Archive for the ‘STIs’ Category

August 16, 2013

A Guide to Cervical Cancer Screening & HPV Vaccines

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. According to the Centers for Disease Control and Prevention (CDC), “nearly all sexually-active men and women will get at least one type of HPV at some point in their lives.”

But the virus usually clears on its own, without causing any damage — and often without showing any symptoms.

The HPV vaccine can prevent infection, but it’s not for everyone. We’ll tell you what you need to know about the virus and the vaccine.

What are the risks from HPV?

In both men and women, HPV infection can lead to warts or cancer in the person’s genitals, mouth, or throat. There are more than 150 types of HPV, but two (types 16 and 18) are thought to cause almost two-thirds of all cervical cancer cases, and close to half of all vaginal, vulvar, and penile cancers.

What are the current recommendations for cervical cancer screening?

The U.S. Preventive Services Task Force (USPSTF) recommends that women who have a cervix have a Pap test (which looks for pre-cancerous cells to screen for cervical cancer) every three years between ages 21 – 65.

Every five years, starting at age 30 and until age 65, women are advised to get a Pap test plus HPV DNA testing to screen cells for certain high-risk types of HPV.

The USPSTF does not recommend cervical cancer screening for women under 21 (i.e., neither Pap nor HPV DNA tests), because the tests are unlikely to find any problems. Similarly, the USPSTF does not recommend HPV DNA tests for women under 30, because almost everyone will test positive for the virus at least once. Even though the virus almost always goes away on its own, a positive HPV test increases people’s health care costs and anxieties.

Some clinicians may order a HPV test as follow-up to an abnormal Pap test, but HPV DNA test is not meant for general screening or simply to determine HPV status.

Can HPV be prevented?

There are two vaccines — Cervarix and Gardasil — that prevent infection with the most common types of HPV, thereby reducing the risk of cervical and other cancers that are associated with high-risk strains of HPV.

Cervarix protects against HPV types 16 and 18, the highest-risk strains of HPV, and is approved for girls ages 9 – 26.

Gardasil protects against HPV types 16 and 18, as well as types 6 and 11, which provides additional protection against genital warts and anal cancer; it is approved for both girls and boys ages 9 – 26.

While studies have shown vaccine efficacy over five to six years, longer-term data is not yet available to determine exactly how long the vaccines work to protect people.

How safe are the vaccines? What side effects can they cause?

The CDC notes that the United States “currently has the safest, most effective vaccine supply in history. Years of testing are required by law before a vaccine can be licensed. Once in use, vaccines are continually monitored for safety and efficacy.”

The HPV vaccines are considered to be very safe, although reactions like dizziness, fainting, and soreness around the injection may occur.

More information is available about Gardasil than Cervarix because it was approved first, but on-going safety studies are being done on both vaccines. As with any vaccine, patients should carefully review whether they have allergies to any of the ingredients before getting the vaccine. (The CDC has also published a guide to vaccine safety, written especially for parents.)

When should vaccines occur?

For greatest protection, the CDC recommends vaccination around age 11-12, so it has time to become effective before sexual activity begins. (There is no evidence that having the HPV vaccine encourages a person to become sexually active.)

For people under age 26 who are already sexually active, the HPV vaccine won’t affect any existing HPV infections, but it may prevent infection from a different HPV type if it’s also covered by that vaccine. Likewise, the vaccine doesn’t mean you no longer need cervical cancer screening; if you have a cervix, you should still follow the USPSTF’s screening recommendations.

Can pregnant women get vaccinated?

There have not yet been adequate studies to establish the vaccine’s safety for use by pregnant women, and neither vaccine is recommended for use by pregnant women.

Women who got the vaccine and then find out they were pregnant at the time of vaccination should call the manufacturer’s “HPV in pregnancy registry” to contribute to efforts to learn more about pregnant women’s response to the vaccine (800-986-8999 for Gardasil; 888-452-9622 for Cervarix).

Where can I get the vaccine, and how much does it cost?

The vaccine is available from pediatricians, family doctors, ob/gyns, public health clinics, and family planning clinics. It is given in a three-dose series that may cost more than $500 in total.

Insurance may cover the vaccine’s cost; uninsured children and young adults may be eligible to get it at low cost from public health departments and clinics.

Do I need my parents’ permission to get vaccinated?

The rules vary from state to state. In many states, teens are explicitly allowed to get reproductive health care (like family planning and STI treatment and prevention services) without a parent’s or guardian’s knowledge or consent. These laws are in place to reduce barriers to young people getting sensitive health care services.

If you get the vaccine from your provider using your parent’s insurance, keep in mind that they will get an “Explanation of Benefits” form that describes the services received.

Scarleteen has published an excellent HPV Vaccine FAQ with advice for talking with parents who have concerns about the vaccine.

What does the National Women’s Health Network think about the vaccines?

The NWHN supports cervical cancer screening to identify pre-cancerous conditions and timely access to treatment and care, which will prevent cancer from developing. The NWHN has determined that the vaccines are an important option for filling the gap where regular access to health care — including Pap tests and follow-up ­– is not viable. This is particularly the case where women face barriers to health care due to poverty, ethnicity, language, and/or other factors.

