In an interview about his new film “Behind the Candelabra“, actor Michael Douglas told the Guardian that his throat cancer was caused not by years of smoking but “by HPV [human papillomavirus], which actually comes about from cunnilingus.” Douglas said, “I did worry if the stress caused by my son’s incarceration didn’t help trigger it. But yeah, it’s a sexually transmitted disease that causes cancer.” He shrugs. “And if you have it, cunnilingus is also the best cure for it. . . It giveth and it taketh.”
When I first heard this story, I thought Douglas was compensating for playing a flamboyantly gay character by boasting of his heterosexual male prowess (and/or showing that despite his age and illness, he can still satisfy his much younger wife). On further reflection I agree with this post by Girl w/Pen (aka Adina Nack) at Ms Magazine blog:
“Michael Douglas did a good deed by helping raise awareness that serious and often fatal oral cancers can be caused by sexually-transmitted HPV, which is likely contracted by oral sex.” Nack stresses the importance of “not only educating the public about HPV-related cancers in men but also about the HPV-oral cancer link.” She also advocates “the need to destigmatize all STDs, since her research and book shows, “STD stigma makes it more likely for at-risk/infected individuals to put off getting tested and treated. STD stigma also makes it less likely for individuals to disclose their sexual health status to partners, placing those partners at greater risk for infection. In addition, negative stereotypes about the ‘types’ of women and men likely to be infected distort our ideas of who is at risk.”
Last fall, fellow Nursing Clio contributor Tina Kibbe wrote an informative post about HPV and the Importance of Planned Parenthood, which included a discussion of the controversy surrounding HPV vaccines. “Aside from the “to vaccinate” or “not to vaccinate” debate, there arose a clamor from some about whether or not this was yet another free ticket for women to expand their promiscuous repertoire–because yes, the concern here was focused on the increased promiscuity of young women. So much so that a study was conducted to disprove this notion.” Yet opposition to the vaccine continues, especially from those who believe that it will “promote promiscuity.”
Several years ago, I attended a conference on HPV vaccines that led to the co-edited volume, Three Shots at Prevention: The HPV Vaccine and the Politics of Simple Solutions (Johns Hopkins University Press, 2010). My chapter, “Safeguarding Girls: Morality, Risk, and Activism,” argued that anxieties about adolescent sexuality that have emerged in discussions about HPV vaccines are not new, but draw upon earlier trends in American medical and cultural history. Beginning in the 1950s, scientists explored the link between adolescent sexual activity and the development of cervical cancer later in life. Several epidemiological studies published in the 1950s and early 1960s indicated that women who married before age 20 appeared to be at higher risk for cervical cancer. Some speculated that women who had multiple “broken marriages” were especially susceptible.
Isadore D. Rotkin of the Cancer Research Project at the Kaiser Foundation in California elaborated on this research: he found that age at first coitus was the most significant variable distinguishing cervical cancer patients from controls. In a study of over 400 patients, 85% of whom were Caucasian, twice as many cancer patients as controls began coitus at ages 15-17, comparatively few began after age 21, and almost none as late as age 27. Rotkin hypothesized that some kind of infectious agent transmitted by male partners was a contributing factor, and that the adolescent cervix was especially vulnerable to “epithelial transformation” by exposure to such an agent. Although Rotkin acknowledged that measures aimed at improving male sexual hygiene could reduce the incidence of the disease, he argued that postponement of marriage and limitation of number of sexual partners for young women were the most effective means of prevention. In addition, given that a disproportionate number of patients were nonwhite, non-Jewish women of low socioeconomic status, Rotkin recommended that routine pap smears were especially important for “nonvirgins” from underprivileged groups. Rotkin’s work echoed many of the paternalistic attitudes towards America’s “underclass” during the 1960s. Like the political liberals who spearheaded President Johnson’s “Great Society” programs, Rotkin realized that poverty was a contributing factor in cervical cancer risk, suggesting that ideally the way to prevent disease “might be the transference of underprivileged populations into higher socioeconomic levels.” At the same time, he also tended to reinforce prevailing stereotypes about the links between disease risk, race, and class.
Recent campaigns for HPV vaccines have tried to break these ties by featuring a multi-racial cast of girls who choose to be “one less” cancer victim.
At the same time, these ad campaigns side step overt discussions of adolescent sexuality by emphasizing that these vaccines prevent cancer, thereby diverting attention from the STD that causes this form of cancer.
Despite evidence that HPV can cause certain forms of male cancer, health risks for boys were ignored in the initial launch of HPV vaccines. Instead, articles suggested that the best way to get “Guardasil Boys” on board was to appeal to male chivalry by convincing boys to protect future female partners against disease. This is reminiscent of the rubella vaccination campaign in the late 1960s , which urged boys and girls to be “responsible citizens” and to accept vaccination as a way to protect future babies from disabilities. The March of Dimes poster at right specifically targets girls, but boys too were considered essential to the fight against rubella because they could transmit the disease to pregnant women.
The fact that HPV causes cancer in men is old news in the gay community. Steven Epstein’s chapter, “The Great Undiscussable: HPV, Anal Cancer, and Gay Men’s Health,” shows that the link between anal cancer and gay men’s health was first made in 1982. “Yet anal cancer remains relatively invisible in general, while the link to gay men remains undiscussable in the broader public sphere.” When a gay man “comes out” with anal cancer, “he accepts a sort of pejorative feminization” by adopting interventions such as HPV vaccines and pap smears “that have been coded as female.” Yet Epstein shows that “ironically, to the extent that gay men are understood to be ‘like women,’ it may be easier for them to argue that ‘women’s health’ interventions should be extended to them as well.”
Farah Fawcett’s very public struggle with anal cancer may have made it easier to discuss the link between HPV and anal cancer. According to an article in Chicago Tribune printed shortly after Fawcett’s death,
“Anal cancer is one of those cancers no one likes to talk about because it’s, well, anal cancer. But we really should discuss it as much as, say, cervical cancer. Both are predominately caused by the sexually transmitted human papillomavirus. In fact, a 2004 study of 6,000 anal cancer patients (the majority of whom were women) found that 73 percent of the patients tested positive for the strain HPV-16, one of the strains that the Gardasil vaccine protects against. What’s worrisome is that unlike cervical cancer, which has dropped dramatically since the advent of the Pap smear, anal cancer is on the rise. Incidence rates over the past 30 years have jumped by 78 percent in women and 160 percent in men, probably because more people now have more sexual partners and more people have anal sex (both among heterosexuals and gay men), says Lisa Johnson, a cancer epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle who led the 2004 study. Although anal cancer is “far less common than breast cancer–1 in 640 women will be diagnosed during their lifetime, compared with 1 in 8 with breast cancer–only about half of anal cancers are detected in their earliest stage, when they’re most treatable. Partly for this reason, only about 67 percent of people diagnosed with anal cancer survive five or more years.”
Once again, the illness of a heterosexual actor known for her sex appeal brings the “undiscussable” into the open. However, Epstein shows that stigma still clings to gay men with the disease, and straight women who engage in anal sex say that the “gay” connotations of the practice make them feel “queered.”
So, like the early years of the AIDS epidemic, it’s prominent heterosexuals who usually make the headlines and raise awareness of public health risks that endanger everyone. HPV vaccine manufacturers now recognize the importance of vaccinating boys to prevent male cancers by including them in their advertising campaigns.
Whether Michael Douglas’ story will eliminate the stigma associated with HPV-caused male cancers remains to be seen, but if the history of AIDS is any guide, I doubt it.