AIDS at 25

I've blogged previously about the massive effect vaccines against the human papilloma virus (HPV) could have. HPV is a common sexually-transmitted virus. Though most strains are harmless, a few have the potential to cause cervical cancer. Therefore, the HPV vaccine will be the first one ever specifically intended to prevent a type of cancer.

This vaccine has recently been approved by the FDA, and is set to roll out shortly. This is already expected to be a rather contentious issue as the vaccine is rolled out in the U.S. and elsewhere, as one target group for vaccination is adolescents who have not yet begun sexual activity. Some religious groups have already objected on the grounds that it will increase sexual promiscuity.

A Monday session The Potential Role of HPV Vaccines in Improving HIV Prevention Among Young Girls and Women (video at link) suggested that the coming controversy (and hopeful resolution) over adoption of the HPV vaccine could be used as both a model for an eventual HIV vaccination campaign, as well as begin to open the dialogue among parents, teens, caregivers, and public health officials regarding issues in adolescent sexual activity.

There are a number of ways that the rollout of the HPV vaccine may assist in future acceptance of an HIV vaccine. Both are similar, in that they are (or will be, in the case of HIV) vaccines that prevent a sexually-transmitted infection, so there are moral issues at play in addition to the other issues regarding vaccination that are seen with vaccines against respiratory diseases, for example. This presents an opportunity to have a frank discussion of sexuality amongst all parties involved--the child, the parents, the physician, and others they may want to include (such as religious or other mentors). Will people take advantage of this opportunity? Obviously, that's likely to vary, but the very fact that a vaccine exists targeting a sexually-transmitted disease at least provides a stepping-off point to the conversation. And because this conversation includes topics that are difficult to talk about and that are cultural flashpoints--sex, vaccination, reproductive health, cancer--perhaps this vaccine, and an HIV vaccine in the future, can provide a medium to discuss them with less animosity or judgement.

Such vaccines also provide the opportunity to reach populations that are historically difficult, including not only adolescents (who are difficult because one must also deal with the parents of the child), but also women with children (who have traditionally been difficult because they are too busy and focused on others to come in for routine checkups). A booster vaccination in this population could provide an additional opportunity to discuss STIs (and prevention thereof), even in sexually monogamous and/or married women (since, as noted, just because one partner is faithful doesn't mean both are).

Finally, there is the price issue. Currently, the HPV vaccine is predicted to cost around $120/shot, with a 3-shot regimen. The price may come down as the shot becomes more accepted, but it was discussed that such protection shoudn't be just for the rich, either in this country or beyond. As part of this, there needs to be infrastructure laid in place for vaccine discussion and delivery--infrastructure that could, theoretically, be used for a future HIV vaccine.

It's certainly a challenging area, but from challenge springs opportunity, and there is optimism that lessons learned from the upcoming HPV vaccine challenge will lead to more opportunity in the future.