Nonetheless, more research is needed on the vaccines’ safety, long-term effects, and use in sub-groups such as older women.

For more information:

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This post was adapted from an article by Rachel Walden that first appeared in the July/August 2013 edition of NWHN’s The Women’s Health Activist.


February 14, 2013

Happy Valentine’s Day – A Safer Sex Reminder

Hey, it’s Valentine’s Day! Seems like a good time to revisit the topic of safer sex and sexually transmitted infections!

The CDC just released a new fact sheet on STIs, indicating that there are about 20 million new infections each year, and that young people (ages 15-24) account for about half of these.

In its report, CDC provided the following recommendations for women for STI screening:

  • All adults and adolescents should be tested at least once for HIV.
  • Annual chlamydia screening for all sexually active women age 25 and under, as well as older women with risk factors such as new or multiple sex partners.
  • Yearly gonorrhea screening for at-risk sexually active women (e.g., those with new or multiple sex partners, and women who live in communities with a high burden of disease).
  • Syphilis, HIV, chlamydia, and hepatitis B screening for all pregnant women, and gonorrhea screening for at-risk pregnant women at the first prenatal visit, to protect the health of mothers and their infants.
  • Trichomoniasis screening should be conducted at least annually for all HIV-infected women.

Have questions about sex, sexuality, STIs or related topics? Beloved sex-ed site Scarleteen has just launched a new live help feature, providing anonymous live chats with Scarleteen staff and volunteers. The full website, which tackles all kinds of questions about sex, is an amazing resource for young people.


February 4, 2013

Getting Personal: What It’s Really Like Living With a Sexually Transmitted Infection

Jenelle Marie, STD advocateby Jenelle Marie

When you hear the term STD (sexually transmitted disease) or STI (sexually transmitted infection), what do you think of first?

Grotesque pictures of maimed genitalia displayed on a projector during yesteryear’s sex-ed class geared toward frightening you into abstinence? That scene from ” The Hangover” where Sid says, “What happens in Vegas stays in Vegas … except for herpes. That shit will come back with you”?

Whatever first comes to your mind is not likely to include your neighbor, professor, or best friend living with an STI, having an incredible sex life, and otherwise prospering. That is, of course, unless you’re also living with an STI and you know better.

I am your neighbor, a professor at a community college, and am enjoying a wonderfully healthy sex life with a man who thinks the world of me and nothing of my STI. I’ve been living with genital herpes for over 14 years now; I’ve also contracted HPV, scabies, and vaginitis throughout the years. And yet not once did an STI hinder my relationships or happiness once I stopped allowing it to dictate my self worth.

Embracing Stigma

At 16, when our family doctor peered at me with a lazy eye, through thick glasses, and accompanied by a partially missing ear to tell me my genital herpes outbreak was the worst case he’d ever seen, I was devastated. Embarrassment coursed through me as he handed me a prescription and sent my mother and me on our way – sans brochures, additional information, and references to resources, support groups or even a mention of the vast number of people living with an STI everywhere. I was a pariah – a leper – even the doctor was disgusted by my condition.

For years, I accepted my fate and considered myself as being punished for having been sexually active before marriage. As a high-schooler, I was called a slut or a whore and “friends” of mine forewarned men who took interest in me that I would merely infect them, hurt them, and they should steer clear entirely. I actually maintained some of those friendships for a period of time, not knowing otherwise about STIs and those who contract them, thinking myself deserving of such treatment.

A Long Overdue Paradigm Shift

It wasn’t until a few years ago I began to see myself for who I truly was: a beautiful, intelligent, thoughtful, and valuable individual who just happened to contract a long-term infection. In fact, my infection had not stopped me from obtaining two honors degrees, getting married, conquering my fear of heights by going skydiving – not once, but three times – or pursuing my dreams by auditioning for “American Idol.”

While I’m not the next American Idol, I learned an invaluable lesson throughout that period of self-discovery: I am not deserving of poor treatment, cruel friendships, or snide remarks; the stigma placed upon those living with an STI is inaccurate, ignorant, and illogical. And I have the power to change that. We all do.

In order to change the status quo, though, one has to first understand where the misunderstandings and wrongful judgments originate. Rather than be angry at my doctor for leaving me with nothing more than a crass diagnosis or at my childhood friends for mistreating our relationship, I am choosing to delve into why those perceptions persist.

Part of the problem came from within. I didn’t challenge what little I knew about STIs, and I embraced the negative opinions for years before I was able to distinguish between the laymen’s view of STIs and the reality behind the array of people who contract them. STIs do not define one’s character; they’re merely a reflection of an experience – an experience that is as individually unique as are the people who contract the STIs themselves.

Consequently, I’m not angry or frustrated by the amount of time it took for me to finally find solace in my infection. Rather, I have a holistic appreciation for the process one undergoes when being diagnosed with any type of taboo condition (infection or otherwise). Not only have I taken great pains to find myself in a place of self-love and self-respect, I want very much for others to have an opportunity to feel the same fortitude after their diagnosis as I do now and over a far shorter time table.

Becoming an Advocate

Hence, I have become an advocate.

