Hepatitis C

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Hepatitis C (HCV or Hep C) is a curable bloodborne virus (BBV) that causes liver inflammation and disease. It is transmissible by blood-to-blood contact. It can be passed through even small traces of blood and can survive outside the body for days or even weeks. 

Hepatitis C causes both acute and chronic infections. Acute hepatitis C infections usually do not have symptoms or cause life-threatening disease. Around 30% of infected people spontaneously clear the virus within six months without any treatment. The remaining 70% will develop chronic hepatitis C infection and the potential for liver damage, including liver cancer.

The risk of passing on hepatitis C through sexual contact is very low, but any bleeding during sex, open sores or having other STIs or BBVs can increase the chance of sexual transmission.

Signs and Symptoms

Approximately 80% of people do not exhibit any symptoms of hepatitis C. If acute symptoms do occur, they usually appear between 2 weeks to 6 months from the initial infection.

Chronic hepatitis C affects everyone differently. There may be no symptoms at first, and many people may not notice symptoms for 10-20 years. Hepatitis C can (but doesn’t always) damage the liver. 

Symptoms and effects of the hepatitis C virus may include:

  • Tiredness or fatigue
  • Abdominal discomfort
  • Loss of appetite and nausea
  • Muscle and joint pain
  • Liver pain (top right upper abdomen)
  • Jaundice (yellowing of the eyes and sometimes skin)
  • Dark urine

Transmission

Hepatitis C is transmitted by blood-to-blood contact. Hepatitis C can be passed on by tiny amounts of blood that may not even be visible. It can survive in traces of blood outside the body for days or even weeks. While this can occur through sexual contact, this is very rare. 

You can transmit hepatitis C before you have symptoms.

Moderate to high-risk activities include:

  • Any kind of blood-to-blood contact
  • Sharing syringes or injecting equipment
  • Sharing piercing, cutting and tattooing equipment or not using sterilised equipment
  • Needlestick or sharps injury (this can be relevant to sex workers who provide piercing, cutting or suturing as BDSM services, or who also work in healthcare)
  • Sharing personal care items such as toothbrushes, razors, or hair and nail clippers
  • Penetrative anal sex without condoms

Prevention

Hepatitis C is preventable! Here are some things you can do:

  • Using condoms, dams, gloves and other barriers during sex can reduce the risk of exposure to someone else’s blood (and exposure to hepatitis C).
  • Cover cuts, abrasions and wounds with waterproof dressings to reduce the likelihood of blood-to-blood contact.
  • Be aware of the potential or presence of blood in the environment and minimise the risk of exposure to someone else’s blood.
  • Always wash your hands thoroughly if you’ve made contact with someone else’s blood. 
  • Always clean up blood with paper towels and soapy water, isopropyl alcohol, or undiluted bleach. Wear gloves if you can. 
  • Viraclean, a cleaning solution commonly used in the sex industry, is not effective against hepatitis C.
  • Always use fresh, sterile syringes and injecting equipment and dispose of them safely. You can use this website to find your nearest Needle Syringe Program (NSP).
  • Avoid sharing razors, toothbrushes, skin piercing or tattooing equipment, or hair and nail clippers with other people.
  • Regular sexual health screening can help detect other STIs, which may increase your risk of contracting hepatitis C.

Testing 

Here’s some information about testing for hepatitis C. You can view a list of sex worker-friendly sexual health clinics at our Where To Test page.

Testing method

  • Hepatitis C testing is done by taking a blood sample. 
  • You can get tested at your GP or a sexual health clinic. 
  • At-home dried blood spot (DBS) testing is available in some states. DBS
    • uses drops of blood from the end of your finger. 
    • doesn’t use a needle or syringe
    • can be done for free at home
    • your personal details and the results are kept private
    • If your test results show you have hepatitis C, the people who give you your results can help you access treatment and cure. 

