interview with a public health maven.

back in 2003, right after undergrad,  i started working for this awesome women’s health center.  one of the amazing people i worked with there was this wonderful public health masters student, we’ll call her j.  j was working on a project for the cdc to find out more about the social and emotional aspects of the hpv diagnosis.  for those who don’t know hpv is the virus that causes cervical cancer, but more about that in a minute.

so cut to 2007 or so.  while i was in japan i realized that a lot of the foreign women i interacted were (like me) apt to let there healthcare needs go unmet. healthcare in japan was affordable but it was difficult at times to find the resources you needed.  also, i think that being out of the country at a time when all of this information was coming to the forefront of healthcare allowed women to feel a false sense of security.  cases of young women fighting aggressive cervical cancer were not making the english language papers.  i decided to put this interview together to see if i could get it published one of tokyo’s english language magazines.  unfortunately it did not go to print and i eventually lost touch with j.

tonight i was sorting through some old papers and i came across the original interview and decided to post it.  information presented here is minimal, certainly less than you would get from some of the stellar coverage of hpv and gardasil that i’ve heard recently on npr, but definitely worth a look.  of course, if you have questions or concerns about anything you might be experiencing you should go to your doctor or a reputable health center like planned parenthood immediately.  but you know that:)

this awesome mph student went on to medical school and i’m not totally sure what she’s up to now but i’m sure whatever she’s doing she’s kicking some serious butt!

Nicole:  So, what was your research at our health clinic about?  How did the project come about?

J:  While the HPV vaccine, Gardasil, was in its final stages of development and approval, the US CDC/NIH became interested in how the public, and women in particular, would respond to understanding more about what HPV is and what that means for their overall health and self-image.  More specifically, they were interested in the effects of receiving an HPV diagnosis on the social (how women would interact with or tell others), emotional (how a woman would adjust her self-image and react emotionally) and behavioral effects (how a woman would act, or not act, after getting the diagnosis).

The project was funded by the CDC/NIH and 5 universities were chosen to fulfill the mandate as they saw fit.  University of South Florida College of Public Health decided to recruit women from health clinics, like Planned Parenthood, and pay for their annual pap smears and an HPV DNA test, and the women who had abnormal pap smears and tested positive for HPV DNA were invited to participate in an interview or survey to discuss the diagnosis.
Nicole:  What exactly is HPV and how is it connected to cervical cancer?

J:  HPV stands for Human Papillomavirus, and yes, that means that there are papillomaviruses for other species.  It is the virus that causes all warts.  Everything from the tiny bumpy ones on your feet to the ones that cause cervical cancer.  There are over 100 types, and all are transmitted through skin contact (which is why people tell you if you touch a frog you’ll get warts, though that is NOT TRUE).

About thirty types of HPV are transmitted through genital contact, that means they can be passed without intercourse with penetration; all you need is skin to skin contact.  Condoms help because they prevent some skin contact by covering the skin on the penis, but they cannot prevent all skin contact during intercourse.  So wear a condom, it will prevent spreading other sexually transmitted infections as well.
There are two types of HPV that are spread through genital contact.  One type causes genital warts.  Though they are unsightly, they do NOT cause cervical cancer.  The type that causes cervical cancer you CANNOT SEE.  The virus attacks the skin cells and is more harmful to the cells on the cervix because the cervix is a thin, very vulnerable mucous tissue, like the skin inside your mouth.  It is easier for the virus to harm those cells and make them cancerous.  And the younger you are the more vulnerable your cervical cells are.
It is very important to understand that HPV is EXTREMELY COMMON.  Approximately 20 million people in the US currently have HPV, and about 6.2 million get a new HPV infection each year.  If you are not in a mutually monogamous relationship where you were each other’s first sexual partner for ANY genital contact, it is statistically very likely that you have been exposed.  However, the human body is very good at fighting the virus off.  Most women who are infected manage to fight off the infection before there are any effects.  The body’s ability to repair cell damage, and kill viral infection is amazing.  However, sometimes the body must work harder and an infection can establish itself in the cells.  This is why you get your pap smear yearly if you are a sexually active woman who still has a cervix.  You are getting screened to see if an HPV infection has managed to actually harm the cells of your cervix which is how we prevent cervical cancer.  Pap smear screening is one of the most effective prevention screenings available today.
Nicole:  Can you tell us a little about the HPV test?
J:  The HPV test takes a small sample of the cells collected from your pap smear and tests their DNA for signs of HPV viral DNA.  Virus injects its own DNA into cells and then the cells reproduce the virus, which spreads to neighboring cells and continues the cycle.  That is how cells start to grow out of control and become cancerous.  The DNA test is looking to see if the virus DNA is present in the cells which indicates an active infection.
HPV DNA testing is only recommended for women who have an abnormal pap smear, but the presence of HPV DNA does not mean that a woman will develop cervical cancer.  As I mentioned previously, the body is very good at fighting off infection, and an active infection should be monitored, not always immediately treated.  That is a decision a woman must make with her physician depending on her health and risk factors, like whether or not she is smoking, whether she is in a long-term, mutually monogamous relationship, etc.
Nicole:  What is Gardasil and how does it work?
J:  GARDASIL is a new vaccine made by Merck & Co., Inc. and has been approved by the US FDA to prevent cervical cancer in females by administering the vaccine to women between the ages of 9 and 26.

The vaccine protects against 4 types of HPV, two that are associated with causing cervical cancer, and two that are associated with causing genital warts.  It will not prevent all genital HPV infections, nor all genital warts, but it is highly effective in preventing infection by the 4 types of HPV it guards against.  Vaccines work by teaching the immune system how to recognize viral proteins and DNA thereby starting the defense against the virus more quickly and preventing an infection from establishing in cells long enough to cause any symptoms.

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