1. De-Gendering and De-Individualization
Students were highly focused on doing gender, but were developing their sense of self or ethical identities by doing gender through resistance to being put in a box of the
“feminine” (Moore 2010:96) by sales/governance strategies. Students were upset and angry with the gendering of the vaccine (and, hence, the virus) to the extent that 70 percent decided not to be vaccinated or delayed their decision.64 The decision to forgo vaccination is a form of what Streefland et al. call “non-acceptance” (1999:1709) of the vaccination. In non-acceptance, individuals “question the need for vaccination”
(Steefland et al. 1999:1710). When non-acceptance becomes widespread, collective resistance can emerge, but for students decision making occurred on an individual level.
Historically, there have been many organized movements against vaccination, such as the 19th century grassroots campaign against smallpox vaccination in England, and
64 Whether or not this form of “negative agency” (Wardlow 2006) puts students at risk should be debated, but this is not the focus of the research. Public health policy makers and communicators should take note of how gendered framing affects vaccine decision making outcomes.
current day activism in the Netherlands against rubella and mumps inoculations. For students, however, there was “no organization, no active mobilization” (Steefland et al.
1999:1712).
Interestingly, though, in explaining their reasons for vaccine non-acceptance, students moved from the individualized sphere of vaccine decision making to seeking collective measures to address vaccine gendering and its social consequences. As Maya stated, the gendering of the vaccine and STIs made her feel “sick.” Sylvana described this type of gendering as, “the wrong approach.” Amber felt that current day gendering was the continuation of negative historical discourses vis-à-vis women that could be traced back to the 19th century. Maya’s decision not to get the vaccine and Sylvana’s decision to delay were both their way saying “no” to the gendering of the vaccine (and the virus) in governmental and pharmaceutical discourses.65 Even Amber, who changed her mind in favour of being vaccinated after seeing a friend experience a protracted HPV infection, was conscious of the social implications that current, gendered HPV vaccine policy and pharmaceutical sales/governance strategies in Canada brought. Amber elaborated,
“okay, so I have a problem, as I mentioned, with the vaccine even though I got it. I fundamentally have a problem with it because the way it’s being marketed towards girls, stigmatizes girl’sand women’s sexualities as being a part of the problem.” As
65 It is important to note that students did not speak about being targeted because of their age. Discourses surrounding youth and risk are rife in public health programming (see Brown et al. 2013; Spencer 2013; Thing and Ottesen 2013) and society in general (Giroux 2010), but students ranged in age from 20 to 28 and they did not consider themselves to be “youth.”
Gregg notes, “STDs are . . . particularly stigmatizing for women, for whom cultural ideals of premarital virginity, marital monogamy, and respectability clash with the reality of sexually transmitted infections” (2011:77).
Sylvana and Maya resisted the subject formation of the risky, HPV-related girl/woman by saying “no” to the vaccine, but at the same time they were acutely aware of gender imbalances in sexual health negotiation. As such, their vaccine negotiation was rife with similar “paradox” (Butler 2004:3) and complexity that mothers experienced. Students spoke in great detail about negotiating sexual health as a challenging endeavor (see Roche et al. 2005; Richens et al. 2003; Shoveller et al. 2010; Thomas 2005). Sexual health gender imbalances brought risk into their daily lives. In practice, as Sylvana explained, women experience vulnerability, just as she did when she contracted genital warts from her boyfriend when she thought they were in a monogamous sexual
relationship. Sylvana opined that in an effort to avoid “all sexual transmittable diseases, the first step to preventing them is communication between partners and equal
involvement of both partners in awareness of their risks and just check ups and things like that, like knowing your status related to various diseases.” While this would be the ideal scenario, Sylvana herself experienced a breakdown in such communication when her partner was unfaithful and she was left, as she said, “exposed.”
Maya also spoke about the vulnerability young women experience in sexual encounters.
She elaborated:
But then there’s also the layer of young girls not being empowered to make these decisions as well. So, that has nothing to do with education. Like you may right know that having unsafe sex, unprotected sex is dangerous but that you don’t necessarily have the power to make that choice in the situation. And so that adds another dimension to it.
