Feature Interview: Dr. Adina Nack, author of Damaged Goods?
Wednesday, March 31st, 2010
Victoria Clayton recently exchanged emails with Dr. Adina Nack, associate professor of sociology at California Lutheran University and author of Damaged Goods? Women Living with Incurable Sexually Transmitted Diseases. Did you know that 75 percent of us are infected with HPV? Moms take note: perhaps you’re aware of the vaccine that protects young girls. Guess what? Nobody seems to be talking about it, but it also protects young boys. And, in fact, it can have other preventive health benefits. This is a must-read! (Also, scroll down and watch a brief TV interview with Adina Nack and her husband Jose.)
Exurb: I read recently in the NYT that one in six Americans aged 14 to 49 are infected with genital herpes. I was astounded that the number was so high. You note in your book Damaged Goods? Women Living with Incurable STDs that as many as 20 percent of Americans may be infected with genital herpes and up to 75 percent of the population is likely infected with a strain of sexually transmitted HPV (human papillomavirus) that can cause genital warts and cervical dysplasia, a precursor to cervical cancer. Many people have a vague awareness of HPV, but it seems like we should know more. Why don’t we?
Nack: Excellent question because the more people learn about HPV – and the range of HPV-related cancers that affect women and men – the more they agree with me that we are decades overdue for a comprehensive HPV public health campaign. As to the reasons for the lack of this campaign, I have several theories, but, given our current wealth of knowledge about HPV, there really is no excuse for the federal government to not invest significant resources into not only HPV clinical research but also in HPV public health education.
Exurb: Do you think some women don’t even fully understand they’re infected, when they’ve had abnormal Pap Smear results, a colposcopy and/or treatments (like cryosurgery, cone biopsy and LEEP)? Why are some health care providers hesitant to deliver the news in a way that makes women fully understand they have a STD?
Nack: Unfortunately I’ve heard too many accounts from women who’ve received diagnoses of “abnormal Pap smears” or “cervical dysplasia” but were not told that they can have a HPV test done on those cell samples to find out if their precancerous cells resulted from a sexually-transmitted virus. When teaching sexuality courses at California Lutheran University and giving talks on other college campuses, I often have women come up to me to ask whether or not they have HPV if they have had one of those HPV treatment procedures you mention. I tell them the truth: that a HPV infection may have caused their precancerous lesions. It’s inexplicable (and, frankly dangerous for public health) that anyone receives an incomplete and misleading explanation about their cervical health. A well-explained HPV diagnosis gives a patient the opportunity to ask questions and encourages them to consider behavioral changes that can reduce their risk of infecting their sexual partners with this highly contagious STD which is transmitted by skin-to-skin contact (that can occur even with the correct and consistent use of latex condoms or dental dams).
Exurb: There are HPV vaccines like Gardasil and Cervarix (read on for more on this). But what are other ways to reduce risks of HPV infection?
Nack: There is not blood-test that can check for HPV infection: symptoms (warts or lesions) need to be biopsied and sent to a lab for testing. Since HPV can be asymptomatic for months, even years, we have no definitive way of knowing if any one of us is infected. So, the best steps are to get yourself and your partner(s) as thoroughly tested as possible and to practice safer-sex (using ‘barrier’ methods like male condoms, female condoms, and dental dams) so that you are reducing the skin-to-skin contact that transmits HPV. On my website, I have a “Resources” page that includes several excellent websites that review the medical facts about HPV and other STDs, including HPV testing and treatment options. As a virus, HPV is often defeated by individuals’ strong immune systems, which is why many patients and healthcare practitioners favor a ‘wait and see’ approach to give their bodies a chance to fight off the HPV symptoms before pursuing medical treatment. However, it’s important to remember that you may be contagious even if you and your healthcare practitioner no longer see symptoms. Ultimately the best protection from HPV is to know the facts about HPV myths.
Exurb: I read that the makers of Gardasil want to get it FDA approved for women 27 to 45 years old. Would this be a good thing, in your view? Why?
Nack: As early as 2007, the press was reporting Merck’s studies that showed Gardasil to be effective on women ages up to age 45 (http://www.marketwatch.com/story/merck-says-gardasil-effective-in-study-of-women-ages-24-45). Regardless of age, if a woman (or man) has not yet been exposed to one of the four strains of HPV covered by Gardasil, then s/he would likely benefit from vaccination.
