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Invisible Consequences of Visibility: Human Papillomavirus (HPV) and the Making
of Gendered Subjectivities
By Brennan Wittry
A Thesis Submitted in Partial Fulfillment of a Degree in Sociology & Anthropology
Lewis and Clark College
Portland OR
May 3rd, 2016
Advisor: Prof. Sepideh Bajracharya
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Table of contents
Abstract and Key Words………………………………………………………...Page 3
Introduction………………………………………………………………………Page 4
Methodology………………………………………………………………………Page 10
Part I: Visible Women and Invisible Men: History of HPV and the Consequential
Implementation of Biomedical Technologies…………………………………...Page 15
Part II: Negotiating Complications of Student Care: Lewis and Clark Health Staff
and Continued Invisibility of Male Student Subjectivities…………………….Page 29
Part III: Making the Invisible Visible: HPV, HPV vaccination, and Dialogical
Processes of Becoming Subjects of HPV……………………………………..…Page 38
Conclusion………………………………………………………………………..Page 50
Appendix and Bibliography………………………………………………….…Page 54
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Abstract
The Human papillomavirus (HPV) as an emerging health issue, is continually
transforming. I mean this both historically, where knowledge and practice around HPV
has undergone dramatic changes throughout last ten years, and subjectively, as an illness
that largely requires the intervention of outside forces to make the individual aware of
themselves as a subject in relation to HPV. I argue that the individual’s ability to
encounter HPV is regulated by gendered technologies and discourses, which focus on the
female body while subsequently ignoring male bodies. By conducting a discourse review
and personal interviews with Lewis and Clark college health staff and students, I take a
“top-down” and “bottom-up” ethnographic approach to make visible the intersection of
institutionalized public health concerns and the individual’s subjective experience. I find
that while HPV is generally invisible to Lewis and Clark students, over the course of our
conversations, students began to see themselves as either at risk or possibility as a
contagious body of HPV. I utilize Jessica Polzer and Susan Knabe’s theory of neo-
medicalization (Polzer and Knabe, 2012) to understand the gendered and moral discourse
around HPV discourse and technology. I also focus on the making of individual’s
subjectivity in relationship of HPV through João Biehl’s approach of dialogical
ethnography (Biehl, 2005), and Judith Butler’s concept of interpellation (Stevenson,
2014). The goal of this research is to reveal the way in which HPV is a constructed
illness, displaying how its consequences are an unequal and gender based ability to
address personal sexual health.
Key words: Neomedicalization, Human Papillomavirus (HPV), gendered subjects,
subjectivity, Pap smear, HPV vaccine, and invisibility.
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Introduction:
Jay said that he didn’t really know that much about HPV, other than the fact that
it was very common - “It’s something like 70% of people have it right?” He also
knew that people could be carriers of HPV but not experience symptoms,
although some symptoms could be “bumps?” Whatever the specifics, Jay doesn’t
actively worry about HPV and can’t recall any of his friends expressing concern
about it either. He said that that he isn’t sure if that’s because he hasn’t known
anyone who feels like it’s a life threatening matter, or perhaps just that he just
feels like “it’s easily treatable or curable?” Either way HPV hasn’t really been on
his radar.
- Jay, Male student at LC
* * *
Anna said that in high school, when most of her friends were getting the HPV
vaccine, her mother had decided to forgo the vaccine for Anna. She explained that
her mother sort of “picked and chose” when it came to vaccines, although she
reported that “I think her main reason was that when it first came out, [my mom]
didn't think it had proven itself to be good enough to get shots for it.” However,
by college, Anna said that the Health Center convinced her to get the vaccine.
Although Anna does not feel that she knows very much about HPV, she knows
that it causes cancer and so the vaccine was to “help protect her against something
down the road”.
– Anna, Female student at LC
These sections of my field notes illustrate two perspectives of the same sexually
transmitted infection (STI). For Anna, the Human Papillomavirus (HPV) was a reason to
get a vaccine that would protect her from potentially serious health problems in the
future. Conversely, Jay views HPV as a ubiquitous STI but perhaps not a serious health
issue. The difference between these two perspectives illustrate a gendered experience of
the knowledge and practices surrounding HPV. For example, when Anna recalls her
friends getting the HPV vaccine in high school (which would roughly have been between
2006 and 2008). However, Jay would not have been eligible to receive the vaccine until
2009, three years after the vaccine had been introduced as a solution for woman. This and
other gendered developments in HPV technology and discourse, left lasting impressions
that HPV affected some (women) but not others (men). In reality, men and women have
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equal susceptibility to HPV and it remains the most transmitted STI. However,
differences in the manifestation of the virus and neoliberal approaches to medicalized
male and female bodies have historically framed HPV as connected to cervical caner, and
therefore a “female problem”. Although medical practices around HPV have come to
recognize that males and females are both at risk of HPV and its consequences, gendered
perceptions and results persist.
HPV becomes a gendered illness through the means by which people have to
encounter or experience themselves in relation to HPV. As primarily asymptomatic, an
individual’s ability to encounter HPV occurs primarily through biomedical technologies
of prevention and diagnosis. These technologies, such as the Pap smear and HPV
vaccine, have been created and implemented in neo-liberal health contexts that focus on
individual risk and responsibility. While this responsibility, both to self and to the public,
which is fixated on female bodies, I argue that encounters with HPV create a particular
type of female subject. This type of female subject is one that has a moral responsibility
to adopt tools of monitoring and prevention, especially as a body that is not only at risk of
contracting HPV, but also a possible site of contagion. Female morality in this instance is
motivated by the implications of her personal decisions, such as whether or not to
vaccinate against HPV, and how they contribute to the containment of HPV as a public
health concern. However, while female bodies are made hyper visible in HPV discourse
and medical practices, male bodies are conversely made invisible. Not only do HPV’s
technologies and discourse have gendered consequences of invisibility, but they also
exclude differing sexual orientations, socio-economic classes, and gender identities.
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Female bodies have long been the focus of medical dispute. Medical intervention
throughout the development of a woman’s body has become standard, beginning with the
onset of the menstrual cycle and ending with menopause (Bell and Figert 2010: 107-109).
Among these medicalized life stages, other typical life experiences such as sexuality have
been subject to pathology. Developments in feminist scholarship have been critical of
how “…women’s bodies [have been] pathologized by reductionist, biomedical
approaches to health and constructed as objects that require medical monitoring, self-
surveillance, treatment, or improvement through pharmaceutical, surgical, and
technological intervention” (Polzer and Knabe, 2012: 346).
On the subject of monitoring and treating STIs, HPV has been specifically framed
in relation to female bodies, especially upon the onset of her sexuality. Considering the
causal link between HPV and cervical cancer, prevention and containment of HPV
represents the larger dream of cancer containment (Casper and Carpenter, 2008:887).
Women’s relationship to HPV is therefore private and public, both a matter of personal
sexual health but also maintained and monitored by public standards. As a result, women
are dually framed as ‘at risk’ or potentially ‘contagious’, predisposing them as subject in
relation to HPV.
