- The Washington Times - Monday, July 17, 2006

Six years ago, 70 percent of American adults said in a Henry J. Kaiser Family Foundation survey that they had never heard of human papillomavirus (HPV), even though it is the nation’s most common sexually transmitted virus.

But by the end of this year, the phrase “HPV” ought to start sounding more familiar, especially to parents with sixth-grade daughters.

The Food and Drug Administration (FDA) recently approved the nation’s first HPV vaccine, Gardasil, manufactured by pharmaceutical giant Merck & Co. Inc.

A federal panel has now recommended that all girls ages 11 and 12 get the vaccine, as well as teenage girls and women up to age 26. The drug is now being shipped to health care providers.

The long-awaited three-shot vaccine is expected to save countless thousands of American women from getting cervical cancer.

“It’s going to be a good thing,” said Sen. Tom Coburn, Oklahoma Republican and an obstetrician.

It’s a “major step forward in public health and prevention,” said Martha Kempner of the Sexuality Information and Education Council of the United States (SIECUS).

Rumors to the contrary, “there’s not going to be a fight over it,” said Dr. Gary Rose, president of the Medical Institute for Sexual Health.

“We support widespread distribution of the vaccine, but we oppose mandatory vaccination,” said Linda Klepacki, sexual health analyst at Focus on the Family. She said parents should make the decision for their child.

However, although the new vaccine is garnering general approval across political and cultural spectrums, the other HPV prevention debate — whether sexual abstinence or condoms is the best deterrent — is barreling along unabated.

What makes HPV a political issue is that it has become a core argument for not relying on condoms for protection against sexually transmitted disease (STD).

HPV is spread by skin-to-skin contact, including skin left uncovered by condoms. As a result, more than a dozen studies have failed to show that condoms offer any significant protection against HPV.

HPV is made of dozens of viral strains, some of which resolve themselves and some of which lead to genital warts and cancers of the mouth, cervix and other reproductive areas in men and women.

Safer-sex supporters say that condoms work against all kinds of STDs, including HPV, and that it’s irresponsible to push only abstinence when most Americans start having sex before they turn 20.

But abstinence supporters say avoiding sexual contact is simply the best way to safeguard against HPV and other STDs.

Several members of Congress, including Mr. Coburn and Rep. Mark Souder, Indiana Republican, have cited HPV in their push for new condom labels that explain the device’s limitations in preventing infections.

The condoms-and-HPV debate was in a lull until a study appeared in the June 22 New England Journal of Medicine.

The small but well-designed study, conducted on University of Washington coeds who recently became sexually active, showed that coeds who used condoms 100 percent of the time reduced their risk of getting HPV by 70 percent compared with coeds who rarely used condoms.

The journal’s study was hailed for its findings. “It’s time for a ‘cease-fire’ in the war on condoms,” said James Wagoner, president of Advocates for Youth.

The study and the HPV vaccine show that “we have two very powerful prevention tools against this very common STD,” Mrs. Kempner said. But, she warned, these tools “aren’t going to get used” if people continue to “spread misinformation and lies.”

But others see condoms as inadequate in fighting against HPV.

The study found an infection rate of 38 percent for women who used condoms 100 percent of the time, compared with an 89 percent infection rate for women who rarely used condoms, said the Abstinence Clearinghouse in Sioux Falls, S.D.

“An infection rate of 38 percent is certainly better than 89 percent, but it should never be confused with an impressive amount of protection,” said the clearinghouse, which recommends that single people refrain from sexual activity until they marry.

The public shouldn’t confuse “risk reduction” with “risk elimination,” said Dr. Rose of the sexual health institute in Austin, Texas.

“Abstinence and a monogamous relationship with an uninfected partner are risk elimination,” he said. “If you talk about condoms, you are talking about risk reduction.”

The condom labeling issue, meanwhile, appears stalled.

In November, the FDA issued draft labels for condoms that said they reduce — but do not eliminate — health risks, and consistent use may help protect against some STDs, including HPV.

Although some health activists said the proposed label was too negative and likely to discourage condom use, others, including Mr. Coburn, said the new labels were too “inconclusive” and misleading, especially about HPV.

Asked recently about the labels, Mr. Coburn said he didn’t expect any movement “until we get an FDA commissioner and somebody with the guts to say we’re going to do real science.”

President Clinton signed the law requiring the FDA to devise a medically accurate condom label, said a spokesman for Mr. Souder. “More than five years later, the FDA has still not done its job,” and the congressman “remains disappointed” in the agency for failing to comply with the law, the spokesman said.

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