News Sexual Health

California Allows Young People to Access the HPV Vaccine Without Parental Consent

Martha Kempner

On Sunday, California Governor Jerry Brown signed a new law which allows minors to access STD-prevention services, including the now highly political HPV vaccine, without parental consent.

On Sunday, California Governor Jerry Brown signed a new law which allows minors to access STD-prevention services, including the now highly political HPV vaccine, without parental consent.  California already allowed teens to access many other types of confidential care including contraception, pregnancy care, mental health care, and drug abuse treatment.  The author of the bill says that it merely updates state law to include newer treatment options including the HPV vaccine, vaccines for Hepatitis, and drug regimens that can prevent HIV transmission when taken after exposure to the virus.

Still, because sex was involved the headlines focused on “children as young as 12” and many opponents urged the governor not to sign the bill.  The Bishop of the Sacramento Diocese, Jaime Soto, said the law undermines parents’ relationship with teens: “I am very concerned the governor has done something that has really pushed parents aside…I’m dismayed that the governor would put aside the voices of so many families who said that this is not right.”  Others reiterated old (and tired) arguments that the HPV vaccine will lead to rampant promiscuity.  Randy Thomasson, president of SaveCalifornia.com, “worried the law will deceive preteen girls into believing they can freely engage in sexual activity without risk.”

Several parents were quoted in articles as being concerned that their children would receive any medical care without their knowledge.  One mother of a teenage daughter explained:  “I think it’s wrong, because we need to know.  What if something happened to [our teenage kids] and we didn’t know?”  As the mother of two daughters, I can relate to her concern though I think the law is not the problem.  My children at 1 and 5 are still at an age where I know where they are and roughly what they are doing at any given moment.   I certainly know all of the medication they have taken and I have missed only two trips to the doctor between them.  There is a certain amount of comfort in that level of knowledge and control, and I am dreading their independence as much as I am looking forward to it.

That said, I believe the responsibility for open and honest communication about sexuality and health care falls on the parents not the kids and we all know that some parents fall down on this job. Most young people become sexually active at some point during high school and some of them cannot talk about their sexual health with their parents.  It would be wrong to deny these teens potentially life-saving prevention services (remember the HPV vaccine protects not just against an STD but against cervical cancer).

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The law provides an important safeguard that allows these teens to protect their health and well-being.  Now it’s the responsibility of educators and health care providers to encourage young people and parents to talk each other about these important issues.

News Sexual Health

New York Bill Would Allow Teens to Get HPV Vaccine Without Parental Consent

Martha Kempner

A new bill in the New York State Assembly would allow minors to consent to receiving the HPV vaccine without parental consent. Unsurprisingly, it has been met with some opposition.

Minors in New York are already allowed to access sexually transmitted infection (STI) testing and treatment without their parents’ consent. However, a new bill in the assembly, which seeks to add access to STI prevention methods, including vaccinations, has been met with opposition from individuals who say it goes too far.

The existing law allows health-care providers to diagnose, treat, and provide medication for people under age 18 without the consent or knowledge of their parent or guardian if the person has an STI or has been exposed to one. Similar laws exist in all 50 states and the District of Columbia. A recent review by the Guttmacher Institute found that:

  • All 50 states and the District of Columbia explicitly allow minors to consent to STI services, though 11 states require that a minor be of a certain age (generally 12 or 14) before being allowed to consent.
  • Thirty-one states explicitly include HIV testing and treatment in the package of STI services to which minors may consent.
  • Eighteen states allow physicians to inform a minor’s parents that he or she is seeking or receiving STI services; however, with the exception of one state that requires parental notification in the case of a positive HIV test, no state requires that physicians notify parents.

AB 497 would amend the New York state law to specifically address prevention. It adds the following language:

A health care professional may provide health care related to the prevention of sexually transmissible disease, including administering vaccines, to a person under the age of eighteen years without the consent or knowledge of the parents or guardians of such person, provided that the person has capacity to consent to the care, without to regard to the person’s age.

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This bill is clearly meant to increase the number of young people who get the human papillomavirus (HPV) vaccine (sold under the brand names Gardasil and Cervarix). Other than vaccinations for HPV and the less controversial vaccine for hepatitis B, STI-prevention health care is limited to the provision of condoms, which have never required parental consent.

Given how controversial the HPV vaccine has been, it is not surprising that this bill is facing opposition. In fact, one lawmaker who initially supported the bill has changed his mind, apparently after an onslaught of comments from his constituents. Assemblyman Dennis Gabryszak (D-Cheektowaga) told local news station WIVB that he agreed with the law’s goal of preventing STIs but reconsidered his initial support for the bill because “there’s some concern over whether or not the vaccine could lead to some other health problems.”

As Rewire reported a few months ago, those concerns are unfounded. A 2009 report co-written by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration, for example, combed through the Vaccine Adverse Event Reporting System (VAERS) reports regarding Gardasil and found that 23 million doses had been administered in the United States between June 2006 and December 2008. In total, there had been more than 12,400 reports of adverse events following HPV vaccination. The vast majority of these cases (94 percent) were not serious and included fainting, pain, and redness at the site of the injection, dizziness, nausea, and headache. Though there were more serious cases, including blood clots, neurological symptoms, and death, the report was unable to find any evidence suggesting that the vaccine itself was the cause of these problems. In fact, in all of the cases of death, autopsies confirmed other causes. Ultimately, the CDC concluded that “[c]linical trials and post-licensure monitoring data show that both vaccines [Gardasil and Cervarix] are safe.”

