A new at-home test for Human Papillomavirus (HPV) is making it easier, faster and more comfortable for people to screen themselves for the potentially cancer-causing sexually transmitted infection—if they can afford it. The testing kit, which costs $99, became available for purchase across most of Canada this fall.
Quite literally the most common STBBI (sexually transmitted or blood-borne infection) in North America, HPV is a catch-all term for more than 200 closely related viral strains passed sexually (but not through blood or saliva) between people. Some of these strains, referred to as “low-risk HPV,” cause few or no symptoms, although a couple of low-risk strains—most notably HPV6 and HPV11—can cause growths in and around the genitals and anus of infected people. These usually resolve without complications, and have no long-term health consequences, (although infections may recur, and can be spread to other sexual partners).
High-risk HPV strains, however, may initially manifest with no outward symptoms, but can cause cancers to develop years, or even decades, down the line.
HPV affects anyone, regardless of sexuality or gender. Studies have shown that sexual orientation in cis women has no impact on the risk of HPV infection—meaning you’re just as likely to contract HPV as a cis woman no matter who you get down with. Gay and bisexual men, for their part, have a higher rate of HPV-related anal cancers than cishet men.
Trans women may be even more likely to be infected with HPV than gay and bisexual men, and a recent study also found that trans and gender nonconforming people were more likely to develop HPV-related cancers.
While HPV infections can cause mouth, throat and anal cancer through oral or anal sex, the virus is most commonly associated with cervical cancer. Anyone who has a cervix can get cervical cancer, including transmasculine and non-binary people, whether or not they are on testosterone. HPV is the sole cause of cervical cancer.
As nearly all sexually active adults will contract some form of HPV within weeks or years of becoming sexually active, knowing whether or not you have the virus means knowing whether or not you can spread it. And regular testing can help determine whether or not you are at risk of cervical cancer. Because these infections often don’t cause immediate noticeable complications, you could be infected with a virus that could cause you or your partners serious health problems and not even know it—making HPV prevention and detection an important sexual health issue.
Up until recently, however, there was no quick, easy way to tell if a person was infected with HPV, says Michelle Halligan, director of prevention with the Canadian Partnership Against Cancer, an arm’s-length, federally funded non-profit dedicated to cancer prevention and control. The only way to detect cervical cancer was through a Pap smear, which doctors recommend having every three years, says Halligan. This method left something to be desired, however, as it only looked for the abnormal cells that may signal precancerous or cancerous development, and not the presence of the actual virus itself.
“HPV testing is a newer, better test at finding and preventing cervical cancer than the current Pap smear,” Halligan says. “The virus is obviously there well before the cancer develops. The Pap test is instead looking for abnormalities; it’s looking for precancerous cells, so it catches things later than the (new) HPV test.”
This is good news, because as anyone who has ever had one knows, a Pap is uncomfortable at best, quite painful at worst. And having a Pap smear as a trans or non-binary person can mean visiting a healthcare provider who may not be well versed in trans healthcare, especially in rural areas where access to providers may be more limited.
Conversely, this new test, which can be self administered at home without a doctor or done easily at a sexual health clinic, is a simple swab-sample test, very much like the kind of home test you would use to test yourself for COVID-19. It is much more accessible, accurate and timely than a Pap, says Halligan.
This new style of testing can also make access to care more equitable for queer, trans and non-binary people. LGBTQ2S+ folks may suffer from dysphoria, may lack access to healthcare providers or doctors they trust or they may have experienced discrimination or mistreatment because of their gender or sexuality within the medical system. A 2021 study by the Center for American Progress (CAP), for example, found that 50 percent of the trans and non-binary respondents had experienced mistreatment and discrimination within the medical system. For people whose relationship to healthcare feels fraught, having a medical test that’s as invasive and intimate as a Pap done can be deeply upsetting.
Ultimately, these barriers can deter some queer, trans and non-binary people from getting tested—which could result in potential health complications and higher risks for cervical and other types of HPV-related cancers, says Brenna Bezanson, project coordinator in trans health with the Centre for Gender and Sexual Health Equity (CGSHE) in Vancouver. Benzanson, who is working on a study around trans healthcare, says that preliminary numbers have shown that nearly half the trans folks surveyed so far report “avoiding or hesitating accessing sexual or reproductive healthcare, even when they felt like they needed it, because of fear of discrimination around their gender.”
“Something like this [new test], which can be done at home, outside of a healthcare setting, without the factor of not knowing how they’re going to be treated … I think could be quite life-changing for some people in the trans community,” Benzanson says.
“At-home test does presently have some drawbacks, mainly around cost and accessibility.”
Getting tested for HPV, Benzanson says, is an important health issue even among people who don’t have cervixes. But more research is required to better understand how to serve transfeminine people and cis men. Such little research has been done around the potential impacts of STTBIs on trans women who have had bottom surgery, for example, that researchers simply don’t know how easily they can contract HPV vaginally, or what kind of long-term health impacts it might have.
The at-home test does presently have some drawbacks, mainly around cost and accessibility—barriers similar to those some people encounter when accessing the HPV vaccine. In Canada, the test is currently mostly available through private companies; you order the kit online, test yourself with a swab at home and send it away for processing, at which time your results are made available to you through your private account. The test is presently not available in Prince Edward Island, Nunavut, the Northwest Territories or the Yukon.
Testing is also “a mixed bag” in the U.S., says Halligan, where they’re “not as caught up” as Canada is when it comes to HPV prevention and screening. Some states offer it, while others don’t, and cost varies depending on where you live and whether or not you have health insurance that covers it.
Although BC Cancer started an HPV testing pilot project in December 2021, the test is currently almost exclusively accessible in Canada through private healthcare companies like Switch Health, a private company that distributes tests, has you send them back in and delivers results through an online portal for a fee. This may give some people pause, and with good reason. Sensitive data about sexuality, fertility and gender collected by private companies also have the potential to be weaponized in an increasingly trans- and queerphobic world where Roe v. Wade has been overturned, which is why people who can get pregnant have been urged to delete period-tracking apps.
Nine out of 10 healthcare privacy breaches in 2022 occurred through private third-party vendors.
While the price and spotty access is certainly a barrier, the private availability of testing probably won’t last forever. Halligan says provincial governments will likely move to including at-home testing into public sexual healthcare in the near future.
“Provinces and territories are … basically moving away from Pap testing and introducing the HPV test,” says Halligan. “Many of them will look to introduce self-testing as a part of that.
“We want to see this publicly funded across the country and available to people who are eligible, free of cost.”
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