Hepatitis B

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Hepatitis B is caused by the hepatitis B virus. When the virus enters your body, it attaches to healthy liver cells, triggers an immune response, and causes your liver to become inflamed. Adults have a 95% chance that they will recover and develop natural immunity. The 5% of adults who do not develop a natural immunity after 6 months have chronic hepatitis B. While the acute symptoms may subside, people with chronic hepatitis B will be able to pass on the virus in the long term. If chronic hepatitis B is not diagnosed and managed, it can cause cirrhosis (scarring of the liver) and potentially cancer of the liver.

Almost 1% of people in Australia are affected by hepatitis B. Most people with hepatitis B were born in countries with higher prevalence and got hepatitis B from their mother during the birthing process.

The Third National Hepatitis B Strategy 2018-2022 recognises sex workers to be a priority sub-population of ‘unvaccinated adults at higher risk of getting hepatitis B’. This is because stigma, discrimination and structural factors, such as criminalisation, increases vulnerability and creates compounding barriers for sex workers to access hepatitis B prevention, testing, treatment and care.

Transmission

Hepatitis B can be transmitted through:

  • The exchange of blood and sexual fluids, including semen, vaginal and anal secretions
  • Sharing syringes or injecting equipment
  • Sharing piercing, cutting and tattooing equipment
  • Sharing toothbrushes, razors, or hair and nail clippers
  • Breast feeding with cracked and bleeding nipples could pose a risk of blood to blood contact while breastfeeding if your baby has small tears or scratches in or around their mouths
  • Parent to baby during childbirth, however administration of the hepatitis B vaccine within 12 hours of birth can significantly reduce the risk of transmission to the baby

The transmission of hepatitis B through saliva is very rare. It is possible to transmit hepatitis B through biting if there is blood present in the saliva and there is blood to blood contact.

Signs and Symptoms

Many people have no symptoms. However, the symptoms of hepatitis B can include:

  • Abdominal pain or liver pain (top right side of the abdomen)
  • Loss of appetite, nausea and vomiting
  • Weight loss
  • Jaundice
  • Pale coloured faeces and dark urine
  • Fatigue, fever and feeling unwell
  • Muscle and joint pain
  • Often asymptomatic

Prevention

Vaccination against hepatitis B is available and provides lifelong immunity. Babies in Australia have been vaccinated against hepatitis B since the year 2000, therefore many younger sex workers already have immunity. Sex workers who are not immune should consider having the combined hepatitis A/hepatitis B vaccination. Some health care clinics provide sex workers with hepatitis B vaccinations for free. Generally, the vaccination is delivered to adults in three doses.

You can prevent the transmission of hepatitis B by:

  • Using condoms and dams to prevent contact with blood and bodily fluids
  • Not using razors, toothbrushes, skin piercing equipment, tattooing equipment or hair and nail clippers or equipment that has been used by someone else
  • Always using sterile syringes and injecting equipment
  • Always washing hands thoroughly if contact has occurred with someone else’s sexual fluids or blood
  • Always using cleaning products with bleach when cleaning up surfaces that are contaminated with sexual fluids or blood
  • Covering any cuts or open sores to avoid contact with someone else’s blood or sexual fluids
  • Wearing disposable gloves if possible.

If exposed to the sexual fluids or blood of someone with hepatitis B and you are not sure you’ve been vaccinated, see a doctor as soon as possible. An injection of immunoglobulin may be given within 72 hours of exposure to provide immediate protection. Additionally, you may also be given the hepatitis B vaccine as soon as possible or within 7 days of exposure.

Treatments for chronic Hepatitis B

There is no specific treatment for the first six months after hepatitis B infection. Generally, people with hepatitis B are recommended to drink lots of water, get adequate rest, maintain a healthy diet and avoid alcohol. People with hepatitis B need to go for a liver health check regularly, as the virus can be damaging the liver without any symptoms. Not all people with hepatitis B require treatment. Generally, people without any signs of liver damage do not need treatment but it is recommended that you get regular check-ups every 6 to 12 months. Treatment is only recommended for people who are at a particular stage of their infection. Figuring out when to start treatment is complex and should be made in consultation with a healthcare professional.

There are treatments for managing hepatitis B called antiviral medications, but there is no cure. Some of these medications are available through the Pharmaceuticals Benefits Scheme (PBS) for people with a Medicare card.

The goal of treatment is to prevent, slow or reverse the virus from progressing. Maintaining a balanced diet, and avoiding alcohol and drugs which can harm the liver can help limit the amount of liver inflammation.

In some Australian states and territories, there are laws governing sex workers living with hepatitis B such as some states have made it against the law to work as a sex worker with hepatitis B or you may be required to take ‘reasonable precautions’ to prevent the transmission of hepatitis B. Contact your local sex worker organisation to find out more information.