HPV Vaccine

[Odysseus]

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Hey all,
I was having this discussion w/ my girlfriend, and thought you guys may have some opinion. As a guy, would you want your gf to get the vaccine? Ladies, what's your perspective on getting the vaccine, especially since it affects our age group? What about the controversy w/ 9 yr olds getting it and thinking sex is OK afterwards? Since it tremendously affects our age goup, I thought this thread to fellow premeders would lead to interesting feedback. As future docs, what would you recommend your patients?

 

[armybound]

I'd have to have more data on the occurrence rate of HPV and what % of those cases turn into cervical cancer or have any kind of major complications.

My girlfriend was offered the shot for $400 and she passed, thinking the likelihood of this vaccine preventing the particular type of HPV she could or could not get that would turn into cancer is pretty low. Low enough to not warrant a $400 expense, anyway.

 

[Towelie]

Hey all,
I was having this discussion w/ my girlfriend, and thought you guys may have some opinion. As a guy, would you want your gf to get the vaccine? Ladies, what's your perspective on getting the vaccine, especially since it affects our age group? What about the controversy w/ 9 yr olds getting it and thinking sex is OK afterwards? Since it tremendously affects our age goup, I thought this thread to fellow premeders would lead to interesting feedback. As future docs, what would you recommend your patients?

Every female should get it. There should be no controversy. There is no data to suggest that giving this vaccine leads young girls to think that sex is "OK" afterwards. Quite the contrary; learning about HPV would probably make young girls less likely to engage in unprotected sex.

The "controversy" is much like the controversy that is stirred when educators want to make free condoms available at public schools. The Christian right gets furious because, according to them, condoms somehow promote pre-marital sex. Meanwhile, the STD rate in teenagers (particularly low SES teenagers) soars.

As a guy, why wouldn't you want your girlfriend to get the vaccine? Why wouldn't you want your girlfriend to have a decreased cancer risk? I can't think of a reason.

 

[MountainEM]

HPV is very prevalent in all age groups. If you can prevent this you should. I wish my gfriend could get it but she is 27 and it is only approved to age 26 right now. You cant tell if men have it if it is low-risk HPV and in some high risk HPV and there is no tests for males so it is easily passed on.

This vaccination should be standard for teenage girls
dave

 

[ordeliacay]

too bad insurance won't cover it, so most people can't get it. how many 20-somethings do you all know who can afford a $600 vaccine? if only i hadn't spent all of my money on applications...

 

[cowme]

Hey all,
I was having this discussion w/ my girlfriend, and thought you guys may have some opinion. As a guy, would you want your gf to get the vaccine? Ladies, what's your perspective on getting the vaccine, especially since it affects our age group? What about the controversy w/ 9 yr olds getting it and thinking sex is OK afterwards? Since it tremendously affects our age goup, I thought this thread to fellow premeders would lead to interesting feedback. As future docs, what would you recommend your patients?

As a guy, I would prefer my girlfriend to have the vaccine. Here's a link to some HPV stats... http://www.andrew.cmu.edu/user/mfrisby/statistics.htm.

According to this site, it is estimated that 75% of sexually active individuals will have HPV in their lifetimes. And since there is no way to test for the disease in males, even those who practice safe sex are still at a high risk for the disease. Vaccinations for sexually active females will significantly lower their risk for cervical cancer. Their partners will also benefit; not only by not having the disease transmitted, but by avoiding the potential to be an oblivious carrier for HPV and transmitting the disease to each subsequent partner.

 

[Towelie]

too bad insurance won't cover it, so most people can't get it. how many 20-somethings do you all know who can afford a $600 vaccine? if only i hadn't spent all of my money on applications...

This is true. But there are clinical trials for newer HPV vaccines going on all over the place. In a few years, I'm certain that insurance will cover the vaccine.

 

[sdn1977]

too bad insurance won't cover it, so most people can't get it. how many 20-somethings do you all know who can afford a $600 vaccine? if only i hadn't spent all of my money on applications...

Many insurance companies are now covering it - check it out! Two of the major insurers now put it on their covered drug list - Cigna & Aetna.

And, no, there should be no controversy. It vaccinates against a virus which causes disease - no more, no less.

Watch in the next few years....there will be one approved for both men & women.

This one is already recommended by the Am Ped Soc to be included in the routine vaccinations during childhood.

 

[aglaiaer]

.

