Some time in the months preceding the Summer of 2012, the Utah County Health Department threw away hundreds of doses of the Gardasil (HPV) vaccine because these doses had expired due to “lack of demand.” A few blocks away at BYU, hundreds of gay and bisexual Mormon men remained unvaccinated and completely unaware of their risk for contracting this virus. This is a public health tragedy that has already affected the lives of many of these men and those they have been intimate with–one that could have been prevented if the sexuality of these young men had been acknowledged and respected, rather than ignored and suppressed.
Most gay men who are raised LDS will end up, one day, becoming sexually active. This is true regardless of how bright their testimonies of the gospel are or how faithful the family they come from. When I was 21, I thought I would rather die than be sexually active with another man. Turns out, I was wrong, just like almost all of my friends who had been in a similar situation while students at BYU. People who rely on the testimonies of young gay LDS men as the sole thing to protect these men from the risks of sexual contact set these young men up for tragic consequences. In fact, in many instances personal and family devotion to the doctrines of the LDS church leads to high levels of inner-conflict and self-loathing in sexual minority men and low levels of knowledge about sexual health which in turn lead to even higher risk sexual behavior. These young men are being sent blindfold into a minefield after internalizing deep feelings of failure and shame. Are we really that surprised by the explosions?
The danger of this minefield is not trivial. The CDC estimates that half of sexually active men and women will contract HPV in their lifetimes, regardless of sexual orientation. Most of these people will clear or contain the virus with their immune systems without ever experiencing symptoms. Most of the rest will experience uncomfortable and potentially embarrassing warts in areas of the body exposed to the virus while a small minority of infected people will develop life threatening cancers. Through pap smears, women are regularly screened by health care providers for the cancers most commonly associated with HPV infection (ie. cervical cancer). While similar procedures are available in men (ie. anal pap smears), very few physicians are trained at performing these procedures and most men remain unscreened. This leads to a situation in which men who have sex with men (MSM) are less likely to be vaccinated against HPV, more likely to be exposed to the virus, and highly unlikely to be screened for the symptoms of infection–all the ingredients for a boiling health disparity (like a 44 times higher incidence of anal cancer in MSM than the general public.
Health disparities occur when the current medical system fails to address the specific health needs of a minority community due to differences in the community as compared to the general public. While gay and bisexual men as a whole are vulnerable to health disparities, the peculiarities of Mormon gay and bisexual men leads to this community being served even more poorly by the medical community. An individual’s risk for HPV infection has been correlated with his or her age, age of first sexual contact, and number of lifetime sexual partners. The public health community has taken these factors into account when deciding age cut-offs for recommendations about which people will benefit from receiving the Gardasil vaccine. Because most unvaccinated people will have already been exposed to the virus after having two or three different sexual partners, the vaccine is currently only recommended for people who fall under the age at which this level of sexual activity commonly occurs, 21 for all men and 26 for MSM*.
This assumption is rarely true of LDS men, regardless of sexual orientation. Most gay and bisexual men raised in an LDS environment delay sexual contact throughout young adulthood due to social pressures and personal religious beliefs. When these young men decide to be sexually active later in life and want to receive the Gardasil vaccine to protect themselves from the risks of sexual activity, they are faced with obstacles from insurance companies and health professionals who are not used to treating this type of patient population. In fact, most insurance companies will not cover the Gardasil vaccine for men older than age 21 and none cover the vaccine for those older than age 26. This should be a strong motivator for LDS parents to overcome their reluctance or distaste for the idea of their gay or bisexual sons’ potential for sexual activity. If you do not help them get this vital preventive health care vaccine when they are young, they may not have access to the treatment when it is truly needed**.
My generation of unvaccinated LDS gay and bisexual men will suffer because the communities we were raised in did not treat our sexuality as something real. Those of you who have decided to support your gay and bisexual sons are offering them a chance at physical and emotional health that stands out as unique against a stark backdrop of suffering and pain. Their different life circumstances means they have different health needs than the ones you grew up with and you are in the position to learn about these needs and help them be met. Parents who take these extraordinary steps deserve praise as true champions of the LGBT social justice movement. Those who let go of protecting their beliefs and instead protected their sons.
* The age limit is higher in MSMs due to the higher prevalence and greater morbidity in this community.
** The planned parenthoods of utah and salt lake counties offer the HPV vaccine and will help economically disadvantaged clients apply for a waiver from the vaccine’s manufacturer, Merck, for the $140 cost of the shot (times 3 shots). Eligibility for the waiver is based on client’s age, income, and insurance status. Information is collected directly from the client and no attempt to verify the accuracy of the information provided is made.