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We now know more about how hepatitis C is transmitted than we ever did before

Following the release of new effective treatments for hepatitis C, researchers and clinicians are now reporting a new understanding of how the virus is transmitted and better ways to prevent it.

Data is starting to suggest that hepatitis C, a blood borne virus that affects the liver, is being transmitted through anal sex without condoms.

Traditionally, hepatitis C is known to be passed on through blood-to-blood contact, but it hasn’t been thought to be frequently passed on in cum (seminal fluid) or the mucous membranes in the lining of the arse.

During a review of their recent cases, clinicians from the Mortimer Market Centre (MMC) in London reported that a fifth of all newly acquired hepatitis C infections in their HIV positive clients were the result of condomless anal sex and did not include any other risk factors. In addition, a third of all of their new hepatitis C cases were in HIV negative men.

Prevention messages have targeted high risk behaviours such as sharing injecting equipment (also known as fits) and sex acts that can increase the chances of trauma or tearing to the lining of the arse; like fisting, group sex, sharing sex toys, and chemsex (using party drugs during sex that can result in longer sessions and rougher sex). As such, hepatitis C is not usually included in standard Australian STI screening unless the patient meets any of these risk factors or if they specifically ask for it.

This is why the data from the MMC is big news, suggesting that we may need to rethink how we look after ourselves and our partners when it comes to hepatitis C and sex.

Presenting their findings at the British HIV Association conference in April 2017, the MMC clinicians reported that 19% of their HIV-positive clients with newly acquired hepatitis C said sex without a condom was their only risk behaviour. Of the 48 cases, 33% were in HIV negative men, a quarter of whom were using PrEP. The main difference in the HIV positive and HIV negative cohorts, aside from prevalence, was that none of those without HIV reported condomless anal sex as their only risk factor.

Along with a recent American study that showed hepatitis C to be present in cum (semen) in a third of HIV coinfected men who have sex with men, and another which showed half of a similar cohort had hepatitis C detectable in their rectal fluid, the data from the MMC could signal a change in what is considered risky for hepatitis C transmission.

The Australian response to hepatitis C health promotion has been one of the best in the world – our needle and syringe programs have helped prevent more than 10,000 new diagnoses a year according to an AFAO report. And in 2016, around 33,000 people successfully cleared the virus from their bodies with a ground breaking new medication called direct acting antivirals.

Condoms and lube provide the best protection from sexual transmission of hepatitis C, as well as regular testing at least twice a year – good advice for both you and your partners.

To learn more about hepatitis C, including symptoms and treatment visit The Drama Downunder.

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