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Are Gay Men Being Denied A Life Saving Vaccine?

by Kilian Melloy
Monday Jul 25, 2011

A vaccine against the human papillomavirus (HPV), a sexually transmitted infection that can cause warts and has been linked to soft tissue cancer, is covered by many insurance plans -- but some provide coverage for females only.

But the vaccine could save the lives of gay men who are denied coverage and who must pay out of pocket in order to receive it, the Boston Globereported on July 23. For many, the $400 price tag might be steep enough to discourage the treatment.

But gay men who are not vaccinated may face a much higher likelihood of suffering anal cancer, the article noted.

Even heterosexuals might, in theory, be affected, though the cancer risks they face are more likely to involve the mouth, tongue, and throat. Health experts say that although some kinds of mouth and throat cancer are declining, other sorts are rising, and there's a correlation between new cancer cases and the transmission of HPV, which can be transmitted via oral sex, HealthDay News reported on Jan. 25.

The article cited the University of Nebraska Medical Center's Dr. William Lydiatt as noting that some tobacco-related cancers seemed to be occurring less frequently than in the past as fewer people are smokers than in decades past. But cancers that strike the base of the tongue and the tonsils are becoming more common, and those are the sorts of cancer that researchers say correlate to HPV. "It's gotten to the point now where 60 to 70 percent of all tonsil cancers in the U.S. are HPV-related," Lydiatt noted.

The HealthDay News article cited a New England Journal of Medicine study from 2007 that indicated that cancer risks rose for individuals with more sex partners. Among the study's claims: individuals who had had oral sex with six or more partners were more than three times as likely to develop oropharyngeal cancer than were individuals who had had fewer oral sex partners. Moreover, individuals who had had vaginal sex with 26 or more others were also at an elevated risk.

That study suggested that the forms of throat and mouth cancer thought to correlate to HPV have been on the upswing since 1973, and posited one possible cause as an increase in oral sex among young people. The paper also suggested that French kissing could also transmit the virus.

Most individuals -- 90%, according to the HealthDay News article -- who are exposed to HPV do not go on to develop cancer. But certain demographics may be at higher risk due to behavior such as smoking or other health factors, including HIV status.

Last year, the American Cancer Society sounded the alarm about HPV-related cancers that seemingly strike LGBTs more often than they affect heterosexuals.

According to the Department of Health and Human Services, Center for Disease Control and Prevention, men who have sex with men (MSMs) are 17 times more likely than straights to develop anal cancer. The theory is that HPV -- which is thought to cause cervical cancer in women -- can cause anal cancer in men.

But a drug called Gardasil has been proved to be effective at warding off HPV, and protecting people from HPV-related cancer. At first, attention focused on the drug's potential to prevent cervical cancer in women; then researchers showed that it could also protect men, not just from contracting the virus and passing it on to female sex partners, but from facing HPV-related soft tissue cancers themselves.

"Thus, young gay men could get potentially lifesaving benefits from the vaccine," the Boston Globe article said, going on to quote statistics: from the National Cancer Institute: "An estimated 5,260 Americans -- 2,000 men and 3,260 women -- are diagnosed with anal cancer every year, and more than 700 die of the disease annually," the Globe reported.

"Clinical trial data submitted to the US Food and Drug Administration by manufacturer Merck found that Gardasil was 78 percent effective in preventing precancerous lesions in the anus in vaccinated men who had sex with other men," the article added.

But while it is becoming standard practice to vaccinate girls in childhood against the virus (a controversial step in itself, since some viewed the prophylactic measure as an invitation for young women who had been inoculated to engage in sex outside of marriage), boys have lagged behind, partially due, some suggest, to insurance companies being unwilling to pay for their vaccinations.

"They're preventing young gay men from having access to prevention for a very serious disease," said an attorney with Gay & Lesbian Advocates & Defenders (GLAD), Bennett Klein, who found out from pediatricians about gender-based disparities in some insurance companies' coverage for the immunization.

Meantime, the Center for Disease Control (CDC) has not updated its stance about who should receive Gardasil as a matter of course. The CDC still recommends that girls be immunized, and says that boys "may" receive the treatment -- but its guidelines do not recommend it.

Some insurers do, however, provide coverage for boys to be immunized against HPV despite the CDC's guidelines.

One provider that had not previously made such coverage available to males got back to Klein to indicate that it would start doing so: the Neighborhood Health Plan promised "to provide equal care to our gay/bisexual population" by providing coverage for both genders.

Kilian Melloy serves as EDGE Media Network's Assistant Arts Editor. He also reviews theater for WBUR. His professional memberships include the National Lesbian & Gay Journalists Association, the Boston Online Film Critics Association, The Gay and Lesbian Entertainment Critics Association, and the Boston Theater Critics Association's Elliot Norton Awards Committee.


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