Due to the immense stigma behind contracting an STI, most people don’t speak openly about their experiences. However, as people, we learn best through community. Naturally, we are pack animals – we nurture our young for years beyond most other mammals and we develop complex (and hopefully, healthy) relationships with others outside of our family nucleus. It makes sense then we need others to help overcome obstacles and boundaries – in this case, contracting an STI and/or living with an STI.

So, I’m willing to tell you how horrible my experience has been at times, and how I’ve found incredible happiness, love, success, and rewarding relationships despite living with an STD all in hopes you can move through the process with much more clarity, community, and understanding than I once endured.

Join me, and I welcome you.

Jenelle Marie is the founder and administrator of The STD Project, a website geared toward eradicating the sigma associated with having a sexually transmitted infection. This entry was originally posted at BlogHer and is reposted with permission.


October 16, 2012

Study: No Link Between HPV Vaccine and Girls’ Sexual Activity

In 2006, when the FDA approved the first HPV vaccine for girls and women ages 9 to 26, one of the concerns opponents expressed was that it might make young girls think it’s OK to have sex.

That’s because the HPV vaccine protects against a virus that is contracted during sexual contact; specifically, four strains of the human papillomavirus, or HPV, which can cause cervical cancer and some vaginal, vulvar, penile and throat cancers.

In Nashville, where I live, one religious leader claimed, “What we are encouraging is abstinence and sexual purity. If they have a relationship with the Lord, they will recognize that they don’t need that vaccine.”

Others made claims along the same lines — that girls who “come from good homes” don’t need the vaccine, or that it would otherwise somehow promote promiscuity.

We’ve heard a lot less of this rhetoric lately, now that the novelty of the vaccine has worn off and the initial controversy has subsided. It always seemed like a bit of a ridiculous objection, since girls who become sexually active are probably not weighing the risk of some far-off consequence like cervical cancer. 

Heck, even the notoriously conservative Family Research Council has come around to acknowledging that either through abuse or by marrying someone who is a carrier of the virus, “it is possible that even someone practicing abstinence and fidelity could benefit” from the vaccine.

Still, opponents should be pleased with this news: The journal Pediatrics published a new study this week that shows the HPV vaccination is not associated with increased sexual activity among girls.

The researchers looked back at records for almost 500 girls who received the vaccine at ages 11 or 12 compared to about 900 girls who did not get the vaccine. Then they looked at whether the girls, over the next several years, had any record of being counseled about birth control, received contraception (specifically for birth control, not for acne or irregular periods), or had a diagnosis of pregnancy or certain STIs — all markers that imply sexual activity.

The researchers found no significant difference between girls who did and did not receive the vaccine.

Of course there are some limitations to the study, such as that some girls considered unvaccinated could have been vaccinated elsewhere, and girls could have received reproductive health care at places that weren’t counted in the study. A more conclusive set of results could come from following girls in real time over the years and collecting more detail about their health care and behavior.

However, this study provides important initial information that refutes concerns about HPV leading to increased sexual activity. Future research on concerns about the vaccine, then, might be better focused on learning more about long-term safety and effectiveness questions, rather than behavioral concerns.

Now we’ll just have to wait to see if there’s equal worry over whether boys who get the HPV vaccine are more likely to be more sexually active. I wouldn’t count on it.


August 8, 2012

Getting the Word Out About Female Condoms

The FC2 Female Condom

How did one guy come to love using the female condom? Science journalist David C. Holzman answers that very question in a recent piece for Boston’s NPR affiliate, WBUR.

Holzman describes his own iffy approach to male condom use, and how his experience of improved sensation with the female condom  made him a convert. He also talks about some reasons why female condoms may not have yet taken off, and how they may offer better protection than male condoms against sexually transmitted infections.

Holzman also was recently interviewed for WBUR’s CommonHealth segment, alongside OBOS’s own Judy Norsigian, which you can listen to online.

Many sexual health advocates have been working for greater availability of female condoms, both in the United States and around the world. For more information, check out our previous post on a paper doll campaign to demonstrate demand for female condoms, and the Female Condoms 4 All campaign, which strung together all ~20,000 of those paper dolls to display in conjunction with the recent International AIDS Conference.

You can learn about FC2, the only female condom available in the United States, from this excerpt from the 2011 edition of Our Bodies, Ourselves. Health workers can get online training on the FC2 at this website.


July 26, 2012

What’s in the New Health Care Law for Women? Well-Woman Visits That Can Improve Your Health

What's in it for women?

Countdown to Coverage is a campaign to help women understand the concrete ways that the Affordable Care Act can improve our health. This blog entry is the first in a series designed to answer the question, What’s in it for women?

by Leana S. Wen, MD

As an emergency physician, I tend to work on the other side of preventive care services. I see what happens when women don’t know about safer sex and birth control, and end up with complications from sexually transmitted infections. I see what happens when women do not get routine screening for cervical cancer and struggle with life-threatening cancer. I see what happens with out-of-control hypertension and diabetes, and the heart attacks and strokes that are detected far too late.