 

[dannylee718]

I wonder what kind of "controversy" will arise if a vaccine for AIDS was ever made. 😕

 

[tangledupinblue]

It's not that the type of HPV you get will turn into cervical cancer, but that 70% of cervical cancer is associated with infection by HPV type 16 or 18, two of the types that are covered in the vaccine. And since cervical cancer is the second most common cause of cancer related death in women, that is pretty significant. A cancer preventing vaccine . . . . not bad. And they've also thrown in HPV types 6 and 11 that cause genital warts.

I'd have to have more data on the occurrence rate of HPV and what % of those cases turn into cervical cancer or have any kind of major complications.

My girlfriend was offered the shot for $400 and she passed, thinking the likelihood of this vaccine preventing the particular type of HPV she could or could not get that would turn into cancer is pretty low. Low enough to not warrant a $400 expense, anyway.

 

[armybound]

It's not that the type of HPV you get will turn into cervical cancer, but that 70% of cervical cancer is associated with infection by HPV type 16 or 18, two of the types that are covered in the vaccine. And since cervical cancer is the second most common cause of cancer related death in women, that is pretty significant. A cancer preventing vaccine . . . . not bad. And they've also thrown in HPV types 6 and 11 that cause genital warts.

I just took a few minutes to research the vaccine, and I still don't think it's worth it (in my girlfriend's case, I mean.)

The figures vary, but it seems that 50-75% of all women will get some form of HPV. What form? Who knows. Of those, approximately 1% will turn into cancer or precancer in the absence of regular Pap smears. About 89% of women in the US get regular Pap smears, which are 95%+ effective in detecting HPV. Most cancers are caused after a long exposure to HPV, which suggested to me is an exposure in a woman who has not been getting Pap smears, or Pap smears that were insufficient in detecting the HPV over several years.

HPV is more common in the sexually promiscuous. These vaccines only prevent the initial infection of the virus. Maybe I'm short-sighted, but I don't know if women in a long-term monogamous relationship with no history of HPV who get regular gynecological exams are at great risk for cervical cancer.

But as far as recommending it to my patients, sure. It sounds like a great product. 🙂

 

[aglaiaer]

.

 

[Towelie]

I just took a few minutes to research the vaccine, and I still don't think it's worth it (in my girlfriend's case, I mean.)

The figures vary, but it seems that 50-75% of all women will get some form of HPV. What form? Who knows. Of those, approximately 1% will turn into cancer or precancer in the absence of regular Pap smears. About 89% of women in the US get regular Pap smears, which are 95%+ effective in detecting HPV. Most cancers are caused after a long exposure to HPV, which suggested to me is an exposure in a woman who has not been getting Pap smears, or Pap smears that were insufficient in detecting the HPV over several years.

HPV is more common in the sexually promiscuous. These vaccines only prevent the initial infection of the virus. Maybe I'm short-sighted, but I don't know if women in a long-term monogamous relationship with no history of HPV who get regular gynecological exams are at great risk for cervical cancer.

But as far as recommending it to my patients, sure. It sounds like a great product. 🙂

This is crazy. At least talk to a doctor about it rather than doing just cursory internet research.

 

[armybound]

This is crazy. At least talk to a doctor about it rather than doing just cursory internet research.

I never claimed to be an expert. I even said I'd recommend it. From the reading that I did, it's pretty obvious that most women would benefit from it.

My point is simply that if you cannot afford it, and you're not at a great risk for it, it might not be worth going hungry or not being able to pay rent so you get this treatment.

When it gets cheaper or you have the spare money, sure. Or if your insurance covers it.. by all means.

 

[morriske]

pap smears do not necessarily detect HPV. Many women will have normal pap smears and still have HPV. Likewise, many women who do not have HPV will have abnormal pap smears at some point. In order to determine if a woman is infected with HPV, a DNA test must be done. I'm assuming a woman who is already infected with HPV should not get the vaccine. In women who are already sexually active I think a DNA test must be done before they can receive the vaccine.

 

[wannabedoc85]

pap smears do not necessarily detect HPV. Many women will have normal pap smears and still have HPV. Likewise, many women who do not have HPV will have abnormal pap smears at some point. In order to determine if a woman is infected with HPV, a DNA test must be done. I'm assuming a woman who is already infected with HPV should not get the vaccine. In women who are already sexually active I think a DNA test must be done before they can receive the vaccine.

your last sentence is incorrect. even if a woman has a pap smear that turns out to be positive for hpv, their is still merit in getting the vaccine. there are over a 100 types of hpv, many of which can cause alterations to cervical cells. however, only a few of these types cause cervical cancer, as your body is not able to fight it off. the vaccine protects against *4* hpv strains, so if you are positive, most likely from one strain, this vaccine still provides protection against the other four.