While HPV itself is primarily asymptomatic, a person’s experience of HPV
occurs when they come into contact with a person, technology, or some type of education
or knowledge. Those moments of contact with the concept of HPV allows the individual
to realize themselves as subjects in relation to it. Anthropologist Margret Lock argues
that technology and discourse are both social categories and are therefore deeply rooted
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in the social making of a particular subject (Lock. 2004: 86)1
. Screening technologies,
technologies of prevention, and public discourse all instruct the female subject how she
should behave in relation to HPV. She is not just a subject who needs to monitor herself
through the use of a Pap smears, but also join efforts to prevent the spread of HPV
through pharmaceutical solutions, namely the HPV vaccine. Although there is not a
unanimous approach to women and their relationship to HPV, the result remains that
female “bodies are simultaneously ‘objects and effects of technoscientific and biomedical
discourse’ (Mamo and Fosket, 2009:92). That is to say, the forms in which subjects
encounter HPV also derive from specific regimes of discourse that orient women in a
gendered public health concern.
Although HPV is the most transmitted STI, which has the potential to cause
several different types of cancer for men and women, its emergence as a public health
concern was also due to the public uproar around gender specific controversies of the
HPV vaccine. The HPV vaccine also represents “a specific type of pharmaceutical, not
geared toward therapy per se, but rather towards containment” (Bashford and Hooker
2001). While medical institutions viewed the HPV vaccine as cancer containment, some
religious organizations and conservative groups were vehemently opposed to its
presumed potential to condone promiscuity (Casper and Carpenter. 2008: 887). Other
controversial discussions were skeptical of the long-term effects of a new vaccine. These
factions were critical of profit driven pharmaceutical companies, especially when they
came into contact with the U.S. government’s vaccine regulations. In the first chapter of
1 A ‘subject’ is a socially defined position, such as students or father, which
inaugurates an individual with particular traits and behaviors that define that
particular type of subject. The subject position is ascribed to and maintained by that
individual.
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this essay I will expand how public discourse came to affect the framing and
implementation of the HPV vaccine, which excluded particular gendered and classed
subjects.
In Part I of my thesis I demonstrate how HPV, as a largely an asymptomatic virus,
is primarily encountered through biomedical technologies that are used to prevent,
diagnose, and monitor HPV. With supporting anthropological and sociological literature,
by authors such as Steven Esptein, Monica Casper, Laura Carpenter, Jessica Polzer, and
Susan Knabe, I argue that those biomedical technologies create gender specific
experiences of HPV. These technologies, and the discourse the surround them, fixate on
the female body as both a site of risk and possible contagion. I use the theory of
biomedicalization to understand a particular type of female subject, specifically one that
can improve herself by adopting biomedical technologies that allow her define her
relationship to HPV. I find Polzer and Knabe’s use of neomedicalization (Polzer and
Knabe 2012), a term that derives from the concepts of neoliberalism and medicalization,
to critically examine HPV discourse and practice. Neomedicalization points to the
emphasis of personal responsibility, and direct-to-consumer marketing that encourage the
individual to adopt various biomedical technologies as solutions to health issues.
Ultimately, the result was that female bodies were framed as both having a relationship
with HPV, while also having a responsibility to contain a larger health issue.
My second section addresses my ethnographic material gathered from Lewis and
Clark College’s health services, examine how the previously discussed medical discourse
and processes of medicalization are implemented on an in institutionalized. Through
personal interviews and utilization of survey data on Lewis and Clark students, I aim to
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display the negotiation of institutionalized care and student subjectivities of health,
especially in regards to HPV. I find that LC health staff utilizes indirect mode of
communication that fail to recognize the complexities of HPV as a gender specific
experience, and therefore perpetuate the invisible male body in relation to HPV.
Lastly, my third part of my thesis focuses on my conversations with LC students,
and how their subjective orientations to HPV are formed through interactions with
outside forces such as doctors, advertisements, and me the researcher. My approach is
inspired by Biehl’s concept of a dialogical ethnography, where he embraces the
intersection of researcher and subject, recognizing how the researcher is an intimate part
of the results of their research (Biehl, 2005: 19-20). Complimentary to Biehl’s approach,
I use Judith Butler’s theory of interpellation, which views the subject as a socially
defined category that is placed upon and adopted by an individual through naming them
as such(Stevenson, 2014: 159-167). Throughout this section I bring forth the different
ways in which HPV has been gendered, and almost entirely invisible, until my
interactions and conversations with LC students interpellate them as subjects of HPV.
Important themes include invisibility, temporality, vaccination and morality, and the
dialogical process of becoming subjects of HPV.
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Methodology
My original desire to study this subject was personal. I was my subject, sitting in
the examination table with a thin sheet of paper covering my naked lower body. I have
always monitored my sexual health through technologies such as Pap-smears and STI
tests, but the discussion that ensued made my heart drop. What did an abnormal pap
mean? Throat tight I asked several questions, but still left the office shocked and
confused. Although an abnormal pap did not necessarily mean that I had HPV, it
indicated the possibility. I was told that there was nothing to do but return in six months
and monitor the cells of my cervix. When I shared this experience with my female friends
they were supportive and asked questions that I did not know how to answer. None of us
understood what my doctor had said about the fact that almost everyone has some type of
HPV?
Investigating my own history of partners that I knew had been tested for STIs, I
learned that men couldn’t even be tested for HPV. How did I never realize that women
were the only one with test results for HPV? My female friends echoed similar concerns,
and so I felt compelled to pursue the topic. I had thought of myself as knowledgeable on
this subject, but the more I learned the more I realized there was seemingly important
information that had been made invisible to me.
In the beginning of my research I was unsure about how to contact patients with a
connection to HPV, and I began by interviewing any doctor or nurse who was willing to
speak with me. These health practitioners supported my findings on HPV as a gendered
illness, and agreed that it would be interesting to investigate what people knew about
HPV and how they made decisions about HPV vaccination. As it turns out, so did several
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other social scientists. Sifting through journals, I found articles and studies that addressed
how women and daughters made decisions to vaccinate, and what scenarios yielded
higher or lower rates of vaccination (Getrich et al. 2014). I also found several articles that
critiqued the gendered and heteronormative discourse around HPV, and how they framed
HPV as a female issue. Anthropologists had been examining the progression of HPV
through theoretical lenses such as medicalization, biomedicalizaion, and neo-liberalism.
While I was excited to see this topic engaged by anthropologists and sociologists, I did
not have the time, resources, or qualifications to access populations with explicit
connections to HPV. However, I did not find that this hindered my research, but rather
focused it in an important direction.
Without realizing it, I had already started to do my research through passing
conversations where I explained my thesis topic to my peers at Lewis and Clark College.
