16 (Virus), 2016 HPV Project Ceramic 13 x 13 x13 cm
At present it is possible to understand a community through the diseases it develops, especially those of infectious origin. One of the most interesting groups of agents to analyze within the agent-guest-environment model are sexually transmitted infections (STIs). Their close relationship between patterns of transmission and human sexuality is symbiotic and unique. They act as a reflection of our personal attitudes, sexual practices and socio-political context.(1)
Human papillomavirus (HPV), human immunodeficiency virus (HIV), herpes simplex virus (HSV), gonorrhea, syphilis, trichomoniasis and chlamydia all act as a biological marker of social behaviours that prevail in our communities. Only from the last four, it is estimated that there are 376 million new cases per year worldwide.(2) Another 36 million people living with HIV,(3) 417 million with HSV and 291 million women suffer from an HPV infection.(2)
Through these statistics, it is easy to understand that they are inserted in our personal and collective histories between the private and the public. We tend to think of them as single-sided agents but in reality, they look like a heterogeneous family: although they have similar features, some have qualities that make them less infectious or more lethal than their peers.
While we observe them through the microscope and try to decipher the impact of their presence in our populations, in reality what we see is a reflection of ourselves. Each person infected with a virus, a bacteria or a parasite may function as a data source that reveals microscopic and social interactions.(1) Many scientists use this information to create what is known as epidemiological surveillance systems. These systems are used to trace microbiological and social patterns that allow their spread in our society. Commonly, this information is used in medicine to guide contextualized public health responses,(4) but we could use it as the biological record of our social behaviours.
For example, HPV is a group of DNA viruses that integrate into our genome, that is, the vital information that makes us what we are.(5) The lesions produced by this virus are linked to its replication and persistence in our cells, which can produce genital warts and cervical cancer.(6) This is very interesting because on the one hand the virus integrates in the affected area of the skin at a physical level,(7) but on the other hand it does at the species level, following a pattern similar to the policies in relation to it that are established in society.
Sexual Networks (Prototypes), 2018
For men, an infection by this virus is not very significant, since the majority are asymptomatic. At most, it will result in a genital wart that in theory can be easily removed.(8) This is one of the reasons why their role, essential in the transmission of the virus, is usually omitted. In contrast, for women, an infection can be devastating in many cases is. When a high-grade infection by this virus becomes symptomatic in them, it is commonly revealed through vaginal bleeding. From the medical point of view, the diagnosis will consist of an examination of their private parts under a microscope and then taking biopsies. The woman who experiences a viral infection of this type suffers from a physical, economic and social point of view.(9) Their self-esteem is also frequently affected and in many cases, during the course of the treatment of these infections or the cancer they cause, a dissociation with their sexuality occurs. They face a diagnosis that besides being physically painful and causing great emotional stress, is also judged socially.(10)
Untitled (Pendulum), 2016 HPV Project
Steel, resin, magnets and gold.
54 x 30 x 30 cm
These viral lesions appear to be an individual problem, however they represent one of the greatest threats for all women, especially those living in low and middle income countries. Cervical cancer, caused by this sexually transmitted virus, is the second most common and an important cause of death among women from these countries. Just in 2018, the World Health Organization estimated 570,000 new cases and more than 270,000 deaths from cervical cancer worldwide. Of these, 90% of deaths occurred in low and middle income countries.(2) Undoubtedly, this virus leaves a physical, psychological and social trace that marks the lives of millions of people. Not for nothing does this virus carry the word "human" in its name.(11)
A serious consequence of its progression in the body is that it can cause infertility in women due to the damage that the cancer produces in their reproductive system.(12) From another perspective, it has the ability to act as a viral regulator of female sexuality.