 

[TPROrgoTutor2]

Hey all,
\What about the controversy w/ 9 yr olds getting it and thinking sex is OK afterwards?

They need to be vaccinated. 9year olds thinking sex is ok is absolutely horrible parenting.

A huge % of girls get HPV and I have seen projections that put the vast majority of individuals having it within the next two decades. And by vast majority I mean over 85%. But there are harmless forms, there are forms causing genital warts, there are cancer causing forms...why on earth would a woman NOT get the vaccine? ALL female children need to be vaccinated, its ridiculous for them not to be. If there is any form of controversy surrounding this it is being instigated by ignorant individuals.

 

[morriske]

your last sentence is incorrect. even if a woman has a pap smear that turns out to be positive for hpv, their is still merit in getting the vaccine. there are over a 100 types of hpv, many of which can cause alterations to cervical cells. however, only a few of these types cause cervical cancer, as your body is not able to fight it off. the vaccine protects against *4* hpv strains, so if you are positive, most likely from one strain, this vaccine still provides protection against the other four.

Hmm...my friend who is hpv positive was told that she shouldn't get the vaccine. Could she have all 4 strains? 😱

 

[pennybridge]

Hi I just got a Polio vaccine, now I have this irrestistable urge to move to a third world country and start ingesting the feces of local sick kids.

OP, remove head from butt before speaking.

 

[wannabedoc85]

Hmm...my friend who is hpv positive was told that she shouldn't get the vaccine. Could she have all 4 strains? 😱

really, i guess i must have heard wrong!

 

[etsuprinthead]

provided that it's safe (i HAVEN'T done my research), I think it should be standard practice to get it. I want my 11 y.o. sister to get the vaccine. And, especially if Cigna covers it, like someone said, I plan to get it when I go to the doc this summer. i think it's a little funny (not ha-ha) that people talk about "finding a cure for cancer" but are so averse to finding a PREVENTION for cancer. i mean, if your 8th grader is going to have sex, she's going to have sex whether you vaccinate her or not. at 13, what kid is thinking, "oh, I'm not going to have sex because I might end up with cancer in 10 years"?

 

[pennybridge]

Hmm...my friend who is hpv positive was told that she shouldn't get the vaccine. Could she have all 4 strains? 😱

your friend was told wrong, the vaccine is reccommended for all women between (what? 14 and 26?) regardless of hpv status

 

[supersash]

i think the HPV vaccine is a MUST! i work in an OB-GYN office, and can say that: 1) MANY insurance plans are covering the injections. the patient pays up front the $100-$200 fee, but is ultimately only responsible for about $20-$50 per injection (you need three spread over six months). 2) many girls of all ages are coming in for it, and many don't care whether or not insurance will cover it. $600 is nothing compared to the costs that go into treating cancer, and the psychological damage that may ensue.

http://www.niaid.nih.gov/factsheets/stdhpv.htm
more info on HPV, including:

"Gardasil is a vaccine that prevents infection with four HPV types: 6, 11, 16, and 18. Types 6 and 11 are low risk HPV types, associated with 90 percent of genital warts. Types 16 and 18 are high risk HPV types which together cause 70 percent of the cases of cervical cancer."

as for the remark that getting a vaccine to prevent cancer will make 9 year olds go out and have sex, i think it is insane. this should be a regular vaccine, given at the pediatrician's office. i'm not advocating 9 year old going to the OB/GYN if not nessecary, but preventing kids to get a vaccine that can prevent cancer?! that is crazy to me...

 

[MountainEM]

armybound-

If you are really army bound and your gfriend is not getting the vaccine, make sure she dont get lonely😉

 

[BellyDancingDoc]

Hmm...my friend who is hpv positive was told that she shouldn't get the vaccine. Could she have all 4 strains? 😱

Hey morriske,

Whatever doc told your friend that she shouldn't get the vaccine clearly failed to research it properly unless she truly does have all 4 strains (unlikely). It says right in the Gardasil prescribing info on page 3 that "Individuals who were already infected with 1 or more vaccine-related HPV types prior to vaccination were protected from clinical disease caused by the remaining vaccine HPV types."
http://www.merck.com/product/usa/pi_circulars/g/gardasil/gardasil_pi.pdf

My bet is that the doc was just lazy and didn't want to do his/her reserach properly. Tell your friend to get the shot if she still wants it... and then to get a different doctor. 😡

 

[morriske]

Hey morriske,

Whatever doc told your friend that she shouldn't get the vaccine clearly failed to research it properly unless she truly does have all 4 strains (unlikely)

You don't know my friend. It is possible....