I chose the LC population as my ethnographic subjects for several reasons, but primarily
because of my ability to access them. As an LC student myself, I was almost always
surrounded by LC students, and had already established relationships that allowed for
more robust interviews that I could not ethically peruse from populations in public health
centers. This is not to say that I was carefree among friends. Rather, I felt the need to be
vigilant about my assurances of anonymity and care because ultimately I was stull
speaking with a vulnerable population with whom I could not abuse the level of trust
afforded to me. Some of these conversations may be meant for a friend and not a
researcher. Therefore, every time I asked for permission to use any conversation in my
research I assured the same level of anonymity as my other interviewing modes. I
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constantly reflected on my role during these interactions, and recognized how I am
present in the results of my findings.
The majority of Lewis and Clark College students are currently between the ages
of 18 and 23 years old. Ten years ago, when the first HPV vaccine was approved by the
FDA for women between the ages of 9 and 26 years old2
, our age group was among the
first generation that were prime candidates for the HPV vaccine. Around this time,
Gardasil advertisement and HPV awareness efforts were initially directed toward women.
As the population that has lived throughout these transformative years, I was able to see
how Merck Pharmaceutical’s approach to advertising and how HPV’s political/social
response left an impression on how students relate to HPV. Although I sought the
viewpoints of male and female LC students, I strived to recognize when male subjectivity
is made invisible and seek out male perspectives that have not typically been represented
in HPV research. Although I had several conversations with male and female students
throughout the research process, the interviews I drew from for this research came from
five male students, and five female students. I also spoke with four members of LC’s
health staff, three from Students’ Health Services and one from Health Promotion and
Awareness. Because this topic discusses matters of personal health, I elected to use
pseudonyms and other forms of indirect identification. Almost all of the students and
staff I spoke with were white, and although I did not enquire about their personal socio-
economic status, I recognized them as attending an institution that provides health
services to all students.
2 U.S. Food and Drug Administration (FDA)
June 17, 2015 Gardasil (Human Papillomavirus Vaccine) Questions and Answers -
Gardasil, June 8, 2006.
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My methodologies of research were a discourse review and personal interviews.
Although I had considered implementing a survey, to access a wider breadth of student
voice, I decided that this method was not appropriate or necessary. Validity issues of a
survey could have included a non-representative sample and an inability to follow up.
However, LC does implement its own biannual survey by the Health Promotion and
Awareness. The survey is provided to by the American College Health Association
(ACHA), to gather student health information on a local and national level. As a student
at LC, I was given access to some of the results of these surveys that addressed HPV and
student health practices, which I used to help situate my ethnographic findings.
Addressing my conceptual frameworks, I balance a “top-down” and “bottom-up”
approach. Contemporary anthropology has begun to criticize high theory as a “top-down”
approach that fails to recognize the complexities of subjective experience and an
individual’s agency. However, that is not to say that a theory such as medicalization is
not useful within my research context. I use high theory such as neo-medicalization,
which I will explain further in my first section, to understand the institutionalized and
discursive aspects of my research. However, while engaging with the content of my
personal interviews with LC students and health staff, I applied a “bottom-up” approach.
By “bottom-up” I am referring to ethnographic approaches that prioritize subjective
experience, and ideally allow subjects to expose the complexities that may to substantiate
or deny high theory (Biehl and Moran-Thomas 2009).
My research process begot one of my main ethnographic approaches: dialogical
ethnography. João Biehl, a medical anthropologist from Brazil, discusses this approach in
his ethnography Vita. Vita was an institution for mentally ill and abandoned persons, and
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his research there lead him to work closely with a patient named Caterina. Through the
research process, Biehl found that the effect of his presence was that he and Caterina
were working together to “…disentangle the facts of her existence” (Biehl, 2005: 18). By
paying close attention to Caternina’s subjective experience as a mentally ill patient in
Vita, Biehl also strove to bring forward “…the affective impact and political significance
of representations of mental illness and subjectivity…”(Biehl, 2005: 18). For my
research purposes I took a dialogical approach, where I recognized my interaction as a
researcher as integral to how the LC students came to understand themselves in relation
to HPV. Similar to Biehl, I also discuss the affect of discourse and its representation of
HPV and how it has formed particular gendered HPV subjectivities.
It is important to address my use of gendered language and its assumptions of a
heteronormative and cis-gender base. Although there are some instances in which I
address how non-heteronormative bodies are made invisible by tools of HPV prevention
and diagnosis, it is for this reason that I have not found sufficient material to address
these issues. The focus of this essay is not the uncharted territories of HPV discourse, but
rather how the last ten years of HPV knowledge and technologies have created particular
subjects of HPV that are either visible or invisible. Because aspects of the biological and
social body are relevant in creating a gendered subject of HPV, I will use terms such as
female in conjunction with cis-women, and male in conjunction with cis-men. Although
my compliance with these gender-normative and heteronormative terms does not write
against binaries, that in themselves contribute to issues of invisibility, I will address the
consequences of these binaries in my conclusion.
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Part II: Negotiating Complications of Student Care: Lewis and Clark Health Staff
and Continued Invisibility of Male Student Subjectivities
Throughout this section I discuss three main topics: how the LC health staff views
their role in the Lewis and Clark community, how LC health staff access student voice,
and how they navigate the incorporation of systems of medicalization while making of
institutions of care. I will address the health center’s construction of HPV/HPV
vaccination and how they perceive students’ awareness on those topics through indirect
modes of communication. I argue that despite LC health staff’s efforts to reach students,
the modes of communication on the subject of student health continue to make male’s
relationship to HPV invisible. This is not a fault of LC health staff’s competence, but
rather a consequence of the tools built on standard principles of medicalization. Although
I did not speak with every member of the LC student health staff, the staff members I
spoke with expressed that ‘their primary goal was to be an accessible resource for
students and provide support and knowledge so that students feel in control of their
personal health’.
* * *
“I just want people to be in control of their health, and not have their
health control them.”
(Health Practitioner No. 2 personal interview. Jan. 27, 2016)
“We help students transition and prepare to be out in the world.”
(Osmond personal interview. Feb. 15, 2016)
“…[T]hats how I see my role here, not that everyone has to stop by the
health care center before they go off campus, I just think however we can
help support students….[in] taking care of themselves in the ways that
best serve them, whatever they might be.”
(Health Practitioner No. 1 personal interview. Feb. 3, 2016)
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LC health staff8
wants to provide help and support that meets the students as
individuals who are on “…their journey of identification for who they are” (Health
Practitioner No. 1 personal interview. Feb. 3, 2016). The quotes above illustrate how LC
health staff see their role at Lewis and Clark as transitional resources for young adults to
learn about their personal health and how to take control. LC health practitioners also
recognize that college is a unique setting where health is complicated by academic
demands, and that “sickness can make it difficult to attend class and complete
assignments” (Health Practitioner No. 1 personal interview. Feb. 3, 2016.). Their goal is
similarly stated on the Lewis and Clark Student Health Services web page where it states:
As part of the Division of Student Life, staff in the Student Health Services share
in the Student Life mission: To empower students to learn, lead, and engage the
traditions of the liberal arts in the 21st century. As holistic educators, we partner
with students through their development in academic & experiential learning,
civic leadership & career development, diversity & inclusion, and wellness. We
create an enduring community of belonging in which all students can take pride
and realize their potential.
