Friday, July 3, 2009

Study confirms international outbreak of sexually transmitted hepatitis C

From CATIE News
Canadian Treatment Information Exchange (CATIE)

Hepatitis C virus (HCV) can be spread in ways similar to HIV, particularly through sharing or receiving the following:

* equipment for substance use
* tattooing needles
* contaminated blood or blood products

HCV infects the liver and can cause inflammation and liver damage. Over a period of many years, liver damage builds up and this organ becomes increasingly dysfunctional. Complications ensue, and in some cases liver cancer occurs. HIV infection appears to accelerate the course of HCV-related disease.

For the past two decades, HCV infection has mostly affected people who share needles to inject street drugs or who have received contaminated blood products, such as clotting factors, before routine testing for HCV was available. Now an international team of researchers has uncovered evidence that HCV has been transmitted sexually, in many cases among HIV positive people. The emergence of a previously unrecognized sexually transmitted germ is troubling and has implications for sexual health and disease prevention programs.

Read the rest


tnmarky said...

This is an important finding that furthers understanding on this topic.

Many of us have been advocating for more discussion, research, and outreach on this issues for years.

I find, however, the use of language like "emergence of a previously unrecognized sexually transmitted germ" troubling in and of itself. The question is "unrecognized by whom?"

The U.S. C.D.C. has long since recognized sexual transmission of HCV, although to the frustration of many, you often needed a microscope or powerful search tools to find it.

Many HIV/AIDS treatment providers have long since recognized the likelihood of sexual transmission because they were treating many HCV positive individuals with no other risk factors.

It's great to observe the growing body of evidence that validates our concerns.

Marc-André LeBlanc said...

So true, tnmarky!

I have a colleague who worked on issues surrounding HCV/HIV co-infection who found it infuriating that for years claims by gay men and others that they had contracted HCV sexually were dismissed. Despite the fact that they claimed that they never partook in injection drug use, nor did they ever receive blood transfusions, they were just thought to be reluctant to admit their past injection drug use. She didn't buy that for a second.

I wonder if any progress is made on the issue of whether blood is the only fluid to transmit HCV? The article, and I suspect the study, remains mute on the question of whether these men were infected while engaging in receptive or insertive UAI. It is notoriously difficult to isolate such things because people usually participate in multiple discrete sex acts that have various levels of risk. But it is entirely conceivable that most if not all of these infections are from the receptive partner who -- because of repeated UAI, maybe drug use, possibly STIs, certainly if he was fisted -- might have passed on HCV to the insertive partner through the presence of small amounts of blood. Also possible in some cases: the insertive partner, particularly if uncircumcised as most men are in most of the study countries, could have passed it on if there were small cuts, tears, other STIs on the foreskin.

Does semen transmit HCV? I still don't know reading this.

Still, it certainly warrants ensuring that messages about levels of risk take into account that this study found evidence of sexual transmission, and that it is likely that anything that increases the chances of blood being present -- fisting, repeated UAI, other STIs, drug use -- increases that risk. But it seems like the jury is still out on whether semen transmits HCV, and obviously this study tells us nothing about vaginal fluid! Menstrual blood certainly remains an issue.

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