You Should Know: Sex and Hepatitis C -->可可转移

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You Should Know: Sex and Hepatitis C

by Cara Bruce



According to the Center for Disease Control, one in fifty Americans, and 200 million people worldwide, are infected with the Hepatitis C virus. This epidemic is much larger than HIV, and chronic liver disease and cirrhosis now rank as the tenth leading cause of death.



Hepatitis C (HCV) is chronic in about 85% of the people who are exposed to it. It is an RNA virus that attacks and kills liver cells where it multiplies. The virus is often "silent" -- meaning there are often no symptoms until the infected person is sick with some type of severe liver problem. Although, many people do report flu-like symptoms during the acute phase of the illness -- either during the seroconversion period or the first 6 months of contracting the virus. Some people are never affected, while others develop chronic fatigue or become so sick they are disabled.



HCV can lead to cirrhosis, fibrosis or liver cancer. Right now the only treatments are Interferon-based medications, which can be just as debilitating as the disease itself, and aren't guaranteed to completely "clear" the virus. Many people have compared Interferon to chemotherapy and the most common type of hep C in North American, type 1A, is the least likely to respond to treatment. But if you know you have hep C you can take measures to protect yourself against developing severe liver disease: you can stop drinking, doing drugs, and live a healthier lifestyle.



Hep C is a scary disease but a manageable one. In fact, it is believed that 80% of people outlive the disease. Getting tested is the first step in taking charge of your health. Learning as much as possible about the disease is the second.



In the industrialized world, the main vectors of hep C transmission are receiving blood products before 1992 (the blood bank didn't screen for hep C before then), IV drug use (sharing needles, cookers, water and/or ties), sharing straws for snorting drugs, tattooing or body piercing in unsafe and/or unsterile conditions, and sharing a razor, toothbrush or other household item that could contain infected blood. The HCV virus is believed to be able to live outside the body for up to three months and is very tiny. A small percentage of people may contract the virus through unprotected sex but contrary to popular belief, hepatitis C is not really a sexually transmitted disease. Hepatitis B is sexually transmitted, as it is spread through bodily fluids including blood, semen, vaginal secretions and saliva.



Vaccines are available for hep A and hep B. If you engage in any sexually activity that possibly involves feces, such as rimming, you should be vaccinated for hepatitis A, since it is transmitted through the "fecal-oral" route. I encourage all people to be vaccinated for both -- getting co-infected with hep C and either hep A or hep B can be deadly.



Hepatitis C does not distinguish between lesbians, gay men or heterosexuals. The virus doesn't care. It can be passed sexually if you have oral sex with someone who is menstruating. Often our gums bleed and we don't realize it. This is also true about our fingers -- we may have tiny cuts on our hands or fingers that we are unaware of. When a woman who is infected with HCV is on her period you should be very careful. Latex gloves and dental dams are recommended. If you have herpes you are more at risk for contracting hep C since you may have tiny, open sores on your genitals. Rough anal sex is also a potential problem; anal tissue is thin and tears easily, thus increasing the chance of blood-to-blood contact.



Herpes, genital sores, and/or cuts on a penis combined with anal sex are very dangerous -- condoms should always be used. It is recommended that you use a condom for all sexual activity, but in the interest of harm-reduction, be especially careful if one of the partners has herpes or any other STD, with anal sex, or if an infected woman is menstruating.



One of the biggest problems people with hep C face is talking to potential sexual partners about their virus. Many people do not understand what hep C is and may treat the infected person as if they are dirty, diseased and completely contagious. I should know -- I am infected with the hep C virus. I have had people refuse to sleep with me and I have had to sit down with people and explain the risks to them before they felt comfortable enough to have sex with me.



As you can imagine, this is not fun. It can be scary, demeaning and depressing. But I choose to live my life as honestly as possible and it's important to me to be open about my hep C. I don't live closeted as a bisexual and I refuse to live closeted as a woman who has hep C. I have thought of the minimal risk and thought about whether I have to tell people that I believe will be one night stands. And then I think about this: what if they don't end up being one-night stands? Or what if they find out some other way? I would be pretty angry if someone didn't tell me and give me the chance to make my own decision. In fact, I contracted hep C from someone who lied to me and told me he had tested negative, when he had, in fact, had the virus for at least three years. It was completely devastating and I see honesty as my only option.



I'm 28 years old, and single. When I received my diagnosis some of the first things to cross my mind were: Am I ever going to have sex again? How am I going to find someone to love me or want to be with me? These questions are common and I'm happy to say that most people have listened to what I have told them about hep C and not been bothered by it. I have had some bad experiences, and while they were hurtful at the time, I'm now glad I never slept with someone who was so ignorant and not understanding.



New partners are just one issue. Telling a long-term partner when you first find out you are infected can be one of the hardest things you ever have to do. They will most likely be just as scared and worried as you are. Be prepared for an emotional conversation. Studies with long-term monogamous partners have found that only 1 to 3% have contracted the hep C virus from an infected partner.



Let your partner know this, and encourage him or her to get tested. If they do test positive, realize they may not have contracted it from you -- often people are together because they have similar backgrounds, but in times of intense fear and uncertainty, accusations can fly. Anger and guilt are common reactions.



When you find out you have a chronic illness many people go through a grieving process for the loss of their health. This includes the five stages of grief: denial, anger, bargaining, depression and acceptance. You can go through these stages at the same time and over and over. I have heard from many couples that their doctor told them to keep doing what they have been doing -- if they haven't been engaging in safer sex they don't have to start. The risk really is that low. But what if you want to have children? The good news is HCV is rarely passed from mother to child and rarely passed by breast feeding, in fact breastfeeding is usually allowed unless the mother has cracked or bleeding nipples.



Here are some tips for communicating with your partner:





1.) Find a time and place that is comfortable to talk.

2.) Be prepared: bring information to back up what you are saying. I have told people the minimal sexual risks and they have still not believed me -- you can bring a book, the number of a hep C hotline, or a pamphlet or print out information from a respected Web site.

3.) Know what you want out of the conversation and try not to accuse or be defensive.

4.) Be honest.



If someone doesn't want to have sex with you or be in a relationship with you because of your hep C, they are probably not worth your time. Your hep C is something that you will most likely have to live with for the rest of your life, so find someone supportive. You deserve it. No matter how you got hep C, you deserve happiness, love, and great sex!



And for those of you, who may someday come in contact with someone who has hep C, treat him or her with respect, listen to what they have to say, and put yourself in their position. How would you feel if you had to come out and tell someone this? Treat them as you would like to be treated. Many of us who are queer have already had some sort of coming out process. Remember how that was for you. This person, possibly this potential lover, is coming out to you. Be respectful and listen.



It's hard to talk to someone you have just met about having hep C. But add talking about sex on top of that and it can be a very frightening experience. Just remember that hep C is a manageable disease. If you are careful and take care of yourself you can live a long, happy, sexually active life!





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Cara Bruce is co-author with Lisa Montanarelli of The First Year: Hepatitis C (Marlowe & Co., February 2002). She can be reached at [email protected] and is happy to answer any of your hep C questions. She is also the Web Content Editor at Good Vibrations.