Viral Marketing: What’s Stopping Men From Getting the HPV Vaccine

In early 2011, my doctor informed me that a vaccine to protect against the human papillomavirus—HPV—was now available for men. I was relieved, then frustrated—my doctor didn’t actually offer the principal vaccine, Gardasil, to her male patients. After a couple days of hunting around town, I finally found the vaccine at the Mazzoni Center, a LGBT health clinic in downtown Philly. I received all three shots, and joined the less than 1 percent of American men who are vaccinated against the most dangerous strains of the virus.

While I was exceedingly grateful to the Mazzoni Center inoculating me, I knew of only one other male friend who’d received his shots. So since I got my shots, I’ve made a point of discussing my experience with any friend, acquaintance, or bemused bystander who will listen. And I’ve learned two things about young, straight men and HPV: We all know it exists, and not much else.

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When I posted about my vaccinations on Facebook and Twitter, the response was largely positive—but the dozen or so likes and comments mainly came from my female friends. When I brought up the issue with a few straight guys, they seemed confused about my decision to air the information in public. Embarrassed, I let the conversation drop. But a couple weeks later, I received a Facebook message from an acquaintance in another city, freaking out about his own HPV scare, and asking me whether he could be vaccinated, and where. My status update provided a rare safe zone around a toxic topic.

Like local zoning policy, a death in the family, or what actually lurks within Taco Bell tacos, few people feel comfortable talking publicly about STDs. There’s no better environment for breeding misinformation than the dense cocoon of embarrassment we’ve woven around sex. The result is that most men I’ve spoken with are familiar with just one statistic that pervades the conversation around HPV: An estimated 50 to 80 percent of American adults will contract it. The universality of the threat engenders a laissez-faire attitude: Fuck it. I probably already have HPV, as do all my peers. Why worry?

The stats above are as accurate as we have. But the real story of HPV is more complicated. There are more than 130 strains of HPV, and the vast majority of them do no harm: No cancer, no warts, nothing. Most immune systems take care of the few nastiest strains just as they would any other virus. Then again, some don’t.

“[Nearly] everyone is going to be HPV positive in their lifetime, but we are only worried about the people who have an immune system who cannot clear the infection,” says Brian Hill, president of the Oral Cancer Foundation and a survivor of HPV-related oral cancer, which was located at the base of his tongue in 1997, before the virus was recognized as a cause. “Of the 99 percent of people that engage in a sexual activity that transfers the virus, orally or genitally, only 1 percent will have it cascade into a cellular event. It’s the luck of the draw in having a gene pool that does not recognize HPV 16”—the dominant cancer-causing strain—“as a threat.”

There’s no way to tell if you, or your partner, lost the genetic lottery. HPV is transmittable through skin-to-skin contact, so condoms aren’t as effective as they are at, say, preventing HIV/AIDS. There aren’t even worthwhile tests to determine if you have a dangerous HPV infection or, unnervingly, a way to test for the penile cancer HPV can cause. Anal and oral cancer screenings exist, but dental insurance often does not cover the latter, as I found to my dismay when I booked one while researching this article. (I decided that the $65 out-of-pocket fee was worth protecting against tumors on my tonsils.)

The truth is that most young men don’t know about the risks of HPV—and their options for preventing it—because our culture’s sexual awkwardness distorts corporate, government, and even scientific decision-making. In the mid-2000s, before the vaccination was marketed to the public, the CDC conducted extensive focus group research to ascertain the American public knowledge of, and attitude toward, HPV. “Current focus-group findings revealed that STD-associated stigma served as a barrier to HPV-vaccine acceptability,” the researchers found. “[E]xperts…cautioned strongly against focusing primarily on the sexually transmitted nature of HPV…which can be stigmatizing and detract from the more important public health concern of cervical cancer.”

Merck took note. The results can be seen in the company’s initial “One Less” advertising campaign, which used images of jump-roping school girls to advocate the vaccination use for girls ages 9 to 26. Any mention of sexual transmission, genital warts, male victims, and non-cervical HPV-linked cancers are noticeably absent.

I don’t remember seeing those ads, which were rolled out in late 2006, in the midst of my higher education. But my college girlfriend knew about HPV and Gardasil, and I’m sure her awareness was directly affected by Merck’s framing. I remember her frustration at learning of another negative consequence of sex—and that women, as usual, were expected to bear its financial and health costs. Neither of us knew that men could be anything more than passive carriers, or that the vaccine might eventually be available to both genders.

“When we talk to guys, often young men especially will say, oh, but that’s the girl vaccine,” says Dr. Robert Winn, Medical Director of the Mazzoni Center. The culture of silence around men and HPV means that the burden is on women to protect themselves and their partners—and that the virus can be doubly dangerous for men. Of the HPV-associated cancers, cervical cancer (11,967 cases annually) is only slightly more prevalent than oral cancer (11,726). The death rates are three times higher for the latter, and men are far more likely to contract it. In a population of 100,00, 6.2 men and 1.4 women are diagnosed with HPV-related oral cancer. Of the 2,500 cases of HPV-related anal cancer reported annually, 900 are in men and 1,600 in women. According to the CDC, men who have sex with men are 17 times more likely to contract anal cancer. Prevalence rates are also higher among those with HIV/AIDS.

Some of the statistics on male HPV rates are still emerging, but the idea that HPV affects men, too, has long been obvious. "When vaccines were being developed, HPV had the clearest causal link to cervical cancer," says Adina Nack, Associate Professor of Sociology at California Lutheran University and author of Damaged Goods: Women Living With Incurable Sexually Transmitted Diseases. “[But] they knew boys contract it. Boys transmit it. There was already a growing body of clinical research that some cancers men suffer from are caused by the same strains of HPV.”

Three years after the 2006 release for women, the vaccines were quietly approved for men. Neither Merck nor the U.S. government widely advertises its universal availability. I consider myself relatively plugged-in when it comes to sexual health, and I didn’t learn I could use the vaccine until 2011—two years of exposure while protection was there, unknown and unasked for. But in men, the HPV vaccine is still only approved as a defense against genital warts and anal cancer. Oral cancer is not officially one of the cancers Gardasil protects against, although the CDC notes that it’s “likely that this vaccine also protects men from other HPV-related cancers,” like cancers of the penis and the back of the throat. The Oral Cancer Foundation has been pushing for studies on the issue, but Merck announced in 2010 that it had no “plans to study the potential of Gardasil to prevent HPV-related [oral] cancers.”

These false assumptions can be easily reversed. But men and women are still paying for Merck’s crappy reasoning. It would be great if the CDC conducted a sweeping public health campaign to alert Americans to the full facts about HPV and its vaccines. Merck should advertise its services to both men and women. But with the institutional players showing little inclination to try another big push for HPV vaccination, word of mouth remains our principal sources of information about HPV protection. So start calling your local clinics—LGBT and otherwise—to see if they offer free shots. And when you get your vaccine, tell everyone who will listen.