Visualizing the connection of a cancer cell to social behaviours may not be so simple. Perhaps one of the most direct ways is through the analysis of the prevention strategies described by the World Health Organization, which are classified as primary and secondary prevention.(13)
The first group aims to prevent the disease from occurring in the first instance and includes improving socioeconomic status, education, empowerment of women and vaccination against HPV. The second group aims to detect a disease and stop its progression, therefore they include access to medical care and a screening test such as a Pap test or cervical test. Interestingly, the prevention strategies for this virus are mainly targeted at solving social problems, especially socioeconomic and gender inequality.(13)
We could say that the presence of this virus in a community directly points to social and political behaviour. Proof of this is that in most countries of the world, girls are vaccinated, while boys are not.(14) The predominant argument is that women are the most affected by HPV.(15) However, the role of men in the transmission of the virus and in sexual health services is often overlooked. Women are often stigmatized because the causative factor is a sexually transmitted infection. Even among the medical literature it is possible to find discriminatory descriptions of women carriers of this infection.(10, 16)
Untitled (Engagement Ring), 2017 HPV Project Gold and glass
In some cases, the comparison with breast cancer, which has a completely different aetiology, is made to emphasize an association with disapproved and considered promiscuous sexual behaviours. In most countries, women experience this cancer in isolation as a result of this stigma, the nature of the infection and their socioeconomic conditions.(10)
The lack of education and deficient access to sexual health services becomes evident through the presence of this virus within a community. Generally, it would take more than 10 years for a standard HPV infection to turn into cancer.(17) From the microbiological point of view, the virus remains dormant in the body as a silent infection that may or may not progress. At a social level, women are also expected to be silent about their sexuality. Likewise, this also prevents them from accessing a screening test, negotiating condom-use, demanding decent working conditions or even receiving an adequate education. For many others, talking about it could even cost them their lives.(18)
Both in social behaviours and viral infection patterns, there is a regulation of women by not allowing them to take control of their body and sexuality. The virus controlling the expression of their DNA with the capability to cause cancer,(6) and the social control of women by denying sexual autonomy, which contributes to sexual violence behaviours.(18) The absence or inapplicability of laws that protect their human rights is comparable to the null or partial immune response that fails to protect the body from this virus. Precisely, there is a vaccine to train the immune system against HPV and prevent an infection, however its application depends on current public health policies.(14)
There is an echo between these social behaviours, the epidemiology and the patterns of infection that enables us to see our societies. The purpose of opening this dialogue is not to create a battlefield, especially between men and women. Instead, to accept the responsibility of working together to reduce these avoidable pains and deaths. The ability to recognize our social behaviours through the diseases or infections we develop is a potentially overlooked value of these agents. We have the opportunity to visualize our societies from a viral or bacterial perspective, approaching them with biological evidence of the social. In that sense, our body, both physical and social, functions as the record of the socio-political context in which we live seen through the agents that colonize it and its diseases.
Karyogram 23, XX (Chromosomes), 2017 HPV Project
Tricholoroacetic acid and ink
110 x 66 cm each
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World Health Organization. Report on global sexually transmitted infection surveillance 2018. Geneva: WHO; 2018.
UNAIDS. Global HIV & AIDS statistics - 2018 fact sheet: UNAIDS; 2018 [updated 2018, 15 May]. Available from: https://www.unaids.org/en/resources/fact-sheet.
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Bruni L, Diaz M, Barrionuevo-Rosas L, Herrero R, Bray F, Bosch FX, et al. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet Glob Health. 2016;4(7):e453-63.
Chesson HW, Ekwueme DU, Saraiya M, Dunne EF, Markowitz LE. The cost-effectiveness of male HPV vaccination in the United States. Vaccine. 2011;29(46):8443-50.
Biswas L, Manna B, Maiti P, Sengputa S. Sexual risk factors for cervical cancer among rural Indian women: a case-control study. Int J Epidemiology. 1997;26:491-5.
Schiffman M, Castle PE. The promise of global cervical-cancer prevention. N Engl J Med. 2005;353(20):2101-4.
World Health Organization, London school of Hygiene and Tropical Medicine. Preventing intimate partner and sexual violence against women: taking action and generating evidence. Geneva; 2010.