As a part of the holistic educators, Student Health Services doubly aligns itself
with LC’s mission as a part of an institution and also a partner with students through
their development. While this sentiment seems to be genuine among the LC health staff,
this mission statement illustrates a line that they navigate between institutionalized goals
and students’ subjectivities. That is not to say that these two factions are in opposition,
and in fact LC health staff does what they can to make them congruent, but
institutionalized health goals and student health subjectivities are formed in different
ways. While the LC health staff is attentive to LC students, students’ health goals derive
8 When referring to both generalized staff of the Student Health Services (SHS) and
Health Promotion and Awareness (HPA) I use the term LC Health Staff
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from a more varied background. Therefore, the challenge to LC health staff is to balance
LC as a part of the regime of medicalization and service a population with complex
health subjectivities.
The LC health staff’s navigation between institutionalized care and student
subjectivities reflect the ways in which Biehl has discussed the challenges of negotiating
medicalization in the making of institutions of care (Biehl 2005). The implementation of
medical discourse is not as straight forward as simply turning knowledge into practice.
Physicians take into account their patients’ subjective experience of their own health,
which do not always align with medical practices. In the instance of sexual health, this
negotiation is particularly difficult, where tools of medicalization can “ignore
complexities of gender” (Bell and Figert. 2010).
Lewis and Clark College, ACHA, OCHA: Acronyms that inform and medicalize
Lewis and Clark Health Services
LC health staff certainly reaches out to the student body and makes health
information readily available to students, but do students reach back? According to
members of the LC health staff, not really. Students reach out when they need help with a
specific health problem, but the majority is not engaging in an open discussion about how
to cultivate student health. This is not to say that LC students are not conscious or active
about their health and the health of their community. Rather, that what LC’s health staff
learns about the student’s personal health knowledge and practices, is accessed through
indirect modes of communication.
Lewis and Clark College belongs to two organizations that provide a pool of
resources that are specifically focused on the health needs of college students. These
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organizations are the American College Health Association (ACHA) and the Oregon
College Health Association (OCHA). ACHA hosts annual conferences that at least two of
LC’s health staff attend to share and learn about current student health concerns and
practices from over 800 Colleges and Universities across the United States.
[ACHA] is a sort of umbrella organization for colleges and universities across the
United States, you have to become a member, and they have a huge conference
every year to talk about everything from A-Z… it’s really a big wonderful
conference that one or two of our members always go to…[ACHA] brings
together things like that, so that health center, counseling centers, and health
promotion and education. A body of knowledge that is specific to this population,
cause it’s hard to get otherwise. (Health Practitioner No. 2. personal interview.
January 27, 2016)
Where information about student health is otherwise “hard to get,” ACHA is a
useful resource where physicians can compare notes and learn about current health issues
and treatments of this specific population. It is through these conferences that LC health
staff is able to engage with the dominant medical discourse and the complications of
implementing care on student populations. The conferences for OCHA, whose fall
conference of 2015 was hosted on LC’s campus, are held twice a year for colleges and
universities in Oregon. LC health practitioners view the ACHA and OCHA as valuable
resources. While LC health is not regulated by the ACHA or OCHA, they are a major
source of information and inspiration to LC health staff:
Sitting side by side with other people who are passionate about medicine is very
inspiring. And many times it motivates me - maybe it’s a matter of learning more,
maybe its sharing with other people…just networking…many times I learn a great
deal, but other times I’m reassured that what I’m doing is best practice. (Health
Practitioner No. 2. personal interview. Jan. 27, 2016)
Learning how other health centers negotiate the position between institutionalized
health and complexities of a student population, LC health staff relies on their colleagues
for conformation or denial of what is currently “best practice.” Members of student health
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centers across the nation pool their knowledge to assess the current state of healthy and
non-healthy students. For example, recently the ACHA has been focusing on abusive
relationships. To understand this issue, they are conducting an incentive based survey, as
well as promoting pamphlets and online articles that display models of abusive unhealthy
relationships vs. non-abusive healthy relationships.
Although LC health staff is also concerned with topics such as HPV and other
STIs, the main focus of ACHA and OCHA are on health issues that they perceive to be
most prevalent among college/university students. Prevalence of health issues based on
surveys, which represent a tool of medicalization that is used to monitor the overall
health of a population, do not detect HPV as an issue in need of immediate attention. For
reasons that I will discuss in the following subsection, negotiating where the effort of the
health staff is directed, mediated by resources such as OCHA and ACHA, cannot always
recognize the complex aspects of HPV that might bring it to the forefront of college
health issues. I am not insinuating that HPV should be a main concern for OCHA,
ACHA, and subsequently the LC health staff, but that their allocation of care on a student
population is negotiated by modes that might not be able to detect the prevalence of HPV.
It is important to note that LC health staff are aware of HPV and are available to meet
students requests of information or medical assistance regarding HPV or the HPV
vaccine. However, the evidence discussed in this subsection demonstrate how they create
an institutional foundation where addressing student health is limited in its ability to
bring forward HPV as a priority in relation with the student’s body, let alone recognize
the complexities of gendered subjectivities of HPV.
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Reaching Out to Anonymous Students With Care: Lewis and Clark College health
Services and Indirect Student Voice
Lewis and Clark students have access to the Student Health Services in lower
Templeton, and Health and Wellness offices in lower Odell. LC health staff also reach
out to students with information about health concerns that are specific to the Lewis and
Clark population. These modes of outreach start at the beginning of the LC student’s
experience through New Student Orientation (NSO) where all the different health
services (physical health, mental health, etc.) are made known to students. The second
most prevalent form of outreach is the Student Health 101 magazine that is distributed via
a monthly email. LC also provides literature about health concerns in the form of
pamphlets, which are freely available to students in both health offices. All of these
modes of outreach aim to provide students with helpful information, especially tailored to
reach and speak proactively to student needs.
Lewis and Clark health practitioners and health outreach come into direct contact
with students only on specific occasions. They see students either as their patients or
while guest speaking for student led organizations that request their presence. Therefore,
LC’s access to a more representative source of LC student voice is through a biannual
survey issued by Health Promotion and Wellness offices. This survey is a part of a
nationwide pull by ACHA. The results of the survey help LC health staff make decisions
on what population and issues of student focus. For example, the current primary
concerns of LC Health Promotion and Wellness is addressing substance and sexual
abuse. Although, as Melissa Osmond said, she and the rest of Health Promotion and
Wellness would love to focus on other issues as well, such as positive sexual education,
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but the survey guides their efforts where time and resources are needed most (Personal
interview, Osmond; Feb. 15, 2016).