Like Maya, students did not always feel they had the power to press for the use of barrier contraceptives while engaging in sexual practices. They might indeed have known that not using such measures could lead to STIs, but they did not always feel they could advocate for their own health concerns in such situations without alienating a male partner. This, coupled with the fact that partners were not always faithful, made students feel vulnerable. While Maya’s and Sylvana’s decisions not to be vaccinated can be placed within the frame of doing gender through resistance, Amber’s “yes”
decision can also be viewed as being a form of quiet protest. Amber may not have refused vaccination, but she deployed vaccination as a tool to help strengthen her position in future sexual health negotiation. Amber revealed, “I guess my own concern about my sexual health outweighed any potential problems that might come with it.
And, so, which is why I decided to get it.” Thus, students demonstrated that resistance was as intricate as the paradoxes exhibited by mothers and could not be measured by vaccine decision outcomes alone.
Students, overall, urged for a more open climate about sex, sexual relations and STIs.
They reasoned that if more people talked openly about sex, sexual health negotiation would be more balanced; if such a climate existed both men and women would be aware of STI risk and take measures to protect themselves. They posited that delivering
an STI-related vaccine – the HPV vaccine – in school settings across the province and country while not leveraging this program to provide accompanying sexual health education was a missed opportunity. Not only did students wish for sexual education curriculum to include HPV as a topic, they were convinced that if sexual education was covered more frequently and in more depth in both primary and secondary schools,66 not only would young women be aided in negotiating their sexual health, it would help lift the STI-related “stigma” (Goffman 1963). They argued that the more sex, sexual relations and STIs were talked about, the more individuals would realize how commonplace they were. This would alleviate the compulsion to shroud such experiences in silence for fear of being judged. As Maya insisted, instead of being considered a big or traumatic event, “people should think of HPV as part of a normal, healthy sexuality because it can’t necessarily be prevented, so if you are going to have sex, you are going to end up getting HPV, probably, at some point.” Maya did not put the onus solely on the educational system, she stressed that society as a whole, must also start to “talk about sex.”
By wanting to bring sex and sexual relations into everyday conversation, students were not only aiming to ease the stigma – they were trying to resist it. This was an effort in re-ordering daily discourse. Through this suggested re-ordering, they resisted the social exclusion that resulted from others knowing they had contracted an STI and being
66 Lear (1995) also found that young adults reported that the sex education they received before university was “woefully inadequate” (1317).
depicted as “dirty” or “deviant” women. Although writing about disability, Das describes the effects of social exclusion:
The entire discourse of anxiety that surrounds the stigma of deformed bodies thus is about reduction of sociality, exclusion from moral community as well as subjective feelings of guilt and shame. Being cast out of the social community coupled with a diminished sense of worth reduces the capability of the afflicted person to seek help even when this is in objective terms, easily available.
[2001:5]
Student resistance to the gendering of the vaccine and the virus, vulnerability in sexual health negotiation, and the stigma associated with STIs were all factors integral to their developing sense of self as young women. Their telos involved rejecting being painted as “dirty” and “sexualized” women, all the while being acutely concerned about the uneven power relations present in sexual health negotiation with male partners. This was a complex form of risk negotiation because on the one hand they were out rightly refusing to be identified as risky sexual beings, but on the other hand, they were trying to find ways to mitigate their risk as sexually active women who had contracted STIs.
Their prescription for dealing with stigma was increased sexual health education, both in schools and in society in general through public health measures. Students attempted to adjust the neo-liberal devolution of public health services, which has been rampant under the auspices of the new public health paradigm (Lupton and Petersen 1996), by
urging for greater sexual health education in schools. As such, students were trying to shift the onus for public health education from the individual back onto the state.67 Thus, their negotiating risk was cast as a re-ordering of existing power structures, but not in a way that dissolved the institution currently perpetuating the subject formation of the HPV-oriented risky young woman. As for mothers, for students there was “no self-making outside of the norms that orchestrate the possible forms that a subject may take”
(Butler 2008:26-27). This speaks to student recognition that risk is a social product – if it can be constructed as an individual and gendered problem through sales/governance strategies, these premises can also be de-constructed through state provided educational programming.