How do I challenge this unfair, sexist NHS policy?

[WeeBisom]

The NHS has a catch up programme for people who didn't get the HPV (Gardasil) vaccine at school. I missed out, so I was interested in getting vaccinated. The NHS website tells me that the upper age limit for women in the catch up programme is 25. My only option is to get the vaccine privately which is 475 quid.

However, the NHS has recently launched a catch up programme for men who have sex with men. They can get the vaccine up to age 45. Fine. But this catch up program also applies to trans women who have sex with men, and trans men who have sex with men. This means that (to use the NHS terminology) people assigned male at birth with a male identity, people assigned male at birth with a female identity, and people assigned female at birth with a male identity get the vaccine until age 45. People assigned female at birth with a female identity get the vaccine until 25 only. They have to go private.

This, on its face, seems arbitrarily unfair to me. If the activity is the same (having sex with men), then why are only a sub group of female patients excluded but every other patient gets almost 20 more years to get protected for free?

I want to challenge the fairness of this policy, or at least find out why the NHS has this in place. I think that it quite easily satisfies being discrimination on the basis of sex. I don't know if this is discrimination on the basis of 'gender reassignment' because I don't know if 'gender reassignment' is a symmetrical characteristic (ie, can protect people discriminated against for NOT undergoing gender reassignment.)Can anyone give me advice on how to do this? Can I put a complaint in, or submit a freedom of information request? It does seem unfair, right?

Could you identify as a transman for the day?

I agree, OP, it definitely seems unfair. Women are being denied healthcare that males, transwomen, transmen are all offered. I suppose unless the transmen are ... attracted to women. Hm. Seems to be discriminatory on sexual orientation, as well as on sex, in fact!

www.citizensadvice.org.uk/health/discrimination-in-health-and-care-services/taking-action-about-discrimination-in-health-and-care-services/complaining-about-discrimination-in-health-and-care-services/

www.equalityadvisoryservice.com

www.citizensadvice.org.uk/law-and-courts/discrimination/public-sector-equality-duty/what-s-the-public-sector-equality-duty/

This lot should be able to help, but I have a suspicion they would run in the other direction.

www.equalityhumanrights.com/en

Yeah, you're going to have to identify as a transman. Show up it's stupid policies.

Boys currently aged 15/16+ also missed out on it and have to go private for £££. It’s purely on cost grounds and isn’t discrimination.

I’m sorry OP. That is totally unfair.

Boys age 16 or any age don't get cervical cancer.
I'd have thought it most cost effective to vaccinate those who do.

Thanks everyone, will check these resources out. I understand that men who have sex with women have missed out and have to go private, which is a pity. However, in this case for people who have sex with men every person who has sex with a man can get the catch up vaccine until age 45 EXCEPT women who have sex with men, who have to be satisfied with a 25 year cut off point. My point is that if the relevant characteristic here is 'has sex with men', why should it matter what the gender identity of the person is? Surely the only salient thing is the activity. Especially when people assigned female at birth can get the vaccine until age 45 for having a masculine gender identity.

As for identifying as a man for the day, I checked out NHS policies in this area and they say that being trans is '"personal and individualistic. there is no wrong way to be a trans man,." They also say that people may have part time or fluid gender identities, so I could just be a man for a day and that would be fine. And there is also a policy that NHS staff cannot question anyone's gender identity or query their clothing, or looks (I'm helpfully reminded that trans people can wear any kind of clothing they like.) So if THIS is their official definition I don't see how it would be wrong in any way to identity as a man. I don't appear to have to look a certain way or believe anything other than "I'm a man today'.

The “cervical cancer” jab also protects against penis cancer (amongst others). It’s a vaccination against several strains of a virus that causes various cancers.

Feed back to us.

@aiwblam

The “cervical cancer” jab also protects against penis cancer (amongst others). It’s a vaccination against several strains of a virus that causes various cancers.

I wanted to second this - I'm pleased it's being offered to wider groups although the age differential and exclusions that the OP describes makes no good sense on the face of it. (There's probably an explanation somewhere that I haven't seen.)

www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/

www.nhs.uk/conditions/vaccinations/who-should-have-hpv-cervical-cancer-cervarix-gardasil-vaccine/

I'd have a strong inner feeling that I wanted to be a man for a day if it meant I could be protected from cervical cancer.

I'm a bit pissed off I'm 47 and therefore ineligible. Maybe I can ID as a 44 year old man?

It sounds like the policy is mixed up in general.

My understanding has been that when upper age limits exist for these vaccines for women it's because after a certain age, too many have already been exposed to the virus in the wild and it's no longer cost effective.

I wonder if they've decided that isn't true, or if it is a different calculation for men, or the decision was just made completely independently of the other policies? But in any case I'd guess the reason they are including trans patients as if they were the relevant biological sex is to avoid a fuss.

It sounds to me like what you need to do first is to query the reasoning behind the whole set of policies.

