A few weeks ago I received a message through a listserve that disturbed me. It was posted by Rabbi Arthur Waskow, an activist as well as a religious leader whose work I respect enormously. In this case however, we disagree. Rabbi Waskow's posting celebrates the release of the new HPV vaccine, and uses it as an opportunity to urge congregations to adopt new sexual health curricula as part of Bar/Bat Mitzvah training. He also suggests that congregations might require the HPV vaccine as a pre-requisite for Bat Mitzvah (for girls) but not for Bar Mitzvah (for boys). This is my response. (I apologize for the binary language. Try to ignore it. I was not aiming to get into a discussion about transgender and intersex issues with the Rabbi at this time.)
Hello Rabbi Waskow,
I got your message about the new HPV vaccine through the Jewcy (West) listserve. I know it's been a while since you sent the message, and we (Jews, and anyone else paying attention) have had a lot else to think about in the weeks since. Still, the message brought up a lot of thoughts for me, so I decided to respond.
I work in HIV prevention and general sexual health education. I agree it is so important to begin talking with kids about the dangers and pleasures of sexual activity from a young age. I applaud your suggestion that bar/bat mitzvah training be taken as an opportunity to talk with kids about their own sexual health, and to invite them to take responsibility by participating in decision-making about their bodies and health, such as the decision whether or not to be vaccinated for HPV as well as Hepatitis B (now reccomended for all babies and teenagers).
However I also have some critique of your message that I'd like to share with you. The first thing is that I don't think the new HPV vaccine is unqualified good news. Here's why -
I'm sure you're familiar with the history of the birth control pill - how at first it contained such high doses of estrogen that it led to long-term complications including cancers in some women, and how only years later did the medical establishment notice the problem and move to change the formulation to something safer. In the decades since then, several birth control methods have gone on and off the market because their safety is not well-established and their side effects are not well understood. The IDUs are one example, as well as Norplant, and I will not be surprised if Depo-Provera is next. So one layer of my discomfort with the new HPV vaccine is that it is a fairly new medication, being marketed only for women (although as you point out men also get HPV). Based on the history I've outlined, I have learned to distrust most medical treatments that are marketed only toward women, because I don't trust the medical establishment to take women's health seriously.
Another layer of the issue is that many of these dangerous birth control methods were (and still are) marketed primarily to certain kinds of women. Homeless women and others living in extreme poverty as well as women of Color are pushed to take Norplant or Depo rather than pills or other safer, lower-dose birth control options. The reasoning put forth by providers is that these women may not have the literacy or organizational skills to use pills correctly and consistently. Yet, knowing how oppression works, I distrust a system that reccomends one form of birth control to middle class white folks, and another, riskier one to poor people and people of Color. The HPV vaccine also is being marketed heavily toward people who are labeled "high risk" because they are poor and/or because they are people of Color. That makes me worry even more about the safety of this product.
At this point, I am not reccomending against people taking the vaccine, if they consult with a physician they trust and decide that's the best course for them. However I won't reccomend for it, either. I certainly would not approve of a synagogue requiring the vaccine for Bat Mitzvah students (but not Bar Mitzvah students?), since this takes away young people's right and responsibility to make decisions about their own bodies in an informed and consensual way. To me this is the opposite of using Bar/Bat Mitzvah training to get young people engaged in taking responsibility for their own health.
Finally, on a slightly different issue, I am confused by your focus on young women and not young men. As you point out, males do carry HPV infection and sometimes have symptoms from it. You emphasize men's role in transmitting HPV to women, who typically suffer more drastic long-term effects. This emphasis assumes heterosexuality, and also leaves out some important points about men's health. HPV can lead to rectal cancer in both males and females, as well as cancer of the penis in males. To put the emphasis and responsiblity only on girls seem unfair, sexist, and ultimately ineffective.
I believe that sexual health problems, including HPV, are always community health problems. The surest way to protect young people (and everyone!) from HPV and other sexually transmitted infections is with universal prevention education, aimed at giving people the skills, information and support they need to make their own informed choice and implement it. I emphasize universal because I think educating half the population is less than half as effective as educating the entire population. Risk for HPV is afterall behavioral, and making responsible long-term decisions about sexual behavior requires not only knowledge but also ongoing support from friends and role models. People are most likely to make and stick to responsible decisions if the decisions are their own, and if their peer group understands and respects the reasons for those decisions.
This is why I love your suggestions that sexual health education be an integrated part of Bar/Bat Mitzvah classes! What I object to is the idea of mandatory vaccinations (or any mandatory behaviors), and the unequal responsibility placed on girls and not boys.
I hope my thoughts have been useful to you. I continue to respect your work and appreciate your postings to the Jewcy list. I'll be very glad to read any response you might have.
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