Seriously Messed Up Priorities
Nov. 2nd, 2008 12:29 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
le_bebna_kamniIn a recent conversation, a friend and I were talking about routine STD screening and what kinds of things ought to be tested. As a woman, while routine STD screening per se isn't included in Ye Olde Annual Physical(TM), HPV testing often is if you're over 30. This is because, as most people educated in the modern sexual era know, HPV can lead to cervical cancer.
Since one of my current partners and I recently got tested together, it occurred to me during the conversation that HPV testing hadn't been included in *his* recommended set of tests, and I wondered why. After all, while men clearly don't have a risk of cervical cancer, isn't part of the reason for getting tested so that you don't unknowingly pass it on to your partner?
So I did some research online, and here's what I found:
At present, there are no FDA-certified HPV tests for men. One of the problems is that currently approved tests have only been developed for women, and the most obvious way of checking for HPV -- visible genital warts -- is not always effective because not all the cancer-causing strains cause visible warts.
That doesn't mean tests don't exist -- on the contrary, men apparently can get tested through a urologist and some sperm banks test for HPV in the sperm itself. Anal Pap tests are also available for homosexual or bisexual men. Also, whether it is to be believed or not, one site offers a test that can be performed at home and sent into a lab.
The question becomes, with all the focus on vaccinating young women for HPV (sadly, I'm out of the age range that supposedly can benefit from the vaccine), why is there less of a drive to get a male test [or vaccine] approved as well?
From looking at various sites, the answer seems to be, as Wikipedia so aptly puts it, that it's considered "medically unnecessary". For most men, HPV is inconsequential -- since an estimated 80% of the population carries some form of HPV, we already know that most men don't experience genital warts, and they certainly can't get cervical cancer. While there is some debate about whether HPV increases the risk of certain penile and anal cancers, most sites geared towards males reassure that both types of cancers are exceedingly rare and so should not be a concern. In other words, HPV is a woman's problem, so nothing more need be done on the man's part.
So as a woman, I'm the one who gets to take the risk. I won't know if my partner has HPV until I catch it myself, at which point I've been put at risk for cervical cancer. Unlike my male partners, who can make an informed choice about whether or not to sleep with me if I catch HPV, I've got to cross my fingers with every partner and hope for the best.
By using the phrase "medically unnecessary", it implies that the only reason why you might get a test for an STD is if you personally would be harmed by it. That your partner could potentially be harmed by it is irrelevant. While I could be upset at an apparent gender inequality, what bothers me more is how it seems to illustrate a more fundamental way of thinking in our culture: that the responsibility of STD transmission lies with the victim, not the person doing the transmitting.
This can be seen in the slowness of many states to enact laws making sleeping with someone without informing them of a positive HIV diagnosis a crime. Nevermind that knowingly putting a SARS culture in someone's else's food would certainly lead to prosecution, even though SARS has a much better survival rate. This can also be illustrated in several other non-disease related sexual arenas, such as pregnancy, where effective male birth control has been very slow to develop because males themselves cannot get pregnant.
There seems to be an overall opinion in the United States that sex should only be done in a single, monogamous relationship that you maintain for your entire life. That if you have sex outside of said paradigm, you are clearly an immoral person who deserves what you get. And that because you, as an immoral person, are to blame, the person who gave you the disease is not held accountable. It's very much like the argument that because prostitution is illegal, a prostitute who gets beaten up by her client or john doesn't get any legal recourse...except that in most places having sex with a non-spouse isn't illegal.
While it is true that each person should be responsible for their own sexual welfare, the "blame" argument overlooks certain fundamental facts:
The mentality of "medically unnecessary" puts the focus on the "after STD contraction", as opposed to before it's even spread at all. We need to get away from this idea and put primary responsibility where it really belongs: on the transmitter -- whether male or female -- and not the person who ends up suffering from it.
Since one of my current partners and I recently got tested together, it occurred to me during the conversation that HPV testing hadn't been included in *his* recommended set of tests, and I wondered why. After all, while men clearly don't have a risk of cervical cancer, isn't part of the reason for getting tested so that you don't unknowingly pass it on to your partner?
So I did some research online, and here's what I found:
At present, there are no FDA-certified HPV tests for men. One of the problems is that currently approved tests have only been developed for women, and the most obvious way of checking for HPV -- visible genital warts -- is not always effective because not all the cancer-causing strains cause visible warts.