These experiences have shown me that prevention is the best medicine. That’s one big reason why the Affordable Care Act provision requiring new insurance plans to cover women’s preventive care without any extra charges or co-pays is a real victory for women. These requirements, which go into effect Aug. 1, will be phased into existing insurance plans over time.

Because of this change, women will be able to obtain complete contraceptive care, screening for sexually transmitted infections, and screening and counseling for intimate partner violence. This builds upon earlier requirements that insurance companies cover — at no additional cost to women — mammograms and screenings for cervical cancer. It’s clear to me that these mandates will significantly improve women’s health and lives and ultimately lead to a reduction in health care costs.

The Well-Woman Visit
One of the easiest ways to obtain preventive services is through a well-woman visit. These visits, which will soon be covered with no co-pay, give you the opportunity to ask key questions about birth control, sexually transmitted infections, and other reproductive issues, along with questions about diet and exercise and any health concerns you may have. You can also discuss changes in your family’s medical history that are important for your health care provider to consider. For example, when my mother was diagnosed with breast cancer, my doctor recommended that I get earlier screenings.

Along these same lines, your health care provider may have questions or issues to discuss with you. Smoking, drinking and recreational drug use can create and contribute to health problems, and often need to be discussed and addressed multiple times before change happens. Well-women visits also give your health care provider a chance to screen for potential high blood pressure, diabetes, depression, domestic violence, and more.

The well-woman visit is important for another reason: It gives you and your health care provider a chance to get to know each other. Most people go to their provider or to a clinic only when there’s a problem, but the best time to get to know your provider isn’t when you’re in distress from a painful or troublesome condition. Studies have shown that health care providers make more accurate diagnoses when they know their patients and can put the symptoms in the context of your life. A well-woman visit is a precious opportunity to build this trusted relationship.

As an emergency physician, I am excited about the new provisions taking effect Aug. 1, which include annual well-women visits for those who want them. I would much rather women regularly visit their health care providers than come to the E.R. later suffering from preventable problems. So please take this opportunity and make an appointment with your provider. The importance of investing in your health is too crucial to ignore.

Plus: Want to learn more about the Affordable Care Act? These resources from Countdown to Coverage provide detailed information about coverage for women, including specific information for LGBT people, women of color, young women, older women, moms and families, and more. 

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Leana S. Wen, M.D., is an emergency physician at Brigham & Women’s Hospital and Massachusetts General Hospital and a clinical fellow at Harvard Medical School. She is the author of a forthcoming book on patient advocacy, “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.” For more information, visit her blog When Doctors Don’t Listen or her website. You can also follow her on Twitter @DrLeanaWen.


July 20, 2011

Institute of Medicine Recommends Birth Control as a Covered Preventive Service

Good news! You may remember that the health care reform legislation enacted last year included provisions for preventive health care services to be fully covered without requiring patients to have copayments.

It was not clear, however, whether birth control would be included as a preventive service. It seems obvious to us, but the Institute of Medicine was asked to make some recommendations about which preventive services for women should be included, and included birth control in those recommendations, released yesterday.

If they are adopted, preventive services including birth control could become much more affordable and accessible to women in the United States.

The Institute, after reviewing the rate and consequences of unintended pregnancy, effectiveness of birth control, and cost and access concerns, concluded:

The committee recommends for consideration as a preventive service for women: the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.

In addition to copay-free coverage of birth control, the Institute recommended:

  • screening for gestational diabetes
  • human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
  • counseling on sexually transmitted infections
  • counseling and screening for HIV
  • lactation counseling and equipment to promote breast-feeding
  • screening and counseling to detect and prevent interpersonal and domestic violence
  • yearly well-woman preventive care visits to obtain recommended preventive services

You can view the Institute’s press release, recommendations, report brief, and full report, “Clinical Preventive Services for Women: Closing the Gap,” online. The Department of Health and Human Services will still need to adopt this list of recommendations for the care to be covered under the Affordable Care Act.

Some other coverage and discussion of this topic:

Seen other good links on this news? Leave ‘em in the comments!


November 24, 2010

Quick Hit: New Data on U.S. Sexually Transmitted Infections

If you need something to read over the long weekend and have a really strong interest in sexually transmitted infections, you’re in luck – the CDC has released a 100+ page report, Sexually Transmitted Disease Surveillance, 2009, on statistics and trends in STIs.

The report focuses primarily on the common STIs of gonorrhea, chlamydia, and syphilis, with data on rates by geographic region, age, sex, and race/ethnicity. It also discusses antibiotic resistance (*shudders*) and drugs in use for treatment of these infections. This publication also includes sections on specific populations, including racial/ethnic minorities, adolescents, and people as they become incarcerated. There’s a lot of data here that might be useful for health care providers, program planners and activists, or other public health types.

There *is* a special section on women, but “women and infants” are lumped together, and the focus is primarily on how STIs might affect women’s reproductive capacity. There is no real attention there to women who may be past their reproductive years, who do not plan to have children, or who are not heterosexually partnered. *Sigh*


May 10, 2010

National Women’s Check-Up Day: Wondering if You Should Get Tested?

