Monday, May 5, 2008

HPV Inequalities

I have previously posted on the inequalities within the UK National Health Service roll-outs of the vaccine for Human Papillium Virus (HPV). That NHS Scotland has rolled it out to all teenage females whilst NHS England has been dragging its feet ... seemingly commentators suggest for politico-economic reasons.

Supposed concerns among parents are that teenage girls will become more promiscuous as they become protected against cervical cancer.

In England a trial of take-up of the HPV vaccination in 26 schools in Greater Manchester found that only 80% of girls of the eligible age group (needing parental consent) received the vaccine.

The percentage take-up was far lower amongst ethnic minority and/or low-income students. This can, of course, be for several reasons ...

However, of parents who stated their reasons for refusing consent lack of information about the vaccine and its long term safety were foremost and changes in sexual behaviour least. It is, of course, most probable that ethnic minority and/or low-income parents would be more unlikely to give reasons for their refusal to give consent. It would seem that the NHS needs to provide more information.

There are compelling arguments that vaccinating boys against HPV is equally important in combatting the spread of HPV to girls and the subsequent development of cervical cancer – after all, it does take two to tango. A trial of one of the vaccines (there are two Merck's Gardasil and GlaxoSmithKline's Cervarix) showed it to be equally effective amongst boys as girls.

In further developments Doctor David reports (here and here) the increase in oral cancer caused by HPV – which, clearly, affects males as well as females with the rate of oral cancer amongst young men increasing at such a rate that it may soon, in the US, surpass the number of cervical cancer cases. As smoking decreases HPV is becoming a more important cause of oral cancers than coffin nails. I am told by our GP that HPV can also be responsible for penile and rectal cancers.

So the NHS HPV vaccination programme neglects:

a) the English

b) ethnic minorities

c) males

d) those who are into oral sex whether homo – or heterosexual

e) those who are into anal sex whether homo – or heterosexual (although for the life of me I cannot understand why anyone would have unprotected anal sex these days.)

Of course, we'll have to wait for the National Institute for Health and Clinical Excellence to conduct a cost-benefit analysis but if you're black, male, homosexual or just plain sexually diverse ... don't hold on to the edge of your chair ...


Update: NHS management wrote a letter on 2 May to all PCTs, SHAs etc concerning the forthcoming HPV vaccination programme in England. We are informed that supportying materials and information are available here. As of writing and in typical NHS IT style the link is non-existant.

The Equality Impact Assment report is here.

No comments: