More must be done to reduce hepatitis C transmission amongst HIV positive gay men.
NAT has launched a report, ‘HIV and Hepatitis C Co-infection’, which looks at hepatitis C co-infection among HIV positive gay men and the UK’s response to this growing health challenge. Like HIV, hepatitis C* is a blood-borne virus and approximately 9% of HIV positive people in the UK also have hepatitis C. Having both conditions at the same time can have severe health implications, with liver disease caused by hepatitis B and/or C a leading cause of serious illness and death in people with HIV.
7% of HIV positive gay men are co-infected with hepatitis C. Of those who successfully clear hepatitis C through treatment, a significant percentage get re-infected within a short time. Infections among gay men are largely due to sexual risk factors, thought to include unprotected anal sex, fisting, use of sex toys, group sex – though drug use may also have a role. There have been some important information campaigns in the gay media around the risk of hepatitis C for HIV positive gay men but -
- There is no explicit national strategic approach to tackling this issue
- Hepatitis C testing recommendations for gay men at risk are not being adequately implemented
- A wide range of possible sexual risk factors are cited which can detract from focussing on what are clearly higher risk behaviours
- Stigma around hepatitis C in the gay community and amongst people with HIV hampers prevention efforts and harms gay men living with hepatitis C
Deborah Jack, Chief Executive of NAT (National AIDS Trust), comments:
‘The rate of HIV-positive gay men co-infected with hepatitis C in the UK is too high. It is crucial for this to be addressed as a strategic priority in gay men's health promotion.
‘It is vitally important that, as recommended, all people diagnosed with HIV are annually screened for hepatitis C infection and this should be made a requirement in the commissioning of all relevant services (in a recent audit only 66% had had an annual test). Clinics and health promoters need to provide intensive advice and support to gay men at significant risk of hepatitis C transmission. To that end, consensus is urgently needed on the key risk factors for sexual transmission so clear and appropriate recommendations can then be made.
‘We also strongly urge gay men not to rely on their sexual partners’ disclosure of their HIV or hepatitis C status as a high proportion are unaware they are infected, which is certainly fuelling onward transmission. And even when diagnosed, disclosure can be difficult - we need to start challenging hepatitis C stigma as well as HIV stigma - both are unfair, ill-informed and destructive.’
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Notes to the editor:
* Hepatitis C is a blood-borne virus that can cause liver inflammation and other long-term health problems. Unlike hepatitis A and hepatitis B there is no vaccine against hepatitis C.
Approximately 25% of people naturally clear the infection at the acute phase (the first six months of infection), but for the remaining 75%, hepatitis C infection becomes chronic. Treatment for hepatitis C is available and response rates vary from approximately 40% to 80% and therapy can cause significant side-effects. Unless successfully treated, the infection can lead to liver fibrosis and cirrhosis, end stage liver disease and liver cancer, and death.
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