Go for it weebisom

You don’t even have to identify as anything at all

@SmokedDuck. Yes, it was also my understanding that after a certain age women have had too much exposure to the virus so it's not worth vaccinating them. But the NHS website says that the vaccine programme has been extended to men who have sex with men because they are at greater risk of getting oral and genital cancers...so why is the cut off point not also age 25? Because one would think that by age 44 a sexually active man is going to have been exposed as well. I'm going to email them to ask for an explanation of the different cut off points.

Is it not because the first age group of people offered it were people who are now 25 so thats what they mean by missed out, its not an arbitrary cut off pkunt

However yes its a very unfair policy. Everyone who has sex with men bar women, or the actual men. Would make more sense actually to vaccinate all the men

What is the risk with men who have sex with men? Oropharyngeal cancer? Why are gay men more at risk of Oropharyngeal cancer over women?

I don't think you have a good case for discrimination any more than teenage boys do, unfortunately. The cost benefit analysis and risk is stratified for these groups before deciding on policy. There are reasons that certain groups might require a catch up programme in the same way that there were reasons girls of a certain age were offered in the first place.

I suspect gay men and TW are offered as the rates of HPV and associated anal, penis and oral cancers are increasing and they will not have been offered the jab when younger. It wasn't seen as beneficial for them when they were teens.

TM could be showing up as a group with a high level of non-vaccination or as a group that will benefit more. If TM are less likely that heterosexual women to have been sexually active (with men) under the age of 25, this would increase the apparent benefits of that group when analysed. It is also possible that some stupidity was at play and classed them as not eligible, when girls were offered - in which case the NHS should attempt to fix that mistake.

It's also possible that the men TM are having sex with are more likely to also sleep with other men, who have no herd immunity in their pool of sexual partners and different type specific prevalence - we can't explain why without more information, but there are plausible explanations beyond discrimination.

If you are someone that would benefit from the vaccine more than most 25+yo women, such as someone who married their first sexual partner who was also a virgin then and recently separated from them (so about to increase risk of exposure) or someone who is still a virgin, you should talk to your GP about your specific situation and see what they say.

"Yes, it was also my understanding that after a certain age women have had too much exposure to the virus so it's not worth vaccinating them. But the NHS website says that the vaccine programme has been extended to men who have sex with men because they are at greater risk of getting oral and genital cancers...so why is the cut off point not also age 25? Because one would think that by age 44 a sexually active man is going to have been exposed as well. I'm going to email them to ask for an explanation of the different cut off points."

With over 80% coverage among young girls, herd immunity is expected to reduce HPV infection and associated disease in unvaccinated females and heterosexual males.

Men who have sex with men (MSM) are unlikely to benefit from herd immunity with the current programme, are more likely to be infected with HPV and have relatively high rates of HPV-related disease, particularly genital warts and anal cancer.

There are also different strains of HPV at different levels in the different groups, and a growing awareness of the association between these strains and different cancers.

DD missed out on her HPV jab and had it done at the GP surgery. Is that an option?

This is actually something I'm really interested in. I wasn't vaccinated, my parents wouldn't give consent. I didn't know about the catch-up program until very recently by which time I was too old. I'm in my late twenties and my DH is the only sexual partner Ive had, so I feel if we split up at any point I would be put more at risk. I didn't know that men who had sex with men could be vaccinated until a later age. I wonder what the rationale is.

My sons have missed out because of age and have looked into getting the jab for them.

My impression was that it was most effective before sexual activity began, hence jabbing them at 12/ 13. So what is the point of vaccinating if the person is already sexually active? Unless only had a mutually monogamous relationship?

The criteria OP has posted makes no sense at all. I thought the point was to catch boys and girls before they become sexually active and exposed to the virus. I really must have misunderstood the guidance.

@PawsomePugFancier: thanks for this explanation, this is helpful. I will see what they say about the reasons.

[quote WeeBisom]@SmokedDuck. Yes, it was also my understanding that after a certain age women have had too much exposure to the virus so it's not worth vaccinating them. But the NHS website says that the vaccine programme has been extended to men who have sex with men because they are at greater risk of getting oral and genital cancers...so why is the cut off point not also age 25? Because one would think that by age 44 a sexually active man is going to have been exposed as well. I'm going to email them to ask for an explanation of the different cut off points.[/quote]
I'd have thought so too, but it may not actually be the case. Perhaps there are differences in sexual behaviour or it doesn't spread as easily that way - it could be there is a reason for the different policy.

It might also just be that the policy was created by a totally different group - say ENT rather than OBY/GYN, and they took a different set of decisions.

So I think it would be worth asking for the reason for the difference.

On a related but somewhat tangential point, I've been wondering if it would be helpful if Sex Matters had a policy wing that was a recognised stakeholder for commenting on relevant health and similar areas for NHS, NICE appraisals or guidelines etc.

Men who have sex with men (MSM) are unlikely to benefit from herd immunity with the current programme, are more likely to be infected with HPV

If they are more likely to be infected than, say, 30 year old women then that is surely an argument for giving the jab to 30 year old women instead?

I agree with SmokedDuck it might not be decided due to relative risk of these groups but rather because there is a specialist team tasked with addressing sexual health in men who have sex with men. In that case it is discriminatory not also consider women's risk from this.