 

[alwaysaangel]

Lots of insurance companies are covering it.

However, many are not covering it if you're not a virgin (specifically places like Kaiser where your doctor and your insurance are interrelated). Because its a preventative measure if you've already had sex it is likely you've already contracted a strain of HPV and they don't want to cover it.

It sucks, but oh well.

It is definitely a good thing to have. If your insurance will cover it (MAKE SURE THEY WILL - OTHERWISE ITS LIKE $300/shot) then you should go for it. No it doesn't cover all strains of HPV, but it covers a lot of them.

I personally don't need it in my current relationship, but if we break up I will probably go ahead and pay out of pocket for the vaccine. Its such a prevalent disease and since guys have no symptoms (unless its a wart strain) you can't know if your partner has it and will pass it to you. Better safe than sorry.

 

[BellyDancingDoc]

You don't know my friend. It is possible....

Oh. Ohhhhhhhhhhhhh. Alas. 🙁

 

[armybound]

armybound-

If you are really army bound and your gfriend is not getting the vaccine, make sure she dont get lonely😉

It's my secret plan to keep her afraid of cheating. If she gets HPV from cheating on me, she deserves it.

Just kidding.

 

[morriske]

Oh. Ohhhhhhhhhhhhh. Alas. 🙁

just to clarify, we're best friends but quite different. I've been married for 2.5 years to my high school boyfriend. I don't want to give myself a tainted reputation by association

 

[stixx]

I don't see any negative besides the cost. I'm in canada and it's still going to cost ~700 bucks (luckily my mom is paying for it)

 

[pennybridge]

However, many are not covering it if you're not a virgin (specifically places like Kaiser where your doctor and your insurance are interrelated). Because its a preventative measure if you've already had sex it is likely you've already contracted a strain of HPV and they don't want to cover it.

are you sure about that? Granted I wouldn't put anything past Kaiser, but that's seven levels of messed up, and probably litgation material.

I personally don't need it in my current relationship, but if we break up I will probably go ahead and pay out of pocket for the vaccine. Its such a prevalent disease and since guys have no symptoms (unless its a wart strain) you can't know if your partner has it and will pass it to you. Better safe than sorry.

if you can use the sentence "if we break up" then, yes, you definitely need that vaccine.

 

[Rachael07]

too bad insurance won't cover it, so most people can't get it. how many 20-somethings do you all know who can afford a $600 vaccine? if only i hadn't spent all of my money on applications...

I know blue cross/blue shield covers the vaccine

 

[Catalystik]

Lots of insurance companies are covering it.


It is definitely a good thing to have. If your insurance will cover it (MAKE SURE THEY WILL - OTHERWISE ITS LIKE $300/shot) then you should go for it.

My clinic purchases the vaccine for $117/dose and sells it without a markup or charge for administration (total for the three doses is $351.00). Anyone selling it for $300/dose is ripping you off, so consider shopping around. Despite this expense, it is selling like hotcakes in our institution to those without insurance to cover the expense.

 

[alwaysaangel]

are you sure about that? Granted I wouldn't put anything past Kaiser, but that's seven levels of messed up, and probably litgation material.

My doctor told me that "the vaccine is only available for virgins." I questioned this later when I called their overall office and they told me they are choosing to cover it for virgins since its preventative but are not covering it for non-virgins. Thats their choice I doubt I could sue over it.

if you can use the sentence "if we break up" then, yes, you definitely need that vaccine.

This is a really stupid statement and I take offense to it.

Just because I'm 22 years old and realistic about my future I "definitely need that vaccine." You're an idiot.

Even though right now I can see myself spending the rest of my life with this man, I'm not stupid. I'm young, and God only knows how much I'll change in the next few years. Do we want to get married - yes. Do we think we are too young - yes. Are we realistic that we may change and not get married - yes.

And if you think that means I "definitely need that vaccine" then you are a *****. Anyone who is dead sure they're spending the rest of their life with their boyfriend at the age of 22 is naive.

