In a week where Labor seemed stained by the funk of something decomposing, it’s a shame they couldn’t capitalise on a true success story for the Gillard government: the extension of the HPV vaccination program to boys. Last Thursday’s announcement by Tanya Plibersek not only strengthens Australia’s unmatched efforts to eradicate cervical cancer but will also finally provide protection to future generations of gay men.
But the brevity of the announcement left s-xual health advocates for the LGBT community wanting. “Some gay men who have been advocating for HPV vaccination for men may be scratching their heads about the announcement,” acting-executive director of the Australian Federation of AIDS Organisations Simon Donohoe told Crikey. “I do think this was one of the key messages missing in the minister’s announcement. Perhaps it’s just more palatable to talk about [the vaccine] as a way of reducing cervical cancer.”
Although the HPV vaccine was originally developed with a focus on reducing rates of cervical cancer, mounting evidence has shown that this wildly common STI leads to a variety of cancers of the mouth, throat and anus in men and women. Levels of infection in gay men in particular are incredibly common and as a result preventable cancers within the community are steadily increasing.
“Rates of anal cancers in gay men are 20 times higher than in heteros-xual men. The rates are particularly high in HIV positive men where it’s 40 times higher,” says professor Andrew Grulich, of UNSW’s Kirby Institute for Infection and Immunity in Society. Recent research by Grulich and his team estimates that anal cancer affects around 10-30 gay men, and 100 HIV positive men, in every 100,000 men. “That makes it at least as common as colon and bowel cancer is in the general population,” he told Crikey, adding that these cancer rates are higher than current cervical cancer rates in women.
Despite the comparable damage the two cancers cause to their communities, gay men have not been protected by current vaccination programs. Most countries choose to vaccinate young girls, directly protecting them and, by extension, also protecting their partners. It’s the most cost-effective way to increase herd immunity. But it’s no help if you’re not part of the herd.
“What we’ve seen since the introduction of [the vaccine] is a rapid reduction in genital warts in girls of this age group. We’ve also seen a less dramatic, but no less significant, reduction for males too. For gay men we see no change,” says professor Marian Pitts, from the Australian Research Centre in S-x, Health and Society at La Trobe University. “When we look through the prism of genital warts as a marker that the vaccine is working then we see that heteros-xual men are getting some protection but gay men are getting none at all.”
But this is set to change. By being the first country to provide free vaccination to boys, Australia is offering protection to all its future citizens. The challenge ahead will be how the government re-brands the goals of Gardasil.
Professor Pitts studies public awareness of the risks of HPV, and her studies have shown that it is predominantly women who are aware of these risks and most understand its link to cervical cancer. Men and gay men, on the other hand, have a very limited knowledge of HPV or the relevant cancers that affects them.
“Gardasil can no longer be thought of as the cervical cancer vaccine,” said Pitts. “This needs to be seen as a gender-neutral vaccine that protects men as much as women. That’s the way to go, for ethical and equality reasons.”
Part of the new $21.1 million program will be invested in new public health campaigns. How the government shifts its focus from cervical cancer to HPV in general presents a significant re-education challenge.
In March this year The Lancet medical journal published a review of the many considerations related to introducing vaccination of boys in Australia. Lead author professor Kristine Macartney, of Westmead Children’s Hospital, told Crikey: “The whole communication and education strategy will need to be revamped to provide more information about how and why vaccinations for males is important … we need to recognise that [HPV] is a common virus in both men and women and commonly enough leads to cancers in both.”
But these lessons are just what comes with being first to jump. Researchers contacted for this article were overwhelmingly positive about the government’s decision, many stating that internationally Australia is already seen as the clear leader in the fight against HPV-related diseases. At a time when the government is criticised for only following our North American confederates on progressive policies, it’s salient to remind ourselves of decisions like these that make our nation the mark to follow.