Medical Program Assistant | Mental Health Services
Brian Edwards, a senior at the University of Wisconsin-Madison, just completed a series of vaccinations that will protect him against HPV. “My doctor recommended it for two main reasons: to protect future partners from HPV strains that may contribute to cervical cancer and to protect myself from strains that may cause genital warts,” Edwards says. “I thought those were both easily worth three little shots.”
Human Papilloma Virus, or HPV, is a sexually transmitted infection (STI). This STI is most commonly known for causing genital warts, but can also lead to cancers in both men and women, including cervical, penile, anal, and cancers of the head, neck, and throat. While there are more than 100 strains of HPV and the infection typically goes away on its own, there is no way of knowing which cases are asymptomatic and which will lead to a more serious health concern.
Fortunately, there is an easy way to prevent HPV. In 2006, Merck introduced a vaccine, Gardasil, which protects against the strains of HPV that cause genital warts, cervical cancer, and other HPV related cancers. The vaccine is delivered in three doses, and while you must wait at least two months to get dose two and a minimum of six months to get dose three, the vaccine is still effective if the doses are received in intervals spaced further apart.
The HPV vaccine is proven to be safe and effective, and everyone who is sexually active is at risk for HPV, making it a universally recommended vaccine for individuals ages 11 to 27. Statistically, almost everyone will get HPV at some point in their lifetime if they don’t receive the vaccination. Craig Roberts, epidemiologist and manager of the Sexual Health Clinic at University Health Services (UHS), emphasizes the prevalence of HPV by referring to it as the “common cold of sex.” Even if a person only has one lifetime partner, they are still at risk for HPV.
But despite the safety, effectiveness, and necessity of the vaccine, a large percentage of the population still remains unvaccinated. University of Wisconsin-Madison students are vaccinated at rates slightly above the national average, but are still lower than desired. Only two-thirds of women and one-fourth of men have at least one of the vaccines, and only 54 percent of women and 12 percent of men received all three vaccinations in the series.
“I believe it’s important for both men and women to get the HPV vaccine. It reduces the chance of infection for everyone. It helps adhere to safe practices and I believe that it’s an essential part of maintaining good health,” says Justin Brzeczkowski, 20, a third-year undergraduate student at UW-Madison.
This gap is puzzling, but a look into the vaccination’s marketing potentially reveals why we see such low vaccination rates and gaps between men and women. In 2006, the vaccine was only approved for females between the ages of 11 and 26. Because HPV is a sexually transmitted infection, there was negative press towards the vaccine claiming that it would inspire promiscuity in young girls. Studies have shown that the vaccine does not lead to increased promiscuity, this tactic prevented some pediatricians and parents from vaccinating their children. It also led Merck to respond with heavy direct-to-consumer advertising toward young girls that was focused on cancer prevention. At that time, cervical cancer was the only cancer associated with HPV, insinuating that women and girls were the only demographic who needed the vaccine.
Marketing was seldom directed at males when the vaccine was approved in 2009. “When [the HPV vaccine] was approved for men, the companies did nearly nothing to promote it,” says Roberts. “There is little consumer awareness about the vaccine.” This lack of information is a huge contributor to not only the large gender gap found in vaccination rates, but also the low vaccination rates. Many men are simply unaware that they are at risk for HPV and would benefit from the vaccine.
This gender gap inspired Angela Long, a graduate student in Public Health at George Washington University and a parent of UW-Madison students, to design an outreach and educational campaign geared toward increasing HPV vaccination rates at UW-Madison. Long reached out to universities across the United States to see if they would be willing to partner with her to design an intervention. “Within two hours of contacting UW-Madison, someone got back to me,” Long says. Long also has connections with UW-Madison through her employer, the United States Pharmacopeia, a drug standards-setting organization. “I was absolutely thrilled that it was the University of Wisconsin.”
As a mother of two college-aged daughters, Long understands firsthand the decision parents made when this vaccine first came out due to the negative press. “There were a lot of questions from parents, like ‘would it lead to sexual activity for an 11-year-old?’” she describes. After learning more about HPV, the vaccine, and its importance for both men and women, she quickly pursued the idea to encourage college students to get vaccinated and inform them that it is not too late to get vaccinated.
Long specifically seeks to target international students and undergraduate men, as they have the lowest vaccination rates, likely due to the general lack of information. Because marketing for the vaccine is still predominately female-focused, other populations may think they do not need the vaccine, or may not even know about it all. This “catch-up initiative,” as Long describes it, could not only bridge gaps in knowledge and awareness, but also in vaccination rates.
The campaign will roll out in conjunction with UW-Madison’s free flu shot clinic in the fall. The clinic brings in nearly 14,000 students every year, making it an optimal time to advocate and inform individuals about the HPV vaccine. In each flu shot clinic there will be information tables about the HPV vaccine and insurance information in both English and Mandarin Chinese. The booths will be staffed by students from student organizations Sex Out Loud and Health Occupation Students of America-UW-Madison Chapter (HOSA). The School of Pharmacy “Operation Immunization” is also involved in the campaign.
Sex Out Loud student members have direct experience with educating peers about sexuality and safe sex practices, a topic that some may initially feel uncomfortable discussing. “Marginalized communities are prone to decreased access and education about these topics,” says Miriam Kelberg, Sex Out Loud’s Outreach and Events Coordinator. “Our goal is to create spaces where we talk openly about HPV and sex like we would anything else.”
The involvement of HOSA is another critical component of the campaign. Co-director Brianna Reichling, a student medical assistant at UHS in the Women’s Health Clinic, attributes the low vaccination rates to lack of knowledge, particularly from individuals who weren’t directly targeted in the initial Merck advertising campaign. “There are misconceptions with men not knowing it’s for them, about what the vaccine is for, and how the vaccination series logistically works,” she says. As an organization that frequently seeks out reoccurring projects, Gagne and Reichling are excited to aid in the campaign this year and potentially in years to come. “The hope is that this becomes an annual campaign,” Long reiterates.
Though a large proportion of the student body needs to be vaccinated, the vaccine has already made a huge impact on the health of the campus community. “The incidence of genital warts diagnosed at UHS has declined by 70 percent in the six-year period after the vaccination came out,” says Roberts. However, HPV and genital warts in particular are still the most common issues seen at the Sexual Health Clinic. “Most other things we see on campus pale in comparison to HPV,” Roberts adds.
The challenges associated with addressing a public health issue that touches on a lot of sensitive topics makes the task at hand difficult. “Unfortunately, it goes hand in hand with all these stigmas about sex,” says Kleinberg. But as Kelberg, Reichling, Gagne, and Roberts point out, these stigmas and sensitivities do not change the nature of HPV. “The virus doesn’t care about your political beliefs, your religious beliefs, your sexual orientation, or whether you’re in college or not,” says Roberts. “Those things are irrelevant to the virus. That’s why this is a universally recommended vaccine.” Despite these challenges, Long is optimistic about the implications this campaign will have on the UW-Madison campus and on college health nationwide. “I’m impressed that the university is addressing this issue head-on and the student groups’ enthusiasm to get on board.”