While LC Student Health Services is a medical institution of modernity, and
therefore uses tools of medicalization – such as monitoring its population through surveys
– the desired action of the institution is not “top down” as medicalization is typically
framed (Bell and Figert, pp.107: 2010). Instead, LC health practitioners want to hear
from students to accommodate their needs and desires in whatever treatment path best
suits them. This process of creating an institution that cares for its students on their own
terms, while still maintaining medical integrity, is a constant re-negotiation for the LC
health staff. Continually attending conferences to discuss the specifics of student health
and reaching out to students, even through limited modes of non-direct communication,
display the specific ways in which LC health staff makes decisions of medical
intervention and care.
Lewis and Clark College and HPV: continued invisibility
The LC Student Health Services and Health Promotion and Wellness services
have a positive opinion of LC students’ health awareness. They believe that LC students
are well educated and conscious about their health and the health of others. When I asked
a health practitioner about the national tendency for men to less HPV vaccinated than
women, they responded “I cant speak for all men, but we have men who come in here
very responsible and very concerned. They want their HPV vaccine”(Health Practitioner
No. 1; pp.2; Feb. 3, 2016). Although this health practitioner’s opinion about LC male
students is that they ‘want their HPV vaccine’, statistics from the 2014 ACHA survey
36. 36
still reflect that more LC female students are getting vaccinated than male or other gender
identifying students at LC.
HPV-related data from the National College Health Assessment (ACHA-
NCHA II)
2014 data
62.8% of students reported receiving vaccination against Human
Papillomavirus/HPV (cervical cancer vaccine).
1% reported being diagnosed with genital warts/HPV in the last year.
Frequency data: Have you received the following vaccinations: Human
Papillomavirus/HPV (cervical cancer vaccine)?
Male Female Unknown* Total
No 37 % 23% 17% 26.1%
Yes 38% 71% 67% 62.8%
Unsure 25% 7% 17% 11.1%
Citation: American College Health Association. American College Health
Association-National College Health Assessment II: Lewis and Clark College
Undergraduate Executive Summary Spring 2014. Hanover, MD: American
College Health Association; 2014.
* Unknown are students who responded to the survey and indicated that they
identify as a gender other than male or female.
This data does not necessarily invalidate the practitioner’s claim that the male
students are concerned with getting their HPV vaccine, but it challenges the simplicity of
her assumption. Although some might highlight a need to educate men about HPV
vaccination, these statistics do not prompt LC staff to promote HPV vaccination or
change their approach to HPV education. Not only does the LC health staff want to create
an environment that accepts all students - for and against HPV vacation - but the last time
the ACHA-NCHA survey enquired about where students access health information in
2008, the majority of students reported that they turn to ‘their parents or the internet,’
37. 37
even though they believed that the health center could provide more factually correct
information. Although this was several years ago, Osmond from Promotion of Health and
Wellness feels that 7 years later these findings remain true for LC students (Osmond.
Feb. 15, 2016).
Despite the LC health staff’s attention to individual students, their modes of
communicating are still dictated by the tenants of medicalization. In the end, LC’s
institutionalized action still relies on statistically significant issues to warrant LC health
staff intervention. Besides just vaccination, HPV is particularly challenging to monitor
through surveys because of student’s ability to experience HPV. Firstly, there is no
standard approved test for men, so indicating whether or not they are HPV positive
cannot be determined unless they have one of the few types of HPV that manifest in
warts. Therefore, male students could be carriers of the other 36 or so strains of HPV and
not even know it. Also, because HPV is often asymptomatic, women who have not
received a pap test could be unaware that they are HPV positive. The technologies that
students can access to create a subjective experience of HPV to report on – both the HPV
vaccine and the Pap test – pre-determine the type of data LC can access. Although I
cannot definitely say that because the technologies that inform LC students, and
subsequently inform LC health staff, have rendered the data as somewhat false, I can
point out that the medicalized system used to monitor and make decisions about LC
student health does not recognize the complexities of gendered subjects that are produced
by gendered technologies. Once again, tools of medicalization and biomedical
technologies not only create indirect contact with LC students, but systematically make
female students more visible than male students.
38. 38
Part III: Making the Invisible Visible: Temporal HPV, HPV vaccination, and
Dialogical Processes of Becoming Subjects of HPV
The topic of my thesis came up, as it often does, and I told them that I was
studying the Human Papilloma Virus, and was met with blank stares. I mentioned
that it is often just called HPV, which they did recognize. I explained that there
were over a hundred types of HPV, which could manifest in normal warts on the
hands and feet, but that 40 of those were sexually transmitted. At this point one of
the girls said, “oh yeah, my aunt experienced some kind of HPV that men can
carry but it only effects women?” I asked what the effects were, to which she
responded “some type of cancer?” I replied that is was probably cervical cancer,
which she agreed with.
(Female student, informal interview. March 4, 2016)
Along my research journey, I began to realize that many of my conversations with
LC students about HPV followed this kind of pattern. Casual conversations turned into
informal interviews where we would go back and forth, equally discussing experiences
and asking each other questions. Still, there was a general sense of ambiguity among the
students I spoke with, and while some knew more than others, no one actively thought
about HPV in their day-to-day lives.
In the first part of this section, I explore qualities of ambiguity and temporality,
and the subsequent invisibleness of HPV to LC students. Secondly, I will illustrate how
HPV vaccination came up as a morally loaded topic with students. Lastly, I explore the
dialogical process in which these conversations occurred, and how my role became a part
of my findings. The individuals that I spoke with, both men and women, where not
selected with a specific demographic criteria in mind, although I was generally interested
in speaking with LC students. Likewise, my interviews were not prearranged, but rather
spontaneously arose. Throughout these interviews the students I spoke with reflected
larger anthropological themes of HPV discourse (which were addressed in Part I of this
thesis), but I want to suspend the desire to explicitly place their experiences in relation to
39. 39
my use of theories such as medicalization. Rather, I want to approach these students as
having complex subjectivities that speak for themselves. However, I still utilize Biehl and
Butler’s approaches to subjectivity and illness that prioritizes the individuality of subjects
and their complexities. Through the excerpts and my observations from interactions with
students, strive to show how the dialogical process caused LC students to be interpellated
as subjects of HPV.
Lewis and Clark students perceive HPV as an issue of the past or future: Visibility,
invisibility and temporality of HPV
The LC students that I spoke with also expressed a temporal encounter with HPV.
It was a thing of the past (highs school sexual education or HPV vaccination), or a thing
of the future (looming possibility of cancer or successfully avoiding cancer because
vaccination). However, in the present, none of the students expressed that HPV was an
illness they thought of or experienced. One of the students pointed out that this was
ironic, given that our age group is the most statistically likely to contract HPV. Despite
this irony, HPV was invisible to students in their present lives. During the beginning of a
conversation with a male student about his lack of knowledge around HPV, he expressed
that he didn’t know how to compartmentalize or relate to HPV from his present
viewpoint:
I mean I don’t know if that’s maybe in the nature of the virus itself, that it’s
asymptomatic and doesn’t look like you’re “sick”, it’s one of those inside-outside
dialectics. But yeah… I don’t know I don’t know if it’s something I should be
worried about now, something that I should have been worrying about years ago,
if it’s going to be something that could be potentially eating my organs? [We both
laugh] I literally don’t know, I guess there’s just a lack of knowledge about the
way I should be relating to HPV in my own wellbeing.
