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In No Hurry to Give It a Shot

(By Mark Finkenstaedt For The Washington Post)

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By Laura Sessions Stepp
Washington Post Staff Writer
Tuesday, April 3, 2007

The four women are lounging in the Sigma Kappa living room at George Washington University, discussing the new vaccine that may keep them from dying of cervical cancer. Bryttava Olson, a sophomore, has had two of the series of three injections "because my mom picked me up the first time and said, 'You're going to have a shot.' " Her three sorority sisters, however -- a sophomore and two seniors -- are waiting.

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"I need someone to tell me I have to do it," says Sierra Strattner, the other sophomore.

Since the cervical cancer vaccine Gardasil came on the market in June, health authorities and student leaders at colleges and universities have been waging a campaign to inform young people about the vaccine and the human papillomavirus, or HPV, that it attacks. At GWU, freshman Emily Brooks and her fellow campus Democrats worked information tables on campus for a week in February, and health professionals have given more than 300 injections. "I've never seen women so excited about shots," says Cindi Spinelli, a nurse at GWU's student health center.

But there are about 5,000 female undergraduates at GWU. While some of them may have started the shots in their home town, many more, obviously, are holding off. One reason is cost, which can range from $360 to $500. (Some health insurance plans do not cover the vaccination, or cover only part of it.) But they give other reasons as well: The virus is transmitted through sexual activity, and they're not having sex right now. Or they are having sex but are uncertain about how effective Gardasil is or what its long-term consequences might be. Some assume that hookup partners who can afford popped-collar shirts and expensive jeans are not the kind of guys who would be infected. And some admit they think that cervical cancer won't happen to them -- even when, like Strattner, they know someone their age who was diagnosed at an early stage of the disease.

Although the vaccine is most effective in individuals who haven't yet had sex -- a profile that most college students don't fit -- medical authorities are closely following the progress of the vaccine on campus because students, male as well as female, are at such a high risk of acquiring the virus. A recent study by the Centers for Disease Control and Prevention found that women between ages 20 and 24 had the highest infection rate: nearly 45 percent, though only 2 percent of those were infected with cervical cancer strains.

What authorities are finding is some acceptance, but also ambivalence and confusion. Truth is, information doesn't drive behavior in adolescents and young adults, particularly social behaviors like sex, according to specialists such as Michael Cohen, professor emeritus of pediatrics at Albert Einstein College of Medicine in New York. "Teens don't plan their Saturday night that way," he says.

What they learn only in a brochure or class won't make them run to the health clinic for a shot. It won't make them have less sex or, if they get a shot, more sex, as some vaccine critics contend. Other factors are involved in such decisions: sexual maturation, the advice of parents and educators, what they see on YouTube or at the cineplex, what their friends are doing and saying -- particularly a friend they've ended up in bed with.

Condom use is a good example. Most young people know that condoms provide some protection against sexually transmitted diseases, including HPV. But those who are sexually active report using a condom only about half the time, according to the 2006 American College Health Survey.

Male partners are one reason protection is not more common, says GWU senior Adrian Tworecke from her perch in a wing chair at the Sigma Kappa sorority. "They'll ask if you're on birth control, and if you are, they'll say they're not going to use a condom."

And if a woman brings up the fact that a man can be infected with HPV and pass the virus to her?

"You're going to offend him," Strattner says. Or, senior Mallory Kirsh says, "He'll say, 'Do I look like someone who would have an STI?' It's so hard. It makes it look like you don't trust him."

A Too-Distant Future

Many young people tell researchers that they use condoms the first time they have sex, particularly if they don't know the partner well. If they and their partner get tested for STDs and the results are negative, or if they go out with the person several times, they're less likely to continue using protection because condoms lessen the sensations that come with sex.


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