If the law passes, New York would not be the first state to allow minors to consent to the HPV vaccine; California passed a law in 2011 that allows minors to receive the HPV vaccine without parental consent. That law also met with opposition from lawmakers as well as parents who argued that they should know what medications are in their child’s system.

Roundups Sexual Health

Sexual Health Roundup: HPV Vaccine Doesn’t Lead to Promiscuity; Condom Use Low Among Women on the Pill

Martha Kempner

A study finds that the HPV vaccine doesn't lead to more sex; another confirms that women who stop using condoms when they start hormonal birth control and don't go back to condoms if they stop hormonal methods.

Study Says HPV Vaccine Won’t Turn Your Teen Into a Tramp

We’ve heard the argument many times about everything from birth-control pills and condoms to sex education: Giving kids information or access to protection is like giving them license to have sex and will make them promiscuous. Most recently this argument has been made about the HPV vaccine because—to ensure that the vaccine series is given before a young woman becomes sexually active—the CDC recommends that girls be vaccinated during their preteen years. Last week researchers at Kaiser Permanente were able to reassure parents that the vaccine is safe. This week they offer reassurance that it does not cause increased sexual activity.

Researchers followed 1,400 girls in Atlanta for three years after they’d received their shots. They did not ask the girls if they’d had sex but instead looked for markers in their medical records, such as pregnancy tests, STI diagnoses, or contraceptive counseling, that would indicate sexual activity. They found no differences between girls who got the HPV vaccine and girls who got other vaccines but not HPV. The study’s lead author explained:

“Overall, what we found through the whole follow-up study was among 1,400 girls only eight actual cases of either pregnancy or sexually transmitted infection.”

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He went on to say that the rates were identical in the HPV vaccine and non-HPV-vaccine groups. And added:

 “We feel this is reassuring. We can start to move beyond these concerns.”

This research followed girls only until they were ages 15 or 16, which is about the average age of sexual activity for young women in this country. Other research, including a report from the CDC, found no association between HPV vaccination and risky sexual behavior among young women ages 15 to 24, though that finding was based on self-report, not medical records.

Experimental Vaccine Might Help Women Already Infected With HPV

The HPV vaccines that are currently available—Gardasil and Cervarix—protect young women (and men) from initial infection with certain strains of human papillomavirus. Both Gardasil and Cervarix are approved for the prevention of infections with HPV strains 16 and 18, which are most likely to cause cervical cancer. Gardasil also prevents strains 6 and 11, which cause genital warts. These vaccines have no effect on women who are already infected.

Researchers are now working on an experimental vaccine for women who have already contracted HPV. It is designed to spur the body’s immune system to fight off pre-cancerous and cancerous changes to the cervix. The vaccine, known as VGX-3100, uses gene therapy to trigger the body’s T-cells (part of the immune system) to “seek out and destroy precancerous lesions.”

The study, published in the October 10 issue of the journal Science Translational Medicine, follows 18 patients who were given three doses of the vaccine along with a small electric pulse, called electroporation, which boosts the post-shot immune response. The study found that the vaccine seemed to “elicit the desired immune response against HP with minimal side effects.”

This study is a phase-one clinical trial; the second phase is already under way. If it continues to be successful, the vaccine could be available within four to six years.

Young Women Give Up Condoms When they Start Hormonal Methods (and Don’t Go Back)

A new study published in the Journal of Adolescent Health finds that young women who start using hormonal contraception for birth control often stop using condoms, leaving themselves open to sexually transmitted infections (STIs). More disturbing, however, is the finding that if these young women discontinued using hormonal contraception they tended not to resume their use of condoms, leaving them completely unprotected against both unintended pregnancy and STIs.

The year-long study followed 1,194 sexually active women ages 15 to 24, who visited Planned Parenthood clinics. They were not planning to get pregnant within the year and were starting hormonal contraceptives—birth-control pills, patches, injections, or vaginal rings. Researchers asked the women about their condom use. They also asked what their attitudes toward condoms were, as well as their perceptions of their partners’ attitudes toward condoms. At the beginning of the study, 36 percent of the women used condoms consistently but this dropped to 27 percent within three months. During the course of the year, some of the women stopped using their hormonal methods but more than half of those who did, did not resume using condoms.

The study also found that the most important predictor of condom use was not a woman’s own feeling toward condoms. Nor was it her perceived risk of contracting STIs. Rather, it was her perception of her partner’s attitudes toward condoms. The study found that women who said their partners thought condoms were “very important” or didn’t know how their partners felt were more likely to use condoms along with their hormonal method than women who said their partners thought condoms were “not at all important.”

Condoms provide important protection against STI’s, including HIV. Most health professionals agree that even young women on hormonal methods of contraception should continue using condoms to prevent STIs. This study confirms the fear of public-health experts that young women are not taking this advice. Worse, they don’t return to condoms (which are also a good method of birth control) if and when they stop using hormonal methods. This study confirms that we need to do more education when it comes to condom use. And educating male partners might be a good place to start.