(Male student, personal interview, Feb. 26, 2016)
40. 40
The temporality of HPV is deeply connected to its qualities of visibility and
invisibility. As this student points out, HPV as largely asymptomatic. HPV can fly under
the radar of a person’s bodily awareness. This is especially relevant to his time in life, as
well as the other LC students, because of where it places us in the HPV timeline. Students
could only relate to HPV in a non-personal way, not associating it with any particular
symptom or physical feeling. The only bodily association was that of femaleness, and
even then female students did not currently relate to or think about HPV. Although
students expressed gender specific associations to HPV, everything else about HPV was
ambiguous. While female students made connections between HPV and cervical cancer,
male students were largely unclear on the potential long-term consequences of HPV. In
the following dialogic interview, the male student I was speaking with described his lack
of knowledge on the subject of HPV as confusing, especially on how to situate HPV
among the ranks of other STIs.
Male student: When I think about STIs I think of the wellbeing of this other
individual (his female partner), whether it’s dangerous … yeah, and whether um
[another pause] if there are a lot of consequences, or not consequences per se, but
rather the symptoms. And think about what it does down the road, what it would
mean. Cause I guess that I compartmentalize STIs as either symptomatic or life
threatening or its nothing. And because I don’t know where to place it [HPV] into
that sort of categorization of ‘DEATH’ or ‘symptoms I can treat’ … it’s hard for
me to know how to think about it [pauses again] where to put it in the binary.
Me: You mentioned of thinking of your partner, do you think of it as affecting
you?
Male student: So well, it is something that I have compartmentalized as
something that effects women, so it’s something that I don’t really, or I haven’t
really, thought about it in that sense.
Not only did this male student not know how to situate HPV among other STIs,
he couldn’t even think about it in relationship to himself as a male body. Later on in our
41. 41
conversation, while considering why his education had led to make gendered associations
with HPV, this student talked about the consequences of what he called hyper visibility:
One thing visible makes another invisible. I literally can’t think of about HPV
except through this mindset of a female body, you know? It’s a hyper visible
thing, it’s not even acknowledged that it can affect male bodies, it’s not
something that I would consider part of a health conscious male’s radar. And
that’s problematic. I mean you can tell your partners, but if they won’t have any
reaction then that puts my life at risk, you know? If it’s attached to cervical cancer
in women then it probably caused some kind of cancer for men. And not knowing
that I am at risk for cancer in this other way is [pauses as if to find the words] I
don’t think that ignorance is bliss.
(Male student, personal interview, Feb. 26, 2016)
Proceeding to our conversation, this student claimed that he knew very little about
HPV. He had learned some facts about the virus, in the past during high school, from his
exposure to the televised Gardasil commercials. However, other than that no one had
approached him about HPV or getting vaccinated. This student considered himself
conscious of his health and the health of his sexual partners and so he felt that it was
problematic that he had been allowed to remain ignorant of his role in HPV. During the
course of this conversation, this male student transitioned from not having a relationship
to HPV to realizing the invisibility of his own male body. Interpellated by our
conversation, he now perceived himself as a subject with a relationship to HPV. The
other students, male and female, echoed the same mindset of HPV being explicitly
connected to female bodies. For some of the male students, HPV was made so invisible
to them that they weren’t aware of any specifics beyond the fact that HPV was indeed an
STI.
42. 42
Morality, public health, and HPV vaccination
I feel like it’s a stance that people take, to not believe in government
recommendations. Before it was just like, ‘my friends are all getting it but I’m
not’, and now I understand that it’s more of a stance to take.
(Female student, personal interview. March 4th
, 2016)
In Margret Lock’s piece on biomedical technologies, she points out that the
introduction of biomedical technologies that are entrenched in moral values can be
rejected or severely limited (Lock. 2004, v. 1: pp. 86-87). Although the HPV vaccine has
been adopted by western medicine, students still felt the tension and implications of
morality that surround the decision of whether or not to vaccinate. For the students who
were aware of the HPV vaccine, often their first reaction to the subject of HPV was to
inform me of their vaccination status. Those who had been vaccinated were almost eager
to tell me so, and those who decidedly rejected vaccination were prepared to provide an
explanation. For those who weren’t aware of the vaccine, phrases of obligation about
what they should do to be responsible appeared in their vocabulary following our
conversation. No matter their stance on vaccination, student’s notion of what made you a
sexually responsible adult were a combination of morality and knowledge. Along with
this was a tension between the self and the whole. The decision to vaccinate was
personal, and students expressed that each person had the right to that personal decision
as long as it was sufficiently informed. However, it is simultaneously a moral decision
because there was a sense that an individual’s sexuality could contribute to the spread of
illness.
Those students who piped up “I’ve been vaccinated!” didn’t defend their decision.
Although I did not explicitly interrogate their motivations, their attitudes toward my
questions implied an assumption that they were informed or had made a good decision.
43. 43
These individuals did not need to explain themselves because their decision allied them
with the dominant discourse in western health. They had followed ‘best practice’ of
modern health institutions, and so hard science made the argument they didn’t have to.
While some students knew that the vaccine could protect them from cervical cancer,
many vaccinated students did not actually know the specifics of what they were being
vaccinated against. Overall, the male students were less aware of the HPV vaccine, either
unable to recall if they had received it, or were still under the impression that they had
been vaccinated exclusively for the benefit of female sexual partners.
The students I spoke with who had decided not to vaccinate were likewise aware
of the dominant discourse on vaccination, conscious of how it targeted and situated them.
One female student summed up her experience with the dominant discourse of pro-
vaccination:
I’ve learned some about herd immunity in my bio class last year, and the moral of
the story is that you should be vaccinated to help protect others in your
community. The professor wasn’t pushing anything on us, but we had to do some
online research and everything I saw was like, “you really should be vaccinated
cause it protects the entire community”, which I think put that responsibility on
the individual. So, the more people that are vaccinated, it is less likely people in
the community are going to get sick.
(Female student, personal interview. March 4th
, 2016)
She was aware that the lesson she was supposed to learn from this research was
that she “should be vaccinated” for the “entire community”. And although the “the
professor wasn’t pushing anything on” them, within the setting of an academic institution
the decision to vaccinate was framed as a logical solution. While the use of the phrase,
“the moral of the story” is often used figuratively; her sense of the situation was tinged
with actual moral obligation. Conceptualizing the decision to vaccinate as related to
44. 44
knowledge and morality falls nicely into the neoliberal agenda of public health. Although
the decision to vaccinate was personal, the moral implications of that decision were
inseparable from the public. This female student felt the pressure from dominant
discourse, but she also disagrees with the vaccine itself. Later in the conversation she
mentions that she feels like it is difficult to reject something that could prevent her from
one day developing cancer. It was not that she viewed herself as a body that was not at
risk, she just did not trust the proposed solution.