Today marks the 8th annual National Women’s Check-Up Day, a nationwide effort coordinated by the U.S. Department of Health and Human Services’ Office on Women’s Health to promote the importance of regular check-ups as “vital to the early detection of heart disease, diabetes, cancer, mental health illnesses, sexually transmitted infections and other conditions.”

Planned Parenthood has put together key points concerning sexually transmitted infections along with a handy quiz (see below) to help assess individual risk.

* It is estimated that nearly 19 million new cases of STIs occur each year, and that by the age of 25, one in two sexually active young people will contract an STI.

* Biological factors place women at greater risk of infection than men, and contribute to more severe health consequences for women.

* Chlamydia and gonorrhea, the two most commonly reported infectious diseases in the United States, are also among the most serious and preventable threats to women’s fertility.

* Both rates and consequences of chlamydia and gonorrhea are far more severe among women than men.

* If left untreated, chlamydia and gonorrhea can lead to infertility.

* Most STIs have also been associated with increased risk of HIV transmission.

* Many STIs often don’t cause any symptoms. Many people get or spread infections without ever having symptoms.


March 11, 2010

Wrap-Up: STD Prevention Conference, HIV/AIDS Awareness & Female Condoms in D.C.

Amanda Lenhart, senior research specialist at Pew Research Center’s Internet & American Life Project, has posted her presentation on social media and young adults that was delivered this week at the National STD Prevention Conference in Atlanta. The slideshow covers the latest data on electronic and digital communciation, including cell phone usage and sexting.

Presenting with Lenhart was Kicesie Drew, who provides sex ed information via YouTube; Sally Swanson from the Adolescent Pregnancy Prevention Campaign of North Carolina, a group that usess texting to answer questions about sexual health; and Cornelis Rietmeijer, director of the Sexually Transmitted Disease Control Program/Denver Public Health.

More health professionals are turning to innovative techniques and technologies to reach young and at-risk populations. I recently took part in a symposium, sponsored by Chicago Department of Public Health and the National LGBT Tobacco Control Network, on how public health workers can use social media to reach the LGBT community. We looked at some of the promises and obstacles that new communciation tools present. One of the most important lessons: Know how your audience uses technology, and go where they go.

I was honored to be on a panel with Lovette Ajayi, a superstar at Community Media Workshop and co-founder of the Red Pump Project, which raises awareness about the impact of HIV/AIDS on women and girls. And that brings me to the second point of this post: March 10 was National Women and Girls HIV/AIDS Awareness Day.

The Red Pump Project presents statistics about HIV/AIDS  and women — and the great disparities. Though black and Latina women represent 24 percent of all U.S. women combined, they account for 82 percent of the estimated total of AIDS diagnoses for women in 2005.  Consider that HIV is the:

* Leading cause of death for black women (including African American women) aged 25–34 years.
* 3rd leading cause of death for black women aged 35–44 years.
* 4th leading cause of death for black women aged 45–54 years.
* 4th leading cause of death for Latina women aged 35–44 years.
* The only diseases causing more deaths of women are cancer and heart disease.
* The rate of AIDS diagnosis for black women was approximately 23 times the rate for white women and 4 times the rate for Latina women.

These numbers illustrate the need for massive improvements in education, prevention and treatment — all topics the National STD Prevention Conference aims to address. High-priority issues are identified for each biennial conference, and this year’s top three issues couldn’t be more  relevant or directly worded.

The last point is a great reminder of how change is both incredibly simple and complex: “It is essential to find ways to move beyond our longstanding societal reticence to openly discuss sexual health issues and to normalize conversations around STD prevention.”

Plus: In related news, Washington, D.C. will make 500,000 female condoms available — for free. The condoms will be available in beauty salons, convenience stores and high schools in parts of the city with high HIV rates, reports the Washington Post. The project is funded through a $500,000 grant from the MAC AIDS Fund, a subsidiary of MAC Cosmetics.


February 23, 2010

Panel de la FDA recomienda vacuna contra el cáncer cervicouterino; Joven de Florida se opone a Gardasil como vía a la ciudadanía

Publicado por Christine / del orginial en inglés Sept 15, 2009:

OBOS is committed to expanding our audience and in this spirit we’ve asked former board member Moises Russo to translate into Spanish several of our blog entries. We hope to translate more entries in the coming year.

En OBOS estamos comprometidos a expandir nuestra audiencia de lector@s  y en este espíritu le hemos solicitado a Moisés Russo, ex-miembro de la Junta de OBOS, que traduzca al español varios de los blogs que tenemos en la página electrónica. Esperamos continuar con dichas traducciones durante este año.

Una segunda vacuna diseñada para proteger contra el cáncer cervicouterino estará disponible pronto en Estados Unidos.

La semana pasada, un panel de la de Food and Drug Administración (FDA) dio su aprobación a la vacuna Cervarix de GlaxoSmithKline PLC*, esencialmente recomendando que la FDA apruebe la vacuna para el uso en mujeres de 10 a 25 años de edad. La recomendación no es obligatoria; la FDA puede rechazar la decisión, pero ésta generalmente acepta la opinión de paneles externos de expertos.

La vacuna protege contra dos tipos de virus papiloma humano (VPH), asociados al 70% de los cánceres cervicouterinos.