Exurb: You recently wrote an article that highlights how most of us aren’t aware that the Gardasil vaccination can also be protective for boys and young men. Can you explain this use of Gardasil and also why very few people seem to know about it? How is Gardasil also linked with protection against other health issues?
Nack: The FDA’s October 2009 approval of Merck’s Gardasil vaccine for the prevention of genital warts in boys and men (ages 9 to 26) confirmed that, since 2006, Merck had been selling us a STD vaccine disguised as a cervical cancer vaccine. Prior to 2006, HPV researchers had linked the types of HPV which cause cervical cancer to penile cancer, as well as to anal and oral cancers in women and men. Last month, Merck released findings that Gardasil prevents anal precancers in men. Oral cancer researchers are hopeful that clinical trials will soon show that this vaccine can prevent types of oral cancer which have been on the rise among traditionally low-risk men and women (non-smokers, non-drinkers). However, the confusion over HPV continues, with few Americans understanding it as a gender-neutral virus that potentially causes serious health consequences for men and women. I discuss these consequences and detail the reasons why all of us should be advocating for gender-neutral STD vaccines in my article “Why Men’s Health is a Feminist Issue” in the current/winter issue of Ms. Magazine.
Exurb: In your book, you deal with the implications for women who are living with genital herpes and/or HPV infections, both of which are treatable but medically incurable. You interviewed a range of women from age 19 to 56 from fairly diverse backgrounds. What were the most common implications? How drastically can a person’s life influenced typically by the HPV diagnosis? Were the findings of your research what you expected?
Nack: The majority of the women were fairly devastated by different aspects of their illnesses – the medical/physiological (symptoms/outbreaks, treatments that were not always effective and in rare cases resulted in infertility), the psychological (especially how they viewed themselves as sexual beings and if they were able to continue to see themselves as ‘good girls/women’ or whether they felt they were now ‘bad girls’ or ‘sluts’) and the social (e.g., the ability of a stigmatizing diagnosis to ruin their reputations and potentially ‘scare off’ current or future sexual partners). Through my website, women and men have emailed me about how their genital HPV and herpes infections have damaged not only their health but also their self esteem and their relationships.
Since I had managed the challenges of my own cervical HPV infection several years prior to beginning this research, I was not surprised by how ‘damaged’ the majority of the women felt after being diagnosed. But, I was happy to uncover several key ways that helped many of the women transform their STD experiences into ultimately positive ‘turning point moments’ in their lives. I’ve also interviewed men, and I’m incorporating all of these research findings into my next book which focuses on how men and women can have happy and healthy sex lives in a world were STDs have become the statistical norm.
Exurb: If you could only get two points across in this brief interview, what would they be?
Nack: Point #1: We all win with HPV education. Given recent news about FDA-approvals for Gardasil and Cervarix, it’s easy to get caught up on being pro- or anti-vaccine. But, I want to remind your readers that, whether or not they decide one of these HPV vaccines is right for themselves or their children, no vaccine is 100% effective. We all need to be better educated about this national epidemic (and global pandemic) of a family of viruses (including several cancer-causing types) that spread easily during acts as ‘casual’ as open-mouth/French kissing, not to mention unprotected oral sex (which some say has become the norm for many young people who want to remain ‘abstinent’ until marriage).
Point #2: We all lose with STD stigma. HPV education needs to address myths that lead to many of us seeing STDs as marks of shame. In my book and talks, I describe the reasons why we have historically ‘mixed morality with medicine’ and why we continue to stigmatize STD-infected women more than STD-infected men. HPV is not a female problem – it’s a human disease. And, given the rates of infection, you don’t have to be promiscuous to contract a STD. Stigmatizing STDs often leads to mental health problems (like depression and anxiety) for those who are infected and can make them afraid to tell their current and future sexual partners. Public health is bound to improve when the majority of us come to view these kinds of infections as medical (not moral) conditions.
So, I’ll wrap up our interview with one last message – medically incurable STDs do not have to mean the end of your sex life or your fertility. The key is early detection/diagnosis and becoming an educated, assertive patient. My book, Damaged Goods, is a resource that can help women and men navigate genital herpes and HPV infections, and hope your readers will also check out other excellent web-based resources.
THANKS ADINA!
