The politics of HPV: Legislation at issue

Conservatives using disease to further cause

By Cynthia Dailard

Senior Public Policy Associate

Alan Guttmacher Institute

Washington, DC

Conservative policy-makers on Capitol Hill have seized upon human papillomavirus (HPV) to advance their abstinence-only agenda. Genital HPV is an extremely common sexually transmitted disease (STD) that cannot be entirely prevented through condom use and is linked to cervical cancer. Based on this information, they believe HPV provides them with a silver bullet to discredit the notion of safe sex.

Conservatives also are using HPV to attack the family planning community — with its ongoing call for safer sex practices designed to reduce the risk for STDs and unintended pregnancy — for turning its back on this disease. However, the family planning community is teaming up with other public health advocates to educate policy-makers about the facts of HPV to achieve a more balanced public policy response to both HPV and cervical cancer.

(Editor’s note: To help answer questions surrounding HPV, a national hotline has been established as the first project of the new National HPV & Cervical Cancer Prevention Resource Center. The center has been launched by the Research Triangle Park, NC-based American Social Health Association, a nonprofit organization dedicated solely to the prevention and control of all STDs. Read more about the Center in the April 2000 issue of Contraceptive Technology Update, p. 46.)

Congress first encountered HPV as a political issue in the context of the Breast and Cervical Cancer Prevention and Treatment Act of 1999 (HR 1070). That legislation is designed to help low-income, uninsured women with breast or cervical cancer obtain treatment. During committee consideration of the bill, Rep. Tom Coburn (R-OK), a conservative physician and long-standing opponent of government-funded family planning programs, threatened to hold up consideration of the bill unless the committee accepted his amendments targeting HPV.

To ensure smooth passage of the bill, which is cosponsored by 280 members of the House of Representatives, the sponsors agreed to accept Coburn’s amendments. Some of those proposals, however, are problematic from a public health perspective, not just from the standpoint of family planning advocates.

Condom warning labels proposed

One of Coburn’s proposals requires the Atlanta-based Centers for Disease Control and Prevention (CDC) to enter into cooperative agreements with the states and other entities to conduct sentinel surveillance surveys to determine the prevalence of specific types of HPV. However, another proposal mandates that condom labels contain a cigarette-type warning stating that condoms do not protect against HPV and that HPV can cause cervical cancer.

In response to that provision, Rep. Henry Waxman (D-CA), a congressional leader on health care issues for more than 20 years, voiced the concerns of the public health community during committee consideration of the bill.

Waxman stated, "There is also a risk of unintentionally confusing the public about when condoms do or do not work. Condoms are unquestionably an important means of preventing the transmission of human immunodeficiency virus and other sexually transmitted diseases. But there is a danger that stressing a message about when condoms do not prevent the transmission of an STD may reduce their use in situations where they do, thereby increasing the transmission of STDs other than HPV.

"I also am concerned that mandating HPV information on condom labels, labeling, and advertising can result in so much information on such a small package that it ultimately reduces the effectiveness of any warnings or other information."1

The proposed warning label would not make clear that there are many HPV types and not all lead to cervical cancer.2 The label also would not help educate women that cervical cancer can be eliminated before it starts by receiving regular Pap tests to detect HPV infection and precancers.2

Groups such as the Washington, DC-based American College of Obstetricians and Gynecologists (ACOG) and the Chicago-based Society of Gynecologic Oncologists have expressed serious concern about the health message that might be received by the public if Coburn’s proposal is enacted.2 ACOG argued that HPV should not be singled out among all STDs and asked that information presented to consumers be based on accurate, medically based research.2

Public health advocates also take issue with Coburn’s proposal to establish a process to lead to the required reporting of all cases of HPV to the CDC. Coburn suggests that such a measure would provide public health officials with vital information about the prevalence of HPV. His critics, however, contend that reporting all cases of HPV would not be worthwhile because many of those cases resolve on their own and only a small proportion leads to cervical cancer.

Bill in consideration

Having passed through the full committee, HR 1070 is awaiting consideration by the full House of Representatives. While the future of this bill is ultimately unclear, public health advocates hope to alter the more problematic HPV-related language as the bill moves through the legislative process. To cover his bases, however, Coburn has introduced his initiatives as a freestanding bill (HR 3248) as well.

Clearly, the politics of HPV have just begun, and HPV is likely to provide ample fodder for other debates surrounding publicly funded family planning programs, abstinence-only education, and other matters of public health.

(For additional information, see the article on HPV DNA testing research in STD Quarterly and the HPV consumer/patient fact sheet from the National HPV and Cervical Cancer Prevention Resource Center, both inserted in this issue.)

References

1. U.S. Congress, 106th Session. House of Representatives, Commerce Committee. Committee Report — House Rpt. 106-486 Part 1. Breast and Cervical Cancer Prevention and Treatment Act of 1999. Associated Bill H.R. 1070. Additional Views.

2. American College of Obstetricians and Gynecologists. ACOG takes stand against proposed HPV legislation. ACOG Today 2000; 44:5.