Escribiendo en el Wall Street Journal, Jennifer Corbett Dooren resumió las preocupaciones con respecto a la seguridad que la FDA levantó acerca de Cervarix, incluyendo “una mayor tasa de abortos entre las mujeres que recibieron Cervarix”. La FDA refirió además “no se puede excluir un ‘pequeño efecto’ sobre los embarazos”. (La vacuna no está aprobada para su uso en mujeres embarazadas).

GlaxoSmithKline intentó por primera vez conseguir la aprobación el año 2007, pero la FDA solicitó más información luego de que algunos reportes sugirieron una tasa más alta de abortos en mujeres embarazadas. Dooren escribe:

La agencia dijo que se requeriría de un estudio de seguridad post- marketing para monitorizar los resultados de embarazos en mujeres que pudiesen recibir Cervarix, junto con otras potenciales preocupaciones sobre su seguridad incluyendo el desarrollo de enfermedades autoinmunes como Artritis Reumatoide y Esclerosis Múltiple. En su revisión del año 2007 de Cervarix, la FDA indicó que tenía preocupaciones sobre un “desequilibrio” en posibles desordenes autoinmunes visto en algunos estudios clínicos. Sin embargo, la agencia ha dicho que revisiones adicionales de los datos realizadas por sus propios equipos y por un reumatólogo externo concluyeron que las diferencias no eran estadísticamente significativas.

Oficiales de Glaxo dijeron que estaban planeando un estudio de post-marketing que enrolaría a 100.000 mujeres en los EEUU, el cual incluiría un registro de embarazos. La compañía también se encuentra realizando otro estudio de post-marketing de grandes proporciones en Finlandia.

Gardasil, la popular vacuna contra el VPH fabricada por Merck y & CO. Fue aprobada por la FDA el 2006. Uno de los principales investigadores para la vacuna recientemente ha comenzado a denunciar preocupaciones con respecto a sus riesgos, beneficios y agresivas estrategias de marketing – principalmente que la protección puede no durar más allá de los 5 años, por lo que las niñas que sean vacunadas a una edad temprana pudiesen en el futuro aún encontrarse en riesgo.

El mes pasado, Rachel apuntó a una editorial del Journal de la Asociación Médica Americana sobre los riesgos y beneficios de la vacunación contra el VPH y analizó un comentario en la misma edición de JAMA (sólo resumen) sobre el marketing de Gardasil. Describiendo los hallazgos de los autores, Rachel escribió: “ La táctica de la compañía fue fomentar que todas las mujeres dentro de un cierto grupo de edad se vacunaran como una medida para evitar el cáncer, en vez de trabajar con oficiales de la salud pública para enfocarse en aquellas niñas que tienen un riesgo más elevado”.

Los Centros para el Control y Prevención de las Enfermedades (CDC por sus siglas en inglés) recomienda la vacuna para niñas de 11 y 12 años, y niñas y mujeres entre las edades de 13 y 26 años que aún no hayan sido vacunadas. Esa recomendación sin embargo se convierte en un mandato para las mujeres inmigrantes entre 11 y 26 años que buscan la ciudadanía Estadounidense. Gardasil fue agregada a la lista de vacunas requeridas el año 2008.

Simona Davis, una niña de 17 años en Florida que nació en el Reino Unido está buscando la ciudadanía Estadounidense pero se rehúsa a vacunarse. El noticiario ABC News tiene un reportaje completo sobre su rechazo a la vacuna. Davis, que es una cristiana devota que dice no tener intención de iniciar relaciones sexuales en el futuro cercano (menciona su promesa de virginidad como una prueba), está buscando una exención por razones morales y religiosas. Los Servicios de Ciudadanía e Inmigración de los EEUU han rechazado su solicitud.

“La decisión de incluir el VPH como una vacuna requerida fue hecha por el CDC”, ha dicho la vocera de los Servicios de Ciudadanía e Inmigración de los EEUU Chris Rhatigan a ABC News. “Nosotros seguimos la ley….La objeción a una exención debiese ser a todas las vacunas, no solamente a Gardasil”.

Un vocero del CDC ha dicho que se espera que el CDC publique nuevos criterios dentro de aproximadamente un mes para determinar que vacunas debiesen ser recomendadas a inmigrantes a los EEUU.


November 18, 2009

CDC Officially Reverses HPV Vaccine Requirement for Immigrant Women

Last week, the CDC issued revised vaccination criteria for U.S. immigration which will reverse the requirement that female immigrants seeking permanent residence or entry to the U.S. be immunized against HPV.

The new criteria require that any mandated vaccine must be age-appropriate for the immigrant applicant, and must either protect against a disease that has the potential to cause an outbreak or protect against a disease that has been eliminated or is in the process of being eliminated in the United States. As HPV does not meet these criteria, the vaccine will no longer be required starting next month (30 days after publication in the Federal Register).

We have written several times about the requirement, including the CDC’s initial comment on the matter and various action alerts/campaigns asking the agency to reverse the requirement.

As we and others noted, the requirement was problematic for multiple reasons, such the lack of an opt-out provision (in contrast to requirements for U.S. citizens), the expense of the series, the lack of significant public health risk posed by omitting this vaccine, and the vulnerability of the affected population.

In the revised criteria document, published in Friday’s Federal Register, HPV vaccination is specifically addressed as follows:

CDC has applied the criteria and determined that once these criteria become effective December 14, 2009, the HPV vaccine will not be required for aliens seeking admission as an immigrant or seeking adjustment of status to that of an alien lawfully admitted for permanent residence….Therefore, while HPV may be an age-appropriate vaccine for an immigrant applicant, HPV neither causes outbreaks nor is it associated with outbreaks (per explanation in the background section). Further, HPV has not been eliminated, nor is in the process of elimination, in the United States. Therefore, because HPV does not meet the adopted criteria, it will not be a required vaccine for immigrant and adjustment of status to permanent residence applicants.

Under the new criteria, the zoster (chicken pox) vaccine will also be removed from the requirements. The agency continues to recommend the two vaccines for U.S. citizens, but vaccine recommendations will no longer be automatically translated to mandates for immigration.

The National Latina Institute for Reproductive Health, the National Asian Pacific American Women’s Forum, and California Latinas for Reproductive Justice issued a statement commending the agency for the change and for “recognizing that all women and girls—regardless of their immigration status—must be treated with dignity in the context of any medical procedure, including the HPV vaccine.”


September 15, 2009

FDA Panel Recommends Cervical Cancer Vaccine; Florida Teen Objects to Gardasil as Path to Citizenship

A second vaccine designed to protect against cervical cancer may soon be available in the United States.

A Food and Drug Administration panel last week gave its approval to GlaxoSmithKline PLC’s Cervarix vaccine, essentially recommending that the FDA approve the vaccine for use in females 10 to 25 years old. The recommendation is not binding; the FDA can reject the decision, but it generally accepts the opinions made by an outside panel of experts.

The vaccine protects against two strains of human papilloma virus (HPV) that are associated with 70 percent of cervical cancers.

Writing in the Wall Street Journal, Jennifer Corbett Dooren summarized the safety concerns the FDA raised about Cervarix, including “a higher rate of miscarriages among females who received Cervarix.” The FDA also “couldn’t rule out a ‘small effect’ on pregnancies.” (The vaccine is not approved for use in pregnant women.)

GlaxoSmithKline first sought approval in 2007, but the FDA asked for more information after reports suggested a higher miscarriage rate in pregnant women. Dooren writes:

The agency said it would require a post-marketing safety study to monitor the outcome of pregnancies in women who might receive Cervarix along with other potential safety concerns including the development of autoimmune diseases like rheumatoid arthritis and multiple sclerosis. In its 2007 review of Cervarix, the FDA said that it was concerned about an “imbalance” of possible autoimmune disorders seen in clinical trials. However, the agency said an additional review of the data by its own staff and an outside rheumatologist concluded the differences weren’t statistically significant.

Officials from Glaxo said they were planning a post-marketing study that would involve 100,000 women in the U.S., which would include a pregnancy registry. The company is also conducting another large post-marketing study in Finland.

Gardasil, the popular HPV vaccine manufactured by Merck & Co., was approved in 2006. One of the lead researchers for the drug recently started speaking out with concerns about its risks, benefits and aggressive marketing — namely that the protection may not last beyond five years, so girls who are vaccinated at an early age may still be at risk.

Last month, Rachel pointed to a Journal of the American Medical Association editorial on the risks and benefits of HPV vaccination and discussed a commentary in the same JAMA issue (abstract only) about  the marketing of Gardasil. Describing the authors’ findings, Rachel wrote: “The company’s tactic was to encourage all girls within a certain age group to be vaccinated as a cancer avoidance measure, rather than to work with public health officials to target those girls at the highest risk.”

The Centers for Disease Control and Prevention recommends the vaccine for 11- and 12-year-old girls, and girls and women age 13 through 26 who have not yet been vaccinated. That recommendation becomes a mandate, however, for  female immigrants between the ages of 11 and 26 seeking U.S. citizenship. Gardasil was added to the list of required vaccines in 2008.

Simone Davis, a 17-year-old girl in Florida who was born in Britain is seeking citizenship but she refuses to get the vaccine. ABC News has a comprehensive story about her refusal. A devout Christian who says she has no intention of having sex anytime soon (she mentions her virginity pledge as proof), Davis is seeking a waiver for moral and religious reasons. U.S. Citizenship and Immigration Services has rejected her claim.

“The decision to include HPV as a required vaccine was made by the CDC,” Citizenship and Immigration Services spokeswoman Chris Rhatigan told ABC News. ”We follow the law … The objection to a waiver would have to be to all vaccines, not just Gardasil.”

A CDC spokesperson said the CDC is expected to publish new criteria to determine which vaccines should be recommended for U.S. immigrants in about a month.


March 28, 2009

Update From WAM! Conference

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I’m thrilled to be at the annual WAM! conference this weekend — so many great activists, writers, journalists, artists and teachers in one (very cool) space brainstorming, debating and learning from each other.

