV-related cancers it may be an even more cost-effective intervention.

This is pretty awesome news. There are still issues to be worked out, of course, particularly in terms of how we get the vaccine to the people most likely to benefit from it. The issue of how people identify sexually versus how they behave sexually, particularly at the ages at which the vaccine will be most effective, will require some decisions to be made about how broadly to cast the vaccination net.

Still, we have an opportunity to help a population that already suffers a disproportionate burden of disease. We can even offer them passive protection up front, when it is most likely to be effective.

Of course, that's not how the Anti-Vaccination Nitwits (yes, I know it's Australian Vaccination Network) sees the issue. From their Facebook page:

Yes, they really did say that young male homosexuals (they left out bisexuals entirely)--and by young, I mean teenagers and very young adults--have a bunch of disposable income. Not only did they indulge in rank stereotyping of gay men, but they completely ignored the truly ugly situation faced by young homosexuals. Or maybe I'm wrong. Maybe Australia is completely civilized in how gay and lesbian teens are treated.


Is it any wonder that the first response to their post was the comment below (removed after six hours on a thoroughly moderated page, according to Reasonable Hank, but captured by StopAVN and brought to my attention by Bob Apthorpe)?

I'm not sure why they bothered to take it down, actually, since it says the same thing the AVN itself said.

Sadly, this stance is entirely in line with what the AVN has previously had to say in an article on HPV vaccines.

This vaccine aims to protect people from a virus that is basically only transmitted when a person engages in what amounts to optional behaviour. HPV is not a public health threat in the same way, say, polio or measles are.

Did I get HPV through having sex? Yes. But it seems a bit odd to refer to something that half of all Australian teenagers have done before leaving high school as "optional behaviour." It's the most pointless of technicalities. Still, that usually how the AVN gets their victim blaming in, if this article is any indication.

Most women who develop invasive cervical cancers have not had regular Pap smears. So to say that because 1,000 women in the U.K. die of cervical cancer every year, and there is thus an urgent public-health need to vaccinate every adolescent girl--without mentioning that many if not most of these women did not have regular screenings--is somewhat disingenuous.

Because heart disease, lung cancer, diabetes, emphysema, and everything else that has a partial cause in human choices is not actually any kind of public health issue. Again, right.

I guess the only thing to do now is to wait for actual vaccination recommendations to be made. In the meantime, we can all "amuse" ourselves laying bets on how the AVN will react to the news. Will it be clueless stereotyping, ignorance of human behavior, or a combination of the three?


joreth said...

That just makes me seethe with rage, since it's wrong on so many levels. The science is wrong, the attributed motivations are wrong, the stereotyping is wrong, and saying "well, it's their own fault anyway, so let's not protect children who might make the kinds of decisions WE have decided are immoral sometime in their future" is just wrong. Wrong, wrong, wrong, it's fractally wrong, so that I don't even know where to start correcting it.

I have an STI tag in my LiveJournal, where I focus mainly on HPV and this kind of shit just pisses me right the fuck off. Excuse me, but as Tim Minchin once sang in another context (paraphrase), this is the kind of language one deserves when one fucks over people.

John McKay said...

I'm surprised that they didn't take the next logical step of declaring AIDS to have been engineered by the pharmaceutical cabal as a means to sell drugs.

Heather M. Rosa said...

Since AIDS is supposed to have started with monkeys in Africa, maybe they engineered it just to show they're better and smarter than people.

It wouldn't take much, sometimes.

Juniper Shoemaker said...

Last year, I discovered that there are very few, if any, good reasons to deny HPV vaccinations to people older than 26. The HPV vaccine first became available the year I turned 26, but I foolishly did not get it. I was a virgin with a lot of other things on my mind, and I eventually forgot about the vaccine.

Recently, I asked my doctor for a prescription for Gardasil. I explained why I still wanted a HPV vaccination. I expected an argument. However, she acquiesced and kindly wrote me "off-label" prescriptions for both Cervarix and Gardasil; I have my choice of either.

Because I am 30, I must pay the full cost of the $450 vaccine. I don't care. I am just grateful that I found a physician willing to give me a prescription. Some doctors refuse to exercise their legal authority to write off-label prescriptions for Gardasil or Cervarix to any woman older than 26 on the grounds that "most women have had so many sexual partners by 26 that it's not going to help them anyway".

I did this research shortly after you wrote your first posts about your HPV infection. I was intensely bothered by the flippant "well, I'm so glad that I'm younger than you and already got my vaccine" responses to your ordeal. I did this research to productively cope with my anger. I learned that there are no scientific reasons to deny the vaccine to women between ages 27 and 49 (if I remember the upper bound correctly). There are no scientific reasons to deny the vaccine to boys and men, either.

I've had enough of the people who are so supremely confident that they have never made and will never make "unwise" decisions that they advocate throwing away the lives of others like trash. I am not worthless because I didn't win a Fulbright fellowship at Berkeley and go on to Harvard Medical School. I am not worthless because I was born in 1980 instead of 1990. I won't accept the idea that I don't count.

kill3rTcell said...

John, in order to believe HIV was developed as a conspiracy, she would have to believe it exists. “nobody has ever ’seen’ the HIV virus....” but I guess that's what you would expect from a germ theory denialist:
She's also said on facebook on the AVN page: “I have been thinking about this for many years and what I have decided is that vaccination and the germ theory are the basis of Western medicine – its foundation – the rock it’s been built on. Let the rock start to crumble and everything else comes tumbling down.”

That little conspiracy you thought it would be funny for her to believe in? She doesn't bother with that, it's straight to the big guns.