The decision not to vaccinate among students did not come from a place of
ignorance, but rather from a place of remembrance. What was considered best practice in
regard to HPV within the last 10 years has not been without negative effects on women.
Only five years ago, aggressive and invasive ways of treating HPV in women were found
to be harmful and often unnecessary. Consequences allegedly linked to vaccination have
also been a topic of much debate and upset in western medicine. While some feel that the
medical trials were enough to prove the HPV vaccine’s utility and safety, others remained
skeptical of the long-term effects of such a new vaccination (Wailoo et al. 2010: xiv-xv).
Dialogical Discoveries of HPV Selves
The following excerpts of an interview where the process through which a female
LC student came to see herself as a gendered subject of HPV during the course of our
conversation. There are several parts of this conversation that I want to highlight in an
effort to make my points clear. However, the conversation with this student, whom I have
given the pseudonym Danielle, is a continuous section from a longer interview.
Me: What do you think or know about HPV in general?
45. 45
Danielle: Pretty much nothing, just what the commercials said. Like cervical
cancer. Definitely I remember it being marketed towards women, for sure. I
remember there being some stats about the amount of women that get cervical
cancer, but that’s pretty much all I remember about it. It’s not a sexually
transmitted disease, but I think you can be pass it on that way, but that’s not
like…that not like what it is, right?
At the beginning of this dialog Danielle demonstrates a fairly common level of awareness
of HPV. The virus was ‘pretty much’ unknown to Danielle, except for her recollection of
Merck’s One Less ad campaign. These ads had left her with a gendered impression of the
virus. Otherwise HPV was invisible, not even recognizable as explicitly being an STI.
Me: Well, it’s kind of a weird thing because there are over 100 types of HPV, but
only 40 that are genitally passed. And it’s actually the most transmitted STI. They
say, statistically, that you will get it in your lifetime.
Danielle: [in a tone of surprise] But it’s not always as bad as –
Me: [interrupting her sentence] No, cause there are several different types, right?
But if you know, like when I was a kid, if you’ve ever had warts on your hands as
a kid or something like that, that’s HPV.
Danielle: Oh really? Yeah I had warts on my feet as a kid a couple times, that’s
really interesting.
Me: Yeah, but that was different [type of HPV], cause it’s not sexually
transmitted. But the other types are highly sexually transmittable, and not just
through penetrative sex.
In that moment, when I shared more information about specific attributes of HPV,
Danielle reconfigured what she had previously known about HPV. Through this
dialogical process, Danielle and I established that she already had a relationship to some
type of HPV from her childhood, although not the STI type. I also exposed her to the
statistical likelihood that she may one day contract HPV, because it is the most
“transmitted” STI and is “highly…transmittable” through sexual activity. Our exchange
led to the interpellation of Danielle as a subject of HPV. Delving deeper into what it
46. 46
meant to be a subject vulnerable to the infection of HPV, Danielle asked questions that
made me consider more closely the actual moment of intimacy that my statistics and facts
were connected to.
Danielle: [with genuine interest] Interesting, huh. So if someone had warts on
their hands and they fingered someone, could they get HPV?
Me: Um, I think that is different?
Danielle: Is it through body fluids?
Me: I’m not entirely sure… No, cause its skin-to-skin contact… I should know
the answer to that!
Danielle: Interesting, it sounds very complicated.
Danielle was correct; the intimate details of HPV are very complicated. Our conjoined
experience furthered our own interpellation as subjects of HPV, exploring the nuances of
the moment of contamination. Subtle differences in the technicalities of HPV
transmission, such as touch but not fluids and some warts but not others, made HPV feel
more complicated the more we pursued clarification. Beyond the statistical probabilities
and the intimate moments of transmission, perceiving whether or not you are HPV
positive was also complex and subtle. Discussing HPV unraveled a situation that seemed
like it had more addendums and circumstances than other common STIs like Herpes.
Me: yeah. That’s why it is such a weird thing, it’s not as clear cut as something
like herpes or something, where if you have sores you know that you are much
more likely to give it to somebody, and it’s a lot more noticeable. And they can
prescribe certain types of medicine to suppress it. But HPV has a lot of “yes, but
also this,” or “this, or this.”
Danielle: I feel like they probably had to try to find a way to market it to make it
more simple? So people could just be like “you get this shot, you won’t be as
likely to get cervical cancer.” So I feel like that’s probably why we have the
understanding that we do, because a lot of us our only understanding came from
those commercials, and they had to market it in a certain way.
47. 47
Although we had talked about the Merck’s ad campaign earlier in our discussion, she
made the connection of how ‘simple’ marketing strategies had presented the HPV
vaccine that were connected to protecting against ‘cervical cancer’ had led her to
‘understand’ HPV in a particular way. The understanding she spoke of was devoid of all
the nuances and complexities we had unearthed throughout the course of our
conversation. Danielle did not feel that she was alone in the way she had previously
understood HPV, alluding that ads interpellated herself and others into gendered subjects
of HPV.
While Danielle found this information interesting, and not everyone felt
positively about realizing their relationship to HPV through our conversations. One male
student who had known very little about HPV prior to our conversation, expressed that
“[I]t’s frustrating. I feel frustrated instead of feeling empowered through the education.
It’s not something I’m very pleased to learn about. But life is a learning process, and you
can’t expect to feel thrilled about everything along the way.” Later he explained that he
was thankful that I “educated” him about HPV, but he also realized his position as a male
body as situated in newly problematic ways, ways that could affect his health or the
health of others.
The experience of being interpellated as a subject of HPV was also difficult for
another one of the female students I had spoken with. After discussing general facts about
HPV, its prevalence and technologies of prevention and diagnosis created gendered
experiences, she launched into explaining her personal relationship with a sexual partner,
who although he said he had been tested, she was still feeling “paranoid.” She said that
she had never seen the test results herself, but he seemed like someone she could trust. In
48. 48
the moment that this female student was interpellated, not only did she become a subject
at risk; she became a subject that was suspicious of her partner, who she had likewise
begun to see her partner as a problematic subject of HPV. Where I have used the concept
of ‘interpellation’ to refer to an experience where individuals come to understand
themselves as a particular type of subject in relation to HPV, knowledge about HPV can
also mean that same person identifies other subjects of HPV and, consequentially treats
them as such.
In Stevenson’s ethnography, Life Beside Itself, she takes Butler’s concept of
interpellation further to explore how naming or labeling of a subjects effects the ways we
interact with and perceive them. Stevenson sees this interaction as a type of ‘listening’
that is also interpellated. In Stevenson’s words:
Crucially, for the argument I am making in this book, listening can be a form of
interpellation. That is, there are modes of listening just like modes of speech that
can fix someone, an individual, in a particular subject position. That is, there is a
certain mode of listening reserved for listening to children, to criminals, to
drunks, to kings. What can the child say that is not childish, the criminal say that
is not itself criminal, the drunk say that is not drunken, the king say that is not
kingly?
