Needle-sharing is the most efficient way to transmit a blood-borne virus, says Gabrielle Bennett, the Victorian Viral Hepatitis Educator at St Vincent’s Hospital in Melbourne.
That is why the bulk of newly diagnosed hepatitis C cases each year are attributed to sharing fits.
About 230,000 Australians have hepatitis C, with about 10,000 new infections annually. Hepatitis Australia estimates about 80 per cent of new hepatitis C cases diagnosed each year can be attributed to sharing drug-injecting equipment.
HCV is transmitted blood-to-blood and is also able to survive outside the body – surfaces, equipment, hands and puncture sites contaminated with blood during the injecting process can pose a risk. The viral load in bodily fluids other than blood is considered too low for transmission.
“Obviously it likes to be in 37 degrees – in the blood, inside the body, in the dark,” Ms Bennett says. “So it starts to break down otherwise. In lab situations where perfect conditions exist, it has lived from days up to a week. No one knows how long it can live outside the body because the conditions are so variable. So the message is: be blood aware and don’t do anything where you can get someone’s blood into your blood.”
Other transmission risks include:
• Unsterile body art practices, such as tattooing and piercing. Any item used during these procedures that may contain traces of blood is a risk. Ms Bennett says single-use only equipment is used in professional settings in Australia and is generally considered safe. “I think professionally our systems here are pretty good regarding that now. But some people do it at home with friends, or overseas.”
• Personal grooming. Items such as nail-clippers, toothbrushes or razors can also present a hazard if even small amounts of blood are involved.
• Childbirth. Most pregnant women are routinely tested for hepatitis C, as there is about a five per cent chance of those with the virus passing it on to their child.
As for sex, Ms Bennett says hepatitis C is not classified as a sexually transmitted infection, yet it provokes much fear in that domain. As she says, there are thousands of couples where only one has hepatitis C but has not passed it on to the other. Risky practices include rough sex or use of sex toys that might tear the skin, or any other exchange where blood is present.
Ms Bennett says one of the biggest issues working against testing and treatment is stigma and lack of information. Health professionals can also sometimes present negative and stigmatising reactions. Once, after she had given a talk to some health workers, Ms Bennett says one person approached her having only just recalled sharing a needle once or twice many years previously.
“She’d been having all these symptoms and investigations and it had never occurred to her or anyone else. She had hep C. It was a huge relief in a way because it meant she had a diagnosis – and then she got cured.”
– Andrew Stephens