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    The Limits of HPV Awareness

    Scientists say the human papillomavirus can pose a deadly risk to both men and women. So why does the pressure of preventing it rest almost solely on the shoulders of the latter?
    Mar 04, 2022#health#policy

    After many years of anticipation and advocacy, regulators on the Chinese mainland finally approved the HPV vaccine Cervarix for use in 2016. This was a major step forward for the country’s women: HPV is a leading cause of cervical cancer, the second-most common form of malignant tumors in women worldwide. Approximately 90% of deaths resulting from cervical cancer occur in mid- to low-income nations — 20% of them in China.

    Yet, based on my research and fieldwork, the benefits of vaccine approval continue to be overshadowed by a variety of problems, including poor awareness, widespread misconceptions about the nature of HPV, and harmful stigmas, especially among men.

    The HPV vaccine may have been developed to prevent cervical cancer, but the truth is, both sexes are equally likely to contract a human papillomavirus. Although scientists began studying HPV’s effects in men much later than in women, the virus has already been linked to serious diseases such as anal cancer, penile cancer, and cancer of the throat. In response, countries like the United States and South Korea have started offering HPV vaccines to men. But Chinese regulators have yet to follow suit, citing a lack of domestic research on the subject.

    As a result, all current Chinese HPV awareness campaigns focus solely on women, and the vaccine itself is often referred to as the “cervical cancer vaccine.” Even among men who have heard of HPV or the vaccine, they generally have an attitude of indifference.

    The highly gendered discourse surrounding HPV has, in turn, breathed new life into old stereotypes surrounding cervical cancer. In the early 1900s, medical specialists collectively referred to cancers of the uterus and cervix as “cancer of the womb,” with some doctors believing that these cancers were caused by women engaging in “excessive” or “immoral” sexual behavior.

    In the mid-20th century, experts instead began attributing the cause of cervical cancer to cervical fissures that occur during labor, temporarily dispelling some of the stigma surrounding the disease. But by the end of the century, a succession of scientific studies proved that the primary cause of cervical cancer was HPV, transmitted through sexual activity, and beliefs about promiscuity and sexual immorality once again reared their ugly heads. Because current HPV detection technology can only effectively identify cases in women, it is women, rather than both sexes, who bear the brunt of the disease’s negative associations. Not only are women expected to protect their bodies from HPV in ways that men aren’t — but a diagnosis can threaten their reputations as healthy, moral, and responsible people.

    Although Chinese norms surrounding sex have gradually relaxed since the late 1970s, mainstream contemporary sexual discourse remains fraught. Women are generally still seen as passive agents in sexual encounters, even as female infidelity is viewed as a tremendous moral transgression — which is not necessarily the case for men. By emphasizing that the risk of infection in women is closely correlated to the frequency of their sexual activity and number of sexual partners, while ignoring the risks the virus poses to men, HPV awareness campaigns tend to exacerbate preexisting misogynistic ideas.

    While conducting fieldwork at a gynecology clinic in the southwestern megacity of Chongqing, I found that women diagnosed with HPV are often not just worried about their risk of developing cervical cancer, but also about what will happen if their partners or others take the diagnosis as a sign of promiscuity or unfaithfulness. Although some more recent campaigns have sought to emphasize that having HPV is not a sign of promiscuity, the fact that women are still viewed as wholly responsible for the prevention and transmission of the virus increases the stress of a diagnosis.

    Meanwhile, most men act as though the virus cannot affect them. Upon seeing HPV awareness campaigns, men might share them with their girlfriends, wives, or daughters, perhaps with a suggestion that they get vaccinated, but they fail to grasp the full extent of the problem and their own role in the virus’ spread. A number of HPV-positive women I spoke to told me that, since their diagnosis, they have begun to feel repulsed or afraid of sex. This is in part because their partners often still refuse to wear a condom, putting them at risk of contracting other HPV strains.

    Medical knowledge doesn’t exist in a vacuum — its production and dissemination has always been influenced by cultural and social values, as well as political systems. As the anthropologist Emily Martin has argued, even specialist medical books don’t always use neutral language. When describing sex cells, for instance, authors might liken the fusion of a sperm and an ovum to a kind of romantic encounter, in which the sperm — representing the male partner — is active, while the ovum — representing the female partner — is passive.

    This notion of feminine passivity has carried over into the realm of public health, as women are made to be the primary focus of medical interventions. In the past, this was because women were thought of as biologically inferior to men, a problem not helped by the dominance of men in the medical field. The historian Ilana Löwy has written about how cancer itself was thought of as a female disease in the early 19th century. Cervical and breast cancers were the first cancers to be studied by medical scientists, and male doctors played a defining role in this research.

    The field’s overemphasis on treating women for diseases that affect both sexes can still be seen in matters related to sexual and reproductive health. Fetal health diagnosis and treatment, pre- and post-natal education, and fertility technology all tend to center on women’s bodies. Although the Chinese public is increasingly aware that fertility problems are not necessarily the woman’s fault, the default is still to assume that infertility is caused by a problem with the female partner. While it’s common for a woman suffering from infertility to visit a doctor or even multiple doctors in search of treatment, many men are closed to the idea that they may be the ones who need help.

    The gendered discourse surrounding HPV is not unique to China. The first two HPV vaccines approved in the United States were initially only recommended for women, and HPV vaccination rates among American men are far lower than they are for women.

    In all my fieldwork, I only ever saw one man get vaccinated for HPV. He was in his early thirties and had accompanied his wife on a trip to Hong Kong — where the HPV vaccine is approved for both men and women — so that she could get her third and final shot. He said that it was from pamphlets his wife had brought back from the Hong Kong clinic after her first trip that he initially learned men are also at risk of contracting HPV. Furthermore, the pamphlet’s male celebrity spokesperson made him realize that men can and should receive the vaccine. “It’s not just about taking responsibility for my own health, but also that of my partner and family,” he explained.

    He was just one man out of hundreds of women I know who have been vaccinated against HPV, but his story was nevertheless a reason for hope — and a preview of what a truly non-gendered approach to HPV education might look like.

    Translator: Lewis Wright; editors: Cai Yiwen and Kilian O’Donnell.

    (Header image: A college student receives an HPV vaccine in Lianyungang, Jiangsu province, Jan. 27, 2022. Geng Yuhe/VCG)