When to test

  • You can get tested for hepatitis C straight after potential exposure.
  • You will need to be tested again after 12 weeks and possibly again at six months.
  • Hepatitis C is not part of a routine sexual health screening, so you may need to ask for a test. 

Hepatitis C testing is recommended for particular ‘priority populations’ who may also be part of the sex worker community. This includes: 

  • people who have injected drugs
  • people who are in prison or have been in prison
  • people who have tattoos or body piercings
  • people who have received blood transfusions, an organ transplant or blood products before February 1990
  • sexual partners of people with hepatitis C. While the risk of hepatitis C transmission during sexual activity is low, there is an increased risk of transmission for HIV positive men who have sex with men.
  • people who were born in hepatitis C high-prevalence countries
  • Aboriginal and Torres Strait Islander populations
  • children who were birthed by a parent with hepatitis C

Other info

  • Sexual health clinic testing is often bulk billed. If you don’t have Medicare, the test will most likely be free 
  • If you see a GP for testing, you may pay a fee or be bulk billed, and you may have to go to a pathology centre to actually do the test. 

Treatment

Chronic hepatitis C is curable for most people. Your doctor will help you find the right treatment for you. Here’s what you need to know about treating it.   

Treatment method/s

  • Hepatitis C is treated with medications known as direct-acting antivirals (or DAAs), which are very effective for most people who take them.
  • You’ll take 1 to 3 tablets per day,  for 8 to 12 weeks, depending on which medicine you are using. 
  • Treatment is more than 95% effective at curing hepatitis C. 
  • Most people can get a prescription from their GP. 
  • Your GP may refer you to a specialist if:
    • you have another blood-borne virus, such as hepatitis B or HIV
    • have previously had DAA treatment for hepatitis C,
    • have kidney disease or liver scarring.
  • If you have not been cured of hepatitis C after the first course of medicine, your doctor may recommend a second course.
  • If you get hepatitis C again, you can be cured again.

Costs and other information 

  • Hepatitis C medications are available through the Pharmaceutical Benefits Scheme (PBS) to people over 18 who hold an Australian Medicare card.
  • You will pay no more than $41 for each script, or less than $7 if you have a concession card (This amount is adjusted each year on 1 January, so these amounts are correct for 2020).
  • Medications for hepatitis C are not currently subsidised for Medicare-ineligible people.
  • Modern hepatitis C medicines have far fewer side effects than older medicines.

Specific resources and services are available for people living with hepatitis C via Hepatitis Australia.

How might this impact my work?

Practical Considerations

  • Some antiviral medications can compromise the effectiveness of oral contraceptives (‘the pill’). Discuss this with your doctors when developing your treatment plan.
  • Hepatitis C is not classified as a sexually transmissible infection (STI); therefore, any worker who has been diagnosed should not be prevented from working. 
  • Sex industry workplace management should not require information about your hepatitis C status.
  • People with chronic hepatitis C can use all types of birth control, including the pill, without concern about negatively impacting liver health. 

Legal and Reporting Considerations

  • Some states and territories may have laws that criminalise sex working with STIs and/or BBVs. There may also be laws about BBV and STI prevention that apply to everyone. See our BBV, STI and the law resource for more information on your jurisdiction and/or contact your local sex worker organisation to find out more information.
  • Hepatitis C is a national routine notifiable condition, which means that diagnosed cases are confidentially reported to the Commonwealth health department. You can find more information on the requirements for your jurisdiction on our BBV, STI and the Law resource. Contact your local sex worker organisation if you need support with a workplace issue relating to hepatitis C or need more information about your state or territory’s laws around sexual health and notifiable conditions.

Contact tracing of previous sexual partners (also known as ‘partner notification’) is a consideration for some BBV and STI. It should be done with consideration of the unique transmission risk and privacy needs of sex workers. Your local sex worker peer organisation can advise on any partner notification process to ensure that it is appropriate for your circumstances.

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