 

[alwaysaangel]

My clinic purchases the vaccine for $117/dose and sells it without a markup or charge for administration (total for the three doses is $351.00). Anyone selling it for $300/dose is ripping you off, so consider shopping around. Despite this expense, it is selling like hotcakes in our institution to those without insurance to cover the expense.

Not me - its what a friend of mine was charged. I'll let her know she was ripped off.

 

[pennybridge]

My doctor told me that "the vaccine is only available for virgins."

are you sure it was a doctor? What do they do, check? Sounds like that's based both on medicine and science!

This is a really stupid statement and I take offense to it.

uh oh. now I need to buy chocolates to make it better.

Just because I'm 22 years old and realistic about my future I "definitely need that vaccine." You're an idiot.

Even though right now I can see myself spending the rest of my life with this man, I'm not stupid. I'm young, and God only knows how much I'll change in the next few years. Do we want to get married - yes. Do we think we are too young - yes. Are we realistic that we may change and not get married - yes.

And if you think that means I "definitely need that vaccine" then you are a *****. Anyone who is dead sure they're spending the rest of their life with their boyfriend at the age of 22 is naive.

see, you misunderstood. We're actually in agreement. The fact that you're not married and don't have kids means you should get the vaccine to protect against the sexually transmitted virus that causes cervical cancer.

I'm not sure if I need to spell it out for you, but I will anyway because it's fun:

your boyfriend will cheat on you.*




* I suppose "could" is a better word.

Here's how it works: You two get in a fight over who loves who more and who should hang up the phone first. He goes to a bar to drown his sorrows because his girlfriend is ******ed. He sleeps with some random bar skank who is infected with god knows what.

You two make up and do the dirty and now you have cancer. Happily ever after.

You're basing your decision on whether or not to protect yourself against a virus based on teh assumption that your boyfriend won't cheat on you?


what was that word you used?..... naive? yeah, that was it.

 

[TPROrgoTutor2]

While I agree that it may not be the best move to opt out of protecting yourself, you are a jackass pennybridge.

 

[pennybridge]

While I agree that it may not be the best move to opt out of protecting yourself, you are a jackass pennybridge.

she dropped the "n bomb" first.

 

[QuantumMechanic]

You two make up and do the dirty and now you have cancer. Happily ever after.

you forgot to mention the nasty case of genital warts that precedes the cancered cervix.

 

[stixx]

While I agree that it may not be the best move to opt out of protecting yourself, you are a jackass pennybridge.

It's harsh but it's probably true.

I can't stand it when certain groups of people get all high and mighty because they think "i'm too good" to get a disease. Sure you could be in a relationship, that doesn't make you special.

It was the same with straight people refusing to get tested for AIDS and spreading it...honestly if this vaccine were free and you won't get it out of pride, you're doing society a disservice. End of story.

 

[pennybridge]

you forgot to mention the nasty case of genital warts that precedes the cancered cervix.

i always like to refer to them as "gentle warts." It's a kinder, friendlier carcinogenic papillomavirus 😉

 

[QuantumMechanic]

i always like to refer to them as "gentle warts." It's a kinder, friendlier carcinogenic papillomavirus 😉

its the PC thing to do

 

[Law2Doc]

Since it tremendously affects our age goup, I thought this thread to fellow premeders would lead to interesting feedback. As future docs, what would you recommend your patients?

Since HPV vaccine is not one of the vaccines required for med school, this thread probably doesn't belong in pre-allo. FWIW, Very few of you will have your anti-vaccine views once you have completed your medical school course in microbiology.

 

[alwaysaangel]

are you sure it was a doctor? What do they do, check? Sounds like that's based both on medicine and science!

She was my OB/gyn and we had just finished my annual - sexual activity came up in the exam. Then I asked and she told me that.

uh oh. now I need to buy chocolates to make it better.

I'm an anti-feminist and even I'm offended by that.

see, you misunderstood. We're actually in agreement. The fact that you're not married and don't have kids means you should get the vaccine to protect against the sexually transmitted virus that causes cervical cancer.

I'm not sure if I need to spell it out for you, but I will anyway because it's fun:

your boyfriend will cheat on you.*

But he won't as my husband? Interesting theory. Its actually the person that determines cheating - not the title. The man I am with will not cheat on me - for a lot of reasons, but he won't.

