HPV vaccines: More than meets the eye

I learned a lot these past few weeks. I learned that what I thought I knew about HPV was all wrong, or at least incomplete.

Cervical cancer has been huge, especially on TV, for the past few years. All of a sudden my doctor is telling me to get vaccinated for HPV, and she makes it sound like I'm going to die if I don't. The message I got from all of this was: get vaccinated or you might develop cervical cancer because it's a huge risk.

But I and millions of other women are missing a lot of crucial information.

Human papillomavirus (HPV) is the most commonly sexually transmitted infection in the United States, and the world. So common, in fact, that half of all sexually active men and women will contract HPV at some point in their lives. Hm. Didn't know that.

However, HPV usually comes and goes without a sound and leaves no lasting effects. There are over 100 strains, and many of them don't do a thing to us.

But then there are the ones that do. Two strains of the virus -- HPV-16 and 18 -- are associated with cancer development. Two others -- HPV-6 and 11 -- are associated with 90 percent of genital warts. There are two vaccines that protect against the cancer-causing strains, Gardasil and Cervarix, and the former also protects from the wart-causing strains.

And while the common misconception is that HPV only causes cervical cancer, the infection can actually cause several cancers, although half of the cancers caused by it are cervical. Anal cancer is also the result of HPV infection, especially in men who have sex with men. Other cancers include vaginal, penile, throat and vulvar. So it seems the HPV vaccine, which a new study shows can prevent infection in men as well as women, is a blessing for many at-risk individuals. 

However, I typed "harmful HPV" into Google one day, and the first thing to pop up was "harmful HPV vaccines."

A lot of the fear associated with any vaccine comes from action taken when there is no perceivable immediate threat. For HPV, the fact that this is a sexually transmittable infection makes it even more uncomfortable for many parents to consider concerning their adolescent children, since the vaccine is most effective before sexual activity begins. Because of this, the vaccine may be thought of as a gateway for sexual activity. Right now uptake in American women is woefully low, less than 30 percent, although it has been rising. 

According to 2010 Centers for Disease Control and Prevention research, major barriers to vaccination include "belief that a child does not need the vaccine, lack of sufficient vaccine knowledge, and the fact that the child was not sexually active."

Another study published in the journal Pediatrics in 2010 found that physicians themselves often didn't have the facts correct about HPV, some mistaking the most common age of transmission as over 30 when in fact it is under age 30. And while almost all of the pediatricians and family practitioners surveyed offered HPV vaccines to 11- and 12-year-old girls, many of them did not strongly recommend it and expressed reservations toward vaccinating younger girls for sexually transmitted infections. 

Add in cost and negative media coverage, including anti-vaccination movements, and a parent may see more value in avoiding the vaccine than attempting it.

In rural communities, these barriers can be magnified. The stigma associated with STIs can prevent parents from getting their kids vaccinated, and might prevent men from getting vaccinated if it is made routine in the future. 

So what can be done to increase uptake in girls and women, as well as to encourage vaccination in boys and men if the benefits lead to routine immunization of them also?

Dr. Joel Palefsky, one of the lead authors of the new study of HPV vaccination in men and boys, believes that the key is education. "People need to better understand the connection between HPV and the diseases that we're trying to prevent," he said. "Obviously, many people have tried to do that [educate], but I think it's still a black box to many people."

Rhonda Dyar, the nurse manager of Hart County's health department, agrees. "Its important to educate them [patients] on the risks of not getting vaccinated, use details and encourage it prior to sexual activity," she said. False information is a problem she notices when parents do refuse the vaccination for their children. 

The possibilities of this vaccine are expanding; in the future it could be used as a preventative for several diseases, especially if uptake in females increases or both sexes routinely get vaccinated. None of those possibilities will come to fruition, however, if education and understanding of the link between the vaccine and disease don't increase. 

The state of health in Hart County

The thing I love most about the drive from Athens to Hart County? Cows. Oh, and the occasional miniature donkey or goat. They're cute but they serve a purpose, of course; the large number of farms in the area contributes to the county's position as fifth in agricultural sales for the state (2007).

After my first few visits, however, I learned that Hart County is much more than just farmland.

Hart County is a rural county with a population of around 24,000. While smaller than most counties in Georgia,  it also boasts an active community and an interesting make-up.

I learned that what was once an area rich in textiles now relies heavily on income from it's man-made lake, Lake Hartwell, which attracts part-time residents, retirees, and vacationers. While there are more affluent residents around the lake, according to Ilka McConnell, UGA's Hart County Archway Partnership professional, they are more the exception than the norm. Those who live in Hartwell, the county seat, tend to have less income and work in industrial settings. The county's unemployment rate as of December, 2010 was 12 percent, with 19.7 percent of individuals living under the poverty level.

Many of the health problems in Hart County seem to stem from lifestyle and income, and are often compounded by a lack of health care services. The county is designated as a health care professional shortage area as well as having a medically underserved population. There is a single hospital in Hartwell with 82 beds, but the beds on the first floor aren't in use. There is also a MedLink clinic to provide primary care, as well as a few other family practitioners.

When it comes to acute care, the hospital is able to provide several services but more often patients are referred to physicians in places like Athens or Anderson, SC for specialized treatment in cardiovascular diseases, neurology, oncology, etc. Interestingly, there is a "wellness" center adjacent to the hospital that specializes in cosmetic procedures such as vein care, Botox injections and various laser treatments.

When speaking with Rhonda Dyar, the Nurse Manager at the local health department, I learned that many of who live in Hart County depend on the health department for all of their health needs, like child health care, women's health care and other services that are lacking in the county or unaffordable. She also said that the tiny clinic, usually equipped with only two nurses, is constantly behind on meeting the needs of its clients and is often booked solid.

As with most rural areas, major health issues in the county include cardiovascular diseases, obesity and diabetes. That obesity and diabetes are problems is evident simply by driving around town. The first restaurant I spotted when I first visited was a McDonald's right in the center of downtown, directly across from the police station. Leading causes of death for the area waiver around lung cancer, heart disease and stroke, which is representative of the US, but the rates are exaggerated for Hart County.

Lisa Graham, an RN and legal nurse consultant at the Hart County Hospital, told me that diabetes and obesity are both cyclical problems in the area that stem from lifestyle, surroundings and income. In fact, she stated that for many diabetes patients, noncompliance with medications and diet is often due to a lack of viable options.

Mary Lowery, an RN at the hospital, reiterated this by saying that people "eat what they can afford," stressing the social and economic aspects not only of diabetes and obesity, but of most health problems in the area. 

"You're gonna buy your cigarettes and alcohol before you buy your food."

Both Lowery and Graham said that the state of the economy has put a damper on health care in the county, preventing some from accessing critical medications or preventative measures. Add in the few available health care services within a close distance of Hart County residents, and you have a recipe for lasting chronic diseases and an unhealthy population.

There is another side to the county's health story, however.

There is a surprisingly long list of local charities, nonprofit organizations, support groups, clubs, and churches that do or could be used to address health care issues in the county. The hospital hosts weight-loss, substance abuse and other meetings. Diabetes support groups and education are rising in popularity, and the school system takes a proactive stance on nutrition and sports.

Hart County, in a nutshell, appears to me to have several county-wide health concerns. But what I also saw when meeting residents or driving around town is a relatively close-knit community with the desire to grow.