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?

If you want to identify as my 14 year old DS you can have his. He refused

@WhatWouldPhyllisCraneDo why?!

Severe needle/medical phobia*.
He missed it at school due to covid. He was off when they came in and then schools were closed. Booked him in to the catch up clinic, and arranged for someone to go with him (they ask you not to unless you have to.) He refused to even get in the car.

Short of tying him up I can't get him there.

*he's fainted at the drs, in a first aid lesson, when visiting at the hospital and at the opticians

Ah ok. That's a bit better than what I was imagining-some sort of rebellious teen protest.
Still, I assume if all his classmates received it he's unlikely to come into contact with it. I didn't realise before there were risks for boys either. Mine is the generation you just got STDs from boys who refused to wear a condom.

If it was just teenage rebellion I'd have made him go somehow. Bribery probably. But even the promise of a tenner didn't work. :( In the end we went with the 'herd immunity' logic. And the knowledge he can have it done when he's older if he wants to.

He only agrees to regular eye tests because he gets headaches if his prescription changes. And we have to take chocolate and ask for the air con to be on just in case!

There must be a more recent document but - JCVI and expanding the group eligibility for HPV vaccination:

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/477954/JCVI_HPV.pdf

Sounds like blatant discrimination

I don't understand about age and exposure to the virus? Is that just an assumption about people's sex lives?

It's part of the NHS constitution that they have to follow the Equality Act; more importantly it's probably part of the Equality Act that they have to follow it.

So you can definitely put in a complaint and appeal to unlawful discrimination under the Equality Act.

Obviously don't expect the complaint to work. They will try to argue (rightly or wrongly) that it's not unlawful discrimination, and that they are acting in a "proportionate way", "towards a legitimate aim". Presumably they would appeal to cost/benefit and different groups being at different risks.

You may or may not be able to successfully challenge that line of argument in theory; in practice they will likely just want to get rid of you with a quick reply. But not necessarily. It's always possible they come back to you and have decided to change their policy.

Maybe some individuals could argue that they are at higher risk than other women, and so equally deserving of the treatment?

Oooh this is interesting.

It wouldn't be unlawful discrimination vis a vis the gay men or the TW who have sex with men if they are getting it because the risks are different to straight women, because they are biological males who have male sexual partners. So I'd want to know if there's a rationale for that difference. I suspect there is but don't know for sure.

The trans men who sleep with men is a weird one. There can be no basis in biology for saying they should be treated any differently to a straight woman (particularly if there has been no genital surgery, although I have no idea what role a neo penis would play in transmission.)

So on the face of it there does look like discrimination on gender reassignment grounds when comparing trans men with straight women. I am not aware of any cases of discrimination being argued by someone not having the protected characteristic of GR. If it is discrimination, it could be direct discrimination, which under the equality act is always unlawful - no justification allowed.

Isn’t what it’s trying to get at is a higher age for vaccination for the group of humans who have sex with gay men (gay men being a population of higher disease prevalence).

It’s clumsy, but in theory straight women don’t have sex with gay men, the others do (not a precise science there, clearly).

@LadyBuffOfBuffdonia

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

Catching up but on this. Others may have replied already.

They don't get cervical cancer but do spread the virus. Not all girls will be vaccinated. So for that reason, vaccinate both.

The virus can also cause penile cancer, anal cancer and throat cancer. So to protect against that, boys should be vaccinated. The fact that it wasn't offered to boys as those cancers are most common in men who have sex with men was a bit of a dodgy decision.

So yes, boys should 100% be vaccinated to protect the people they have sex with and themselves.

And for the OP- men who have sex with men is the group they are targeting.

It makes no sense to include trans men at all.

In the end though nothing about all this is logical.

'Sounds like blatant discrimination

I don't understand about age and exposure to the virus? Is that just an assumption about people's sex lives?'

It's statistical risk. It's an offer. No one has to have it.

I worked in HIV prevention for the govt in the 90s. The fact is that when it comes to std transmission men who have sex with men are highest risk, then women who have sex with men, then men who have sex with women, with women who have sex with women being lowest risk.

It's to do with fluids as well as different types of sex. If a man with an std ejaculates into you that's a lot of fluid transfer so more risk of infection.

The fact that not everyone has penetrative/ unprotected sex/ more partners is really not a reason to water down a statistically based health campaign. And with the NHS the cost Vs impact in terms of health gains across groups is always a consideration.

@aiwblam

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.

No they don't - identify simply as gay for a day and have a vaccine offer until 45.

I'll shortly be gay on three one-day occasions to get mine, you should go trans for the same period, OP, to get yours.

@Tibtom

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.

Exactly apart from being discriminatory, the policy makes no sense. And seeing as it protects against anal and throat cancer and sexual practice is deffo going more anal (I think, shudder), this should be argument enough to vaccinate all people of the female sex.

The TW thing makes sense. The TM thing- are they assuming that TM who sleep with men are likely to be sleeping with men in the MSM category? Because this cohort of people is so tiny that I suspect that they don't have any proper data on it, and they're just reaching. Now if they added non-binary as a valid group who are eligible for the vaccine, we'd know it's based purely on id pol.

* the TM thing- are they assuming that TM who sleep with men are likely to be sleeping with men in the MSM category? Because this cohort of people is so tiny that I suspect that they don't have any proper data on it, and they're just reaching.*

Yes, I think that’s exactly it. And don’t forget it’s a cost benefit analysis, so because the cohort is so small, ergo not much cost, it’s not an especially important point to absolutely clarify (for the JVCI)

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

Seriously, you should do this. It’s the only good thing I’ve heard about self-ID.

www.dailymail.co.uk/health/article-7515235/Give-ADULT-cancer-fighting-HPV-jab-save-thousands-lives-experts-demand.html

There was a piece in the Dreaded Mail about vaccinating adult women against cervical cancer last year.

Being the mail, I can't vouch for it as they report anything and everything about cancer so it is hard to sort the wheat from the chaff.

NHS seems to be heavily invested in maintaining a labour intensive 3 yearly, in person, examination system for women. Even HPV self testing is taking forever to be assessed.

Mummy there will have been a decision based on the stats and the cost/ benefit.

It's not to do with discrimination it's do to with risk Vs cost at a population level.

Why the shudder?

The original decision to only vaccinate girls was seen by some as the heterosexual girls yet again being the ones who do the thing while the boys carry on as usual, combined with the issue that boys who grew up and had sex with men would not be protected.

It's not to do with discrimination it's do to with risk Vs cost at a population level.

But that depends on looking at the correct population: if you are the team tasked with improving the sexual health of men who have sex with men then this would be the population you consider when deciding on interventions such as vaccinations. You don't consider the statistics for women because that is not the group you are tasked to look after.

That's not how it works.

They look at the prevalence of whatever it is (TB, HIV, disease linked to HPV etc etc) across the population and target the most at risk groups/ or everyone if it is highly prevalent.

The idea that looking at who should get HPV vaccine is done separately by separate agencies with different groups they are concerned with is very peculiar.

Where did you get the idea that this is how the CDSC (or whatever the equivalent is called, I worked for them years ago on HIV) works?

That they don't look at population but split it out to groups? I'd be really interested as I genuinely can't understand why you think that and it's a bit worrying if that idea is one that lots of people have!

@aiwblam

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.

How is it not discrimination if two groups of people are dealt with differently? Not having enough money to treat everyone may be the reason why not everyone gets treated, but that doesn't affect how the decision is made on whom to treat.

e.g. if you only have the money to buy 20 cakes but you've got 40 guests coming, then you only buy 20 cakes. Which 20 people get a cake each & which 20 go without is a different matter.