Here's how it works: You two get in a fight over who loves who more and who should hang up the phone first. He goes to a bar to drown his sorrows because his girlfriend is ******ed. He sleeps with some random bar skank who is infected with god knows what.

You two make up and do the dirty and now you have cancer. Happily ever after.

Good thing we don't have fights like that. Never left a fight mad. And he wouldn't sleep with someone to punish me, again for a lot of reasons that aren't appropriate for this board but mainly he has a lot of sexual proclivities that your typical barskank won't meet.

You're basing your decision on whether or not to protect yourself against a virus based on teh assumption that your boyfriend won't cheat on you?

Yes, I am. And I am confident in that choice and its not naivity.

Just cuz you cheat on your gfs doesn't men all men are sleezy.

 

[stiffany]

honestly if this vaccine were free and you won't get it out of pride, you're doing society a disservice. End of story.

I think this comment goes a bit far and no I'm not someone that's going to argue that vaccines are somehow bad or that even younger children (like the 9 year old the OP mentioned) shouldn't be educated about sex. Instead, I think deciding to get a new vaccination should be a personal decision and not heralded as some necessary requirement in order to be a respectable member of society. In my opinion, too many things in women's health have been found to be potentially harmful (look at hormone replacement therapy for an example or certain versions of hormonal pills or the Dalcon Shield or Norplant, et cetera) and therefore one should make an educated decision about getting the vaccination for oneself instead of just going with the crowd out of guilt. Plus, this vaccination is heavily cost prohibitive. For instance, my insurance doesn't cover it (granted my insurance doesn't cover most women's health things except pregnancy - which you'd think would be more expensive for an HMO to cover but I'm digressing...)

Secondly, I think the argument that getting a vaccination for a disease contracted through sexual intercourse encourages kids to have sex is totally bogus. Just because you mention to your child that they should be protected against said disease once they start having sex doesn't mean they're going to go run around and procreate like a rabbit. Give kids a bit more credit. Furthermore, removing the potential harm of HPV doesn't prevent pregnancy, HIV/AIDS, or any of the other detrimental conditions (okay, maybe pregnancy isn't detrimental - but when I was a teenager it seemed scarier than any STD someone could throw at me). Instead, it prevents certain types of a virus that can later me transmitted to said child once they become sexually active (regardless of whether that happens at 13, 20, or 35). Finally, we allow kids to get vaccinated against hepatitis B and don't discuss the fact that we could be encouraging kids to have sex or do intravenous drugs with that vaccination so why should HPV be any different?

 

[alwaysaangel]

It's harsh but it's probably true.

I can't stand it when certain groups of people get all high and mighty because they think "i'm too good" to get a disease. Sure you could be in a relationship, that doesn't make you special.

It was the same with straight people refusing to get tested for AIDS and spreading it...honestly if this vaccine were free and you won't get it out of pride, you're doing society a disservice. End of story.

Its not high and mighty. I know his sexual history and I know mine. As of right now, I cannot have HPV. He will not cheat on me (or at least the possibility is so low its negligible). Taking all that into account and the fact that we are monogamous my chances of contracting HPV are so low that it is in no way worth it to me to pay upwards of $500 for a vaccine I don't need.

If it were free - sure I'd get it. But its not - its really expensive.

 

[stixx]

Its not high and mighty. I know his sexual history and I know mine. As of right now, I cannot have HPV. He will not cheat on me (or at least the possibility is so low its negligible). Taking all that into account and the fact that we are monogamous my chances of contracting HPV are so low that it is in no way worth it to me to pay upwards of $500 for a vaccine I don't need.

If it were free - sure I'd get it. But its not - its really expensive.

How is that not high and mighty? If you don't want the vaccine because of the money, say so. Why bring "oh i can't get it anyway" into it at all?

 

[alwaysaangel]

How is that not high and mighty? If you don't want the vaccine because of the money, say so. Why bring "oh i can't get it anyway" into it at all?

I never said that, I said I can't possible have it NOW, and that the likelyhood of getting it in the future while with my bf is very low.

I tried to get the vaccine, thats why I know my insurance won't cover it. If it were free I would have gotten it.

I bring up my likelyhood of getting the disease because if I thought I was at high risk then I would spend the money. Its a cost benefit analysis. And my likelyhood of getting it is too low to be worth paying the money. I don't know how I can possibly spell it out more clearly.

If you think being economical and realistic is high and mighty then thats your problem.