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Hepatitis C Virus: Revenge of the Killer Icebergs

The comments following an article about hepatitis C (HCV) appearing in the English Guardian suggest that some people still associate the virus with illicit drug taking, illicit sexual practices and those who engage in such activities. Sadly, the article doesn’t make much effort to dispel such views.

Several of the people commenting who have been infected with HCV sound as if they don’t quite understand how this came about, although they know that they have never engaged in any of the well publicized activities that are said to constitute the most serious and the most common risks.

We shouldn’t be facing this problem with HCV; it’s much too like the problem we still face with HIV, the view that it mainly infects people who engage in illicit activities of some kind, their partners and even, sometimes, their children. Trying to scare people about heterosexual HIV being the tip of an iceberg, when public health authorities knew perfectly that that wasn’t true, backfired.

It will backfire with HCV too. Many people are still afraid to be tested for HIV, to be frank about their status, to discuss it with people with whom they may become sexually involved, etc. So why are we risking the same sort of stigmatization with HCV?

The article says: “Only in recent years have doctors realised that the hepatitis C virus (HCV) can be sexually transmitted. As it is carried in the blood but not present in significant amounts in semen and other bodily fluids, the risk of transmission during sex was presumed to be negligible. That was until patients who had never injected drugs started testing positive.”

But patients who had never injected drugs, nor had any other identifiable risks, may have had an endoscopy, colonic irrigation, treatment with contaminated vials (generally multi-dose vials), been exposed to insulin pens, fingerprick lances, been circumcised in a non-sterile setting, received certain beauty treatments (eg, blackhead removal), complementary therapies, or skin-piercing and other invasive traditional practices, shared certain types of haircutting equipment, including machinery, donated blood (donors can face a risk from reused equipment), served time in prison, had anything inserted into a mucus membrane (including hands wearing reused surgical gloves), etc.

The article mentions sharing toothbrushes and razors as if that’s the end of it. The research that the article refers to makes it clear that the relative contributions of various risk factors, whether sexual or non-sexual, have not yet been established.

Mentioning that “Rougher sex, anal sex and the sharing of sex toys, especially among people who are also infected with HIV, make sexual transmission possible” may spice up the article a bit, but it could also deflect attention from other risks. These other risks may well be a lot less likely to transmit HCV (or HIV) than certain sexual practices or intervenous drug use, but the list includes things that many people do many times a year.

We need accurate and comprehensive information about hepatitis C, not scare tactics resembling the ones that failed so devastatingly with HIV. In addition to common skin-piercing and invasive healthcare, cosmetic and traditional practices, it is possible that ordinary, everyday sex, transmits HIV; it may not be as risky as the spicy kinds journalists like to report on, but it is likely to be a damn sight more common.

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