By Jared Chausow
By Katie Toth
By Elizabeth Flock
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By Jon Campbell
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The political storm around the virus began this July, when Republican congressman Tom Coburn tearfully announced plans to stick HPV-related amendments onto the Breast and Cervical Cancer Treatment Act. American women deserve to know about HPV, Coburn insisted. "Women don't need to get cervical cancer anymore."
Indeed, at first blush, the Republican congressman's proposalswhich sailed through a House committee on the coattails of the widely supported bill last Thursdaymay seem logical steps toward protecting women's health. While the law they amend would help uninsured women pay for screening and treatment for breast and cervical cancer, Coburn's additions focus on the relatively little-known virus, which can lead to cervical cancer. One of his measures would move toward requiring physicians to report cases of HPV to a registry at the Centers for Disease Control. The other would require warning labels on condoms, saying they "do not effectively prevent the transmission of the human papilloma virus and that such virus can cause cervical cancer."
But there is more behind the HPV amendments than concern for women's healthor, perhaps, less. Coburn, an obstetrician and committed conservative, has trumped up medical information to promote one of his favorite moral messages: that no one should have sex outside marriage. With HPV, which can be transmitted even during "protected" sex because the virus thrives in skin cells beyond the covered area, the three-term congressman has found a new way to get out his old message. Unfortunately, his chosen tack involves not only eroding confidence in contraception, but also scaring women out of their gourds.
"Either have sex before marriage and get an STD and HIV, HPV, or an unplanned pregnancy, or you save it until marriage and you live happily ever after," warns Janet Parshall, a staff member of the Family Research Council, which has teamed up with Coburn in the HPV campaign. At a September 20 FRC press conference (which the group called "HPV: The STD Condom Pushers Don't Want You to Know About"), Coburn appeared with Laker A.C. Green and other far-right luminaries to announce that "condoms are totally useless against HPV," which they labeled a "particularly contagiousand incurabledisease."
What no one in the HPV brigade mentions, however, is that, even by conservative estimates, a teeny number of people who have the virusfar less than 1 percentwill develop cervical cancer. Another significant omission is that while it's true that doctors don't know how to cure HPV, the majority of HPV infections resolve by themselves. It's not that HPV is harmless. It is, though, "the least important of STDs," according to Kenneth Noller, an ob-gyn at the University of Massachusetts Medical School who has studied HPV extensively. "Millions and millions and millions have the infection," says Noller, "but almost none of them get cancer."
The rarity of HPV infections that develop into cervical cancer has led many experts to oppose the idea of tracking and reporting each of the millions of cases in which the virus has been detected, as Coburn's amendment proposes. "The best way to screen for cervical cancer is a pap smear, not to test for HPV," says Helene Gayle, director of the National Center for HIV, STD, and TB Prevention at the Centers for Disease Control. "You'd have no clue which ones of those people would actually develop cervical cancer. It's a very inefficient way to look for the real problem, which is cervical cancer."
As for the warning labels on condoms, Coburn's critics object to singling out one disease for an educational campaign without also providing information about other diseases condoms can protect against. "The campaign puts people at risk for diseases we can absolutely prevent," says Debra Haffner, executive director of the Sexuality Information and Education Council of the U.S. Noting that sex with a condom is more than 10,000 times safer overall than sex without a condom, Haffner says, "A label won't stop sex, it'll just stop condom use."
Which is precisely the reason that this relatively inconsequential disease has been dusted off and brought to the fore. While the extent of the virus's ability to elude condoms is also disputed territory, there is no question that the virus can sometimes get around latex. And this vulnerability makes it a perfect tool to chip away at support for condoms.
The Family Research Council has long trumpeted its opposition to sex outside of marriage, condemning American society as "oversexed." The council was central in a successful campaign to allot almost half a billion dollars in government funding to teach children that abstinence until marriage is the expected norm of human behavior. Not surprisingly, the group opposes homosexuality. And FRCand Coburn, for that matterhave repeatedly come out against contraception.
In the past, however, the group has made these arguments largely on ideological grounds. With HPV, the council hopes to have found more objective, scientific footing. Like the partial-birth abortion argument, which FRC was instrumental in using to erode support for Roe v. Wade, HPV has the potential to put a new spin on an old debate. "It's not even just a moral argument anymore," FRC spokesperson Heather Farish says of the group's updated abstinence message. "We're talking about health now. The fact is that you risk contracting a bad sexually transmitted disease if you have sex outside of marriage."
You might also risk contracting a bad sexually transmitted disease inside marriage, a point that the American College of Obstetricians and Gynecologists made in one of its many attempts to persuade Coburn to change his proposals. In an October 19 letter to Coburn, ACOG vice president Ralph Hale wrote that he was "alarmed" by the congressman's statements that not having sex outside marriage is the only way to prevent HPV. Hale also pointed out that women should know that other factors, such as smoking, influence whether a woman will get cervical cancer, and that pap smears can help detect infections before they become dangerous.
Coburn didn't incorporate such information, so ACOG and several other health and women's groups decided to fight the amendments. Though they've been unsuccessful in the House, they're confident they will be able to strike or at least weaken the Coburn language when a companion version of the breast and cervical cancer funding bill comes up for a vote in the Senate.
But even then the HPV debate may not be over. Already the issue is cropping up on the state level. Conservative legislators in Minnesota recently arguedwith some successthat warnings about HPV be added to several laws. "They were spouting all kinds of misinformation about [HPV]," says Mary Jo George, a health advocate who was involved in the debates.
Whether on the state or federal level, such an approach is a poor mask for an anti-woman, anti-sex agenda, according to Chris Korsmo, director of government relations for Planned Parenthood. "This is about the idea that women shouldn't be sexual, we should abstain," says Korsmo. "Our punishment for not abstaining is having to report to a registry."