That doesn't mean tests don't exist -- on the contrary, men apparently can get tested through a urologist and some sperm banks test for HPV in the sperm itself. Anal Pap tests are also available for homosexual or bisexual men. Also, whether it is to be believed or not, one site offers a test that can be performed at home and sent into a lab.
The question becomes, with all the focus on vaccinating young women for HPV (sadly, I'm out of the age range that supposedly can benefit from the vaccine), why is there less of a drive to get a male test [or vaccine] approved as well?
From looking at various sites, the answer seems to be, as Wikipedia so aptly puts it, that it's considered "medically unnecessary". For most men, HPV is inconsequential -- since an estimated 80% of the population carries some form of HPV, we already know that most men don't experience genital warts, and they certainly can't get cervical cancer. While there is some debate about whether HPV increases the risk of certain penile and anal cancers, most sites geared towards males reassure that both types of cancers are exceedingly rare and so should not be a concern. In other words, HPV is a woman's problem, so nothing more need be done on the man's part.
So as a woman, I'm the one who gets to take the risk. I won't know if my partner has HPV until I catch it myself, at which point I've been put at risk for cervical cancer. Unlike my male partners, who can make an informed choice about whether or not to sleep with me if I catch HPV, I've got to cross my fingers with every partner and hope for the best.
By using the phrase "medically unnecessary", it implies that the only reason why you might get a test for an STD is if you personally would be harmed by it. That your partner could potentially be harmed by it is irrelevant. While I could be upset at an apparent gender inequality, what bothers me more is how it seems to illustrate a more fundamental way of thinking in our culture: that the responsibility of STD transmission lies with the victim, not the person doing the transmitting.
This can be seen in the slowness of many states to enact laws making sleeping with someone without informing them of a positive HIV diagnosis a crime. Nevermind that knowingly putting a SARS culture in someone's else's food would certainly lead to prosecution, even though SARS has a much better survival rate. This can also be illustrated in several other non-disease related sexual arenas, such as pregnancy, where effective male birth control has been very slow to develop because males themselves cannot get pregnant.
There seems to be an overall opinion in the United States that sex should only be done in a single, monogamous relationship that you maintain for your entire life. That if you have sex outside of said paradigm, you are clearly an immoral person who deserves what you get. And that because you, as an immoral person, are to blame, the person who gave you the disease is not held accountable. It's very much like the argument that because prostitution is illegal, a prostitute who gets beaten up by her client or john doesn't get any legal recourse...except that in most places having sex with a non-spouse isn't illegal.
While it is true that each person should be responsible for their own sexual welfare, the "blame" argument overlooks certain fundamental facts:
1) Depending on the definition and collection methods, between 1 out of 6 and 1 out of 4 women have been sexually assaulted. Asking your attacker to use a condom generally disqualifies it as rape in the court's eyes, so I think it's safe to say that a significant number of women have had an unprotected sexual encounter where they weren't even given an option of responsibility.In other words, putting the responsibility for STD transmission on the victim is not only faulty, but counter productive. A woman who doesn't want to catch HPV has very little choice because she can't effectively know if her partner has it until she catches it herself -- regardless of how careful and/or monogamous she herself is.
2) Condoms are not 100% protection, and that is especially true for STDs like HPV which only need skin-to-skin contact to be transmitted. So careful partners will review each other's sexual histories and/or get tested, even if they use a condom. The only 100% method is abstinence (not even outercourse is effective for HPV) -- or a single monogamous relationship for your entire lifetime with someone who also maintains a strictly monogamous relationship with you and who was not born with an STD transmitted from their mother. Which leads to #3...
3) Monogamy is a myth, at least in effective practice. This can be demonstrated in cultures like India, where a significant number of the women with HIV contracted it from unfaithful husbands. In the US, more than half of all men and women (57% and 54%, respectively) admit to cheating on a partner, and let's not forget that the sex trade is still alive and kicking. So simply being faithful to your partner isn't enough to ensure that your partner will be equally responsible.
The mentality of "medically unnecessary" puts the focus on the "after STD contraction", as opposed to before it's even spread at all. We need to get away from this idea and put primary responsibility where it really belongs: on the transmitter -- whether male or female -- and not the person who ends up suffering from it.
