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HPV vaccine program for ‘at-risk’ boys classifies as discrimination

The British Columbia Ministry of Health's recent decision to offer the HPV vaccine free of charge for young males who are "vulnerable" and "at-risk" aims to protect more children. The province will now extend the cancer-preventing vaccine to gay and "street-involved" boys.

But the well-intentioned policy risks stigmatizing young people. B.C. should follow the lead of other provinces and offer the vaccine to all girls and all boys.

When Health Canada approved the HPV vaccine in 2006, it aimed to prevent cervical cancer and so the vaccine was recommended only for girls. But HPV-related head, neck and other cancers are on the rise. Research has demonstrated that the HPV vaccine is safe, effective and will save future health-care costs in both girls and boys. Consequently, in 2010, Canada's national immunization committee recommended that both girls and boys (ages nine to 26) receive the HPV vaccine.

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The Canadian Cancer Society has called the HPV vaccine "a game changer" in cancer prevention. Clearly, all children should benefit. All provinces and territories provide the vaccine to girls for free. Prince Edward Island, Alberta and Nova Scotia have included boys in their school-based HPV vaccine programs, and wisely do not discriminate on the basis of sexual orientation.

B.C.'s recent decision is probably based on cost. The vaccine is expensive, at approximately $150 per dose, and multiple doses are recommended. But singling out gay children is problematic for many reasons.

First, the B.C. policy asks too much of 11-year-old children to "come out" to their classmates and parents as gay to receive a vaccination.

Second, many males won't identify as gay or bisexual until their 20s and 30s, and will have missed the opportunity to receive the vaccine's full health benefit because the biggest immune response occurs in younger children.

Third, the "at-risk" label might cause young B.C. boys to internalize stigma about being gay when, in fact, most people who engage in sexual touching or sexual intercourse are at-risk for the sexually transmitted HPV infection.

Fourth, B.C.'s new vaccine policy could clash with school-based attempts to reduce bullying. Imagine the classroom snickering that might occur when the school nurse calls for only girls and gay boys to leave their desks for vaccination.

Fifth, we know subsets of girls (aboriginalInuitblack and Hispanic) are more at risk for HPV-associated cancers than other girls. Government vaccine programs have not discriminated on grounds of ethnicity and should not discriminate on grounds of sexual orientation.

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Sixth, parents of boys might believe it necessary to proclaim their son as "gay for a day" to access preventive health care. Given the fluidity and incontestability of sexual identity, policing such vaccine access will be difficult.

Seventh, heterosexual males are unfairly excluded from this cancer prevention program. In many Canadian communities, the number of girls receiving the HPV vaccine is insufficient to ensure "herd protection," leaving heterosexual males not fully protected against the virus. Moreover, B.C. men who have sex with people from countries with no HPV vaccine program or, as in Japan, very low rates of HPV vaccine uptake are at risk.

B.C.'s policy commendably extends HPV vaccination to more of its children. But the cost-saving policy is short-sighted. Recent research on a cohort of 192,940 Canadian boys suggests that HPV vaccination could save between $8-million and $28-million over their lifetimes.

The good news is that B.C. is offering the HPV vaccine free of charge to more young people. The bad news is that a high price will be paid by our Canadian values of non-discrimination based on sexual orientation, and our goal of cancer reduction. Canada's reputation as an international leader in developing free HPV vaccination programs might cause other provinces and countries to adopt this new and unwise policy.

Canadian provinces and territories should offer all children, irrespective of gender and sexual identity, the opportunity to roll up their sleeves to receive the HPV vaccine.

Gilla Shapiro and Samara Perez are doctoral students, department of psychology, McGill University and Vanier Canada Graduate Scholars; Juliet Guichon is an assistant professor, Cumming School of Medicine, University of Calgary; Zeev Rosberger is an associate professor, department of psychology and faculty of medicine, McGill University and Jewish General Hospital.

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