If we replace Stevenson’s examples of individuals that are in particular subject positions
(child, criminal, drunk, king) with the partner of the suspicious female student, her
interpellated listening changed the way she thought of him. Her partner, as a gendered
subject of HPV who was ultimately unable to provide test results on HPV, the way she
listened to his test results were now colored with suspicion. While she ‘trusted’ him, she
still felt ‘paranoid’ because whether or not he was tested because his subject position
represented an inherent and invisible possibility of exposure of HPV to her body.
49. 49
The latter student’s experience of paranoia is something I struggled with myself.
Despite my original desire to learn more about HPV, to make “seemingly important
information” visible to me, the process has not always been comfortable. While I agree
with the male student who said, “I don’t think ignorance is bliss”, neither was becoming
cognizant of HPV. Not only did it make me think more critically about the sexual aspect
of my relationships, but I began to see myself as source of HPV information and a
constant reminder of a problematic illness for those around me. It begged the question of
what students do with their newfound HPV subjectivity, especially if they don’t feel
empowered by their new position?
* * *
As previously stated, my use of student interviews was not meant to situate them
specifically as proof of my discourse review and analysis. My interactions with students
and the subsequent dialogical discoveries of a personal relationship to HPV, as well as
the relationships others have with HPV, were compelling demonstrations of how one
might comes to intimately experience and relate to HPV. However, parts of our
conversations did allude to larger themes of HPV discourse and practice. Specifically, the
students I spoke with expressed the feeling that vaccination was linked with connotations
of an individual’s morality and responsibility. Perhaps more notable, was the
transformation of HPV as an invisible illness into a visible health issue. This
interpellation into subjects of HPV was complex and challenging, both in incorporating it
into their own sense of self and in their intimate relationships with others.
50. 50
Conclusion
Following the presentation of my thesis to my peers, a student asked me if an
individual could encounter HPV outside the framework that allocated particular
experiences of HPV based in the gender binary. I’m unsure if I could ever sufficiently
answer this question, but it opened several important avenues of inquiry. My initial
response was no, at least not while using the biomedical technologies that have been
developed in conjunction with HPV.
Throughout this thesis I give several examples of how female bodies are made
hyper visible in connection to HPV, and as a result male bodies’ relationship to HPV
have been made invisible. Biomedical technologies of prevention and diagnosis, which
are the two of the main modes in which HPV actually becomes perceptible to the patient,
further perpetuate issues of invisibility as they do not provide men and women with an
equal opportunity to have a relationship with HPV. Therefore, encountering HPV outside
of these biomedical technologies and their gendered exclusivity falls beyond the reach of
an already limited system of recognition.
By examining the history of HPV discourse, medical practices, and the complex
biography of the HPV vaccine, we can begin to parcel out several regimes that have
contributed to the gendered experiences of HPV. While there are certainly differences
between the biological manifestations of HPV in male and female bodies, social framing
has been a powerful influence on how consequential manifestations are experienced.
Invisible male bodies are perhaps more vulnerable than female bodies, not because of
their ability to contract HPV, but because of their inability to detect its presence that
would allow individuals to treat early signs of carcinoma. Regarding HPV prevention,
51. 51
some of the male students I spoke with expressed frustration that they had not been given
the opportunity to vaccinate during the first three years of the vaccine’s release due to
gender restrictions. These male students were concerned about unknowingly passing on
HPV to their sexual partners, disempowered by a restricted ability to protect themselves
from HPV related consequences such as cancer or genital warts.
It is also worth noting that HPV, and society’s ability to treat it as an emerging
health issue, is continually transforming. Since the initial release of Gardasil in 2006,
Merck has created second vaccine called Gardasil 99
, which offers a wider range of
protection than the former Gardasil vaccine. Unlike the introduction of Gardasil, Gardasil
9 has arrived into a medical scene that recognizes the potential of the HPV vaccine for
both men and women. Gradually medical institutions have been incorporating historically
invisible subjects of HPV. Although not specific to Gardasil 9, the frequently asked
question on the CDC website about who should get the HPV vaccine provide the
following guidelines:
All girls and boys who are 11 or 12 years old should get the recommended series
of HPV vaccine. Teen boys and girls who did not get the vaccine when they were
younger should get it now. Young women can get HPV vaccine through age 26,
and young men can get vaccinated through age 21. The vaccine is also
recommended for:
• gay and bisexual young men (or any young man who has sex with men)
through age 26 and
• young men with weakened immune systems (including HIV) through age
26, if they did not get HPV vaccine when they were younger.
Not only are “boys” positioned as equally recommended for the HPV vaccination, but
“gay and bisexual men” are also specifically addressed. Where the subject of gay men’s
9In a summary on the results of the clinical trials of Gardasil 9, The National Cancer
Institute claims that “[T] efficacy rate of the 9-valent vaccine was 96.7 percent”
protection against types of HPV that cause most HPV related cancers in men and
women.
52. 52
health and HPV vaccination had been category that Epstein called “the great
undiscussable issue” in public debate (Wailoo 2010: xv), this recommendation illustrates
a shift in HPV public discourse. Within the context of the CDC, which does not represent
the entirety of public health discourse, although is a significant authority on health and
medicine in the U.S., male subjects and non-heteronormative men are being pulled into
visibility and engaged as a part of the HPV as a public health concern.
Where I feel like my original research question of ‘is HPV a gendered illness’ has
long since been answered and elaborated upon, I am now asking what the developments
of increased visibility of male and non-heteronormative subjects means to the overall
experience of HPV as a gendered illness? This is not a question that can be fully explored
within my conclusion, nor I can I make any absolute claims about the future of HPV.
However, I hypothesize that, as all individuals become visible subjects of HPV,
regardless of gender identification or sexual orientation, HPV will gradually become an
illness of the past. Although not all subjects will adopt practices of prevention
(vaccination) and self-monitoring (screening technologies), as wider variety of people
establish their relationship to HPV, and therefore theoretically adopt practices of
prevention and diagnosis, principals of herd immunity 10
assume the decrease of HPV
prevalence. Therefore, to answer my previously stated question, I believe that HPV will
10 Herd immunity explained: “When a critical portion of a community is immunized
against a contagious disease, most members of the community are protected against
that disease because there is little opportunity for an outbreak. Even those who are
not eligible for certain vaccines—such as infants, pregnant women, or
immunocompromised individuals—get some protection because the spread of
contagious disease is contained. This is known as "community immunity."
(Community Immunity 2016)
53. 53
cease to be an experienced illness and a public health issue. However, that outcome
remains far in the future and should not overshadow the importance of attending to the
creation of varied subjectivities throughout this transformation. In fact, I would argue that
without paying close attention to the variety of subjective positions that have been
invisible to HPV, prevalence and consequences of HPV would continue to negatively
affect historically invisible and vulnerable subject of differing gender identities, non-
heteronormative sexualities, and particular socio-economic statuses.