Yesterday I taught a day-long workshop on blogging (note to participants: hope you alert us all to your new blogs soon!). At this moment, I’m in the back row of the session “New Administration, New World Order: The Top Five Reproductive and Sexual Health and Rights Stories You’ll Want to Track — And How,” featuring Dana Goldstein, Jessica Gonzalez-Rojas, Emily Douglas and my boss, Kiki Zeldes.

Kiki’s talking about the not-quite-inaccurate-but-blatantly-biased condom information available on the CDC website under the Bush administration — the website stressed abstinence and downplayed the safety of condoms. Under the Obama administration, the CDC website has already been updated, and the new message states up front that correct and consistent use of condoms can reduce the risk of sexually transmitted infections. It’s just one example of subtle but important changes that can save lives. (Update: TheCh!ctionary.com captured Kiki’s comments.)

The only problem this afternoon is deciding which sessions to attend. I may duck next door to catch Deanna Zandt and Susan Mernit, who are presenting on social media tools.

Read more from the conference at these sites and also check out the Twitter feed


February 21, 2009

Double Dose: The VBAC-lash; Agreement on Health Care Reform?; Teen Sexual Harassment in the Workplace; Bye Bye Go-Daddy …

Searching for Common Ground: Robert Pear of The New York Times reports on an apparent consensus emerging among key players in the health care debate:

Many of the parties, from big insurance companies to lobbyists for consumers, doctors, hospitals and pharmaceutical companies, are embracing the idea that comprehensive health care legislation should include a requirement that every American carry insurance.

While not all industry groups are in complete agreement, there is enough of a consensus, according to people who have attended the meetings, that they have begun to tackle the next steps: how to enforce the requirement for everyone to have health insurance; how to make insurance affordable to the uninsured; and whether to require employers to help buy coverage for their employees.

Health Care “Reform” is Not Enough: “Most current health care reform initiatives, including those of Barack Obama, focus on providing wider access to health insurance. They do little to address the underlying problems with our health care system,” writes Susan Yanow in On The Issues magazine. Yanow identifies the top five problem areas for women with our insurance-driven health system.

Plus: This list of 10 ways to spend less on health care during a recession is well-meaning, but the list assumes a level of privilege that leaves out millions. I keep thinking of this story from last week.

“Is Your Daughter Safe at Work?”: The PBS program NOW has collaborated with the Schuster Institute for Investigative Journalism at Brandeis University on an unprecedented broadcast investigation of teen sexual harassment in the workplace. Check your local PBS station schedule for air dates.

The NOW website has a terrific collection of useful links and resources, as does the Schuster Institute, including an interactive map with links to information about specific teen sexual harassment cases gone to court. Keep in mind the map reflects a tiny proportion of probable cases. Kudos to EJ Graff for kicking off this project with her article, “Is Your Daughter Safe at Work?,” published in Good Housekeeping in June 2007.

The Trouble With Repeat Cesareans: “Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them,” writes Pamela Paul at Time magazine. “More than 9 out of 10 births following a C-section are now surgical deliveries, proving that ‘once a cesarean, always a cesarean’ — an axiom thought to be outmoded in the 1990s — is alive and kicking.” A good look at the VBAC-lash.

North Dakota House Passes Egg-as-Person Bill: “On Tuesday, one body of North Dakota’s state legislature voted, 51-41, not only to ban abortion, but to define life as beginning at conception. Such a measure, considered extreme even by pro-life standards, would have far-reaching consequences on women’s health,” writes Kay Steiger at RH Reality Check.

Understandably, Rachel Has Some Concerns …: About a proposed Tennessee bill that calls for testing some pregnant for alcohol and drugs.

Gone Daddy Gone: I couldn’t agree more with Creativity magazine editor Teressa Lezzi, who writes at AdAge.com:

After this year’s Super Bowl, I just couldn’t do it anymore. As it was, any time I had to log on to Go Daddy I felt some combination of embarrassment and annoyance at the registrar’s approach to women and marketing. But after its execrable ad efforts around this year’s game, I found that I just couldn’t stomach contributing anything to this organization any longer. I’m transferring my domains and my insignificant little piece of business elsewhere.

GoDaddy turned me off years ago because of its super lame ads, though I sometimes have to deal with the company for other clients. If sexist advertising isn’t reason enough to stay away, GoDaddy’s user interface sucks.

Cervical Cancer Vaccine Usage in California: A study by UCLA’s Center for Health Policy Research found that one in four teenage girls in California  — about 378,000 out of 1.5 million — received at least one dose of the Gardasil vaccine in 2007, its first full year of distribution, reports the L.A. Times.

Truth Catches Up: Remember the eye-catching “truth” anti-smoking ads? Researchers at the Johns Hopkins Bloomberg School of Public Health and the American Legacy Foundation estimate that the nations’ largest youth smoking prevention campaign saved $1.9 billion or more in health care costs associated with tobacco use. The findings appear in the Feb. 12 online edition of the American Journal of Preventive Medicine. The American Legacy Foundation, which launched the ads in 2000, spent $324 million to implement and evaluate the truth campaign.

Plus: Cigarette-maker Philip Morris was ordered to pay $8 million in damages to the widow of a smoker who died of lung cancer in a case that could set the standard for 8,000 similar Florida lawsuits, reports NPR.