Every woman 26 or under should be getting vaccinated for HPV. With the University now heavily subsidizing the cost, Harvard women don’t have any excuse for putting it off. I balked at the $154/shot price tag when Gardasil was initially made available (it comes in a three-shot series over six months — about $450 total originally). But beginning in August and lasting through July 2009, Gardasil will only cost women under Harvard health plan $25/shot, a relative bargain for prevention of cancer.
Just a few factoids:

1. Most sexually active individuals have or will have HPV at some point in their lives. Infections are usually harmless and go away within a couple years, but some types of HPV can develop into cervical cancer or genital warts.

2. Cervical cancer is the second-leading cause of death among women, though it’s rare in America. Gardasil protects against the two types of HPV responsible for 70 percent of cervical cancer (as well as two types of HPV responsible for 90 percent of genital warts).

3. Women as young as 9 may be vaccinated, and it is highly recommended that vaccination take place before the woman engages in sexual intercourse. (Virgins, True Love Revolution members, and my 15-year-old sister all need this regardless of their current activity.)

4. Infected males are carriers of the virus, but very rarely experience symptoms themselves. There are currently no vaccinations for males.

5. Besides the vaccine, regular pap smears (at least once annually) are a good preventative measure against cervical cancer. Condoms, at best, provide 70 percent protection against HPV.

Basically, HPV is ridiculously common, and its worst manifestation (cancer) is totally preventable with Gardasil. Personal disclosure: last autumn, my pap smear came back irregular and it is likely due to a HPV infection (which is probably harmless and not cancer-inducing). With estimates of infection rates at 50 percent minimum and as high as 75 percent, it wouldn’t be terribly surprising if I contracted the STI version of the common cold. It’s not like I need to wave a sign that says, “It can happen to you.” In all likelihood, if you’re having sex, it already has happened to you. Still, this over-share — which I anticipate getting shit for — is my attempt at personalizing the typically taboo subject of STIs. I probably have some form of HPV, you probably have/will have some form of it, and if we’re going to be infected with something, let’s at least make sure it doesn’t turn into cancer.

Plenty of my girlfriends have already made appointments, and I’m pestering the rest to get on top of this. I got my first shot on Thursday. Despite the soreness in my upper left arm, it’s worth it. Please do the same.

* Harvard is not the only college that is subsidizing the shots. If your college is doing the same, please inform me in the comments!

New rule: No alcohol, period. Rita, the UHS psychiatrist in charge of deciding my fate (well, my prescription), was not pleased with my weekend visit to Stillman. “How can we accurately assess your condition if you’re using mood-altering substances?”

I didn’t have a good answer for her. “It was the only way I thought I could get through the night,” I explained. She told me I needed better ways to cope. I didn’t disagree but it’s not like she had a better suggestion for working through it.

Rita told me two weeks ago that I should limit myself to “one weak drink” per night. This time, she means it. This time, I need to take her seriously. No one seems to be able to pinpoint exactly what I am, and it’s crucial that I don’t fuck up a diagnosis with substance abuse. After I have a session with my therapist Sarah tomorrow morning, the two are going to “powwow” (actual quote) and determine if I should be a) medicated or b) institutionalized. Hopefully, I escape unscathed and without a recommendation for a dosage of anything but love.

Initially when I started therapy, all I really wanted was a prescription, a quick fix that would keep me productive, prevent me from slipping during all the wrong times. But now? Pills are the last thing I want. There’s absolutely nothing wrong with being on medications; I’d do it in a second if I really believed I needed it. But I’m not so certain anymore. Sure, there are days when I can feel myself losing it, but I almost always recover so I can’t tell if I’m battling depression or angst. Sure, I can be happy without reason at one instance and completely wind down the next, but does that make me bipolar? My symptoms are so imprecise that I bristled at Rita’s suggestion that I begin taking a low dosage of antidepressants. Even she can’t say conclusively what it is I am. And further, I don’t know how these things are prescribed — at the request of the patient or the judgment of the doctor? How much does my own desire for medication influence her decision to give it to me?

“The thing is, I’m a writer,” I told her. And immediately, she understood. Beyond the qualms I have about my vague diagnosis, I’m scared that the pills needed to dull the aches of my heart will be dulling my creativity as well. Sometimes, I feel desperate enough that I’d throw in the towel when it comes to writing if it means getting through another day. It shouldn’t be like that. There has to be a better way. I asked Rita why it was so hard to stay okay, why the normality that other people took for granted was something I had to fight for on a daily basis. To others, it seems like I’m doing just fine but I’m really treading water, barely keeping above the surface, and constantly scared of sinking. This isn’t fair. It shouldn’t be this hard. I’m not even asking to be happy; I just don’t want to be sad.

Today at Urban Outfitters, I bought one of these memo pads (displayed below). Part of cognitive behaviorial therapy involves changing the way I interpret situations. But I ditched the UHS-xeroxed mood charts Sarah gave me after just two days. Following a terrible Harvard-Yale Game (which I left after a mere 20 minutes), I filled out the chart for the first time and immediately decided it was stupid. I don’t have any desire to rationalize my radical thoughts or to create more balanced interpretations of events. I’d much rather talk about how shitty I feel all the time and this kitschy notepad lets me do just that. I know, I know - -I’m self-defeating. But I can’t help the fact that I would sometimes much rather wallow in this sorrow than really work on getting better. The effort seems futile, because I simply don’t know what it’s like to be just normal. Of everything I’ve experienced in life, “normal” has been last on the list.

For those curious, the official policy on dispensing Plan B at UHS. Trust this, not the nurse on duty at after-hours.
From: Gharib, Soheyla
Sent: Thu 11/30/2006 11:45 AM
To: All UHS Clinicians
Subject: FW: Plan B

Dear Colleagues:

As you know, Plan B has been approved by the FDA for over-the-counter
availability to women and men ages 18 and older. The following policies are in
place at the HUHS pharmacy:

* The HUHS Pharmacy will store a segregated supply of Plan B for dispensing to
female Harvard students with a valid Harvard ID who are age 18 or over (proof
of age is required using a government issued form of ID). These students will
receive Plan B free of charge.
* Prescribing and dispensing of Plan B in the clinic will remain the same. That
is, a student will be able to obtain Plan B at no charge.
* The over-the-counter price for Plan B at HUHS pharmacy is $36.19, not
including sales tax. This is the price that HUGHP members and male students
will pay. At neighboring pharmacies, prices range from $39 to $48.
* A pharmacist (or technician under the direct supervision of a pharmacist) will
provide counseling on how to use Plan B at the time of dispensing.
* In the future, a pharmacist will be able to utilize a standing order to
prescribe and dispense Plan B to women under 18 or a women with no government
issued form of ID . A log will be maintained for this purpose. All
pharmacists and pharmacy technicians will be required to complete an accredited
Emergency Contraception Training Program to do so. This is in progress, and
you will be notified once the standing orders are in place. For now, students
and other patients under age 18 will have to come in to be seen to get Plan B.

Thank you,

Soheyla Gharib, MD
Chief of Medicine
HUHS