I've never been impressed by Rick Perry as the governor of Texas (though it's kind of interesting that he's been governor as long as he has, in spite of not being well-liked by even his own party.) In the last couple of days, though, he's done something both provocative and responsible: through an executive order, he's mandated that all girls in Texas be vaccinated against human papilloma virus (HPV) before starting sixth grade. He's also set aside almost $30 million dollars to pay for vaccines for uninsured kids. The effect of the executive order is that, as I understand it, this becomes law without going through the legislature. In terms of protecting a public health initiative from being politicized that was wise. According to today's (Feb 6, 2006) Austin American-Statesman, a lot of republicans in the legislature are angry about being bypassed on this plan because, basically, they wanted a chance to stop it.

In my old life, as a health educator and counselor at a couple of reproductive health clinics, I used to regard telling someone how to treat and manage their HPV as like having to swing at an underhanded softball pitch. Once people got over the initial stress of the diagnosis and the stigma of having a sexually transmitted disease, it was easier to have a sense of how common and generally easy to manage the virus was. They usually felt pretty in control of things.

HPV is so ubiquitous that calling it a sexually transmitted disease is unfair (to the extent that having a wart on one's genitals carries a stigma that a wart on one's thumb does not). It's difficult to get a hard number, but the estimates are that anywhere from 60% to 90% of everyone has some strain of the virus; so many people that if you've had more than one sexual partner (or if you have been with a partner who has had more than one partner) you've very likely been exposed. Moreover, the threshold for exposure is low, compared to most other STDs. HPV, like herpes (but unlike HIV, chlamydia, gonorrhea, or syphilis) can be passed between partners through skin-to-skin pelvic contact; sex isn't even required.

There are dozens of strains of the virus. Most of them cause no outward symptoms, or long-term problems, at all. Some of the strains cause genital warts. A smaller number of them cause cellular changes that can lead to cervical cancer. This means that the vast majority of people who have the virus neither know or need to do anything about it. Having warts can make someone self-conscious or embarrassed, and having them removed can be a little uncomfortable. For most people, the frequency and severity of subsequent outbreaks can usually be mitigated the same way one reduces the likelihood of herpes outbreaks, by keeping your immune system healthy (like not smoking or drinking, eating well, sleeping, keeping your stress level low, etc). Women who have the third strain of the virus will spend more time and money on doctor's office visits, but, again, HPV usually proves manageable: people who die of cervical cancer are almost always those who didn't know they were at risk, or didn't get the prescribed treatments.

I don't mean to imply that Rick Perry's executive order isn't significant. Indeed, my point is there's no reason for anyone to die of cervical cancer. Today's Austin American-Statesman has a statistic saying Texas has the second highest rate of it in the country. HPV is so common and easy to acquire that it should transcend the rhetoric of responsible behavior and morality that usually accompanies public debate on sexual health and practices.

Good work, Rick Perry.