Why gay and bisexual men are at a higher risk for hepatitis C

July 28 is World Hepatitis Day, so it’s a good time to ask: how does Canada stack up globally in terms of eliminating hep C?

Canada is one of 194 countries that have signed on to the World Health Organization’s global strategy to eliminate hepatitis C as a public health threat by 2030. However, we’re still lagging behind other countries — more than 220,000 Canadians live with chronic hepatitis C, and 44 percent don’t even know they have it. Hep C affects a number of populations, particularly men who have sex with men (MSM).

Andrew Brett, communications director at the Canadian AIDS Treatment Information Exchange (CATIE), explains what those at risk need to know about the virus and why it’s important to make hep C part of your sexually transmitted infections (STI) screenings.

What is hep C?

Hepatitis C is a virus that injures the liver. It can cause more serious health conditions over time, such as cirrhosis, cancer and – if left untreated – even lead to death.

How is it contracted?

Hepatitis C is passed blood-to-blood, usually through breaks in the skin. In Canada, most new cases are acquired when equipment for injection drug use is shared. In other countries, hepatitis C can be transmitted through unsafe medical practices — this method of transmission is rare in Canada. Although hepatitis C has not traditionally been known as a sexually transmitted infection, there are increasing reports of itbeing passed through sex between men, particularly when blood is present — even if it is not visible.

Why don’t more people know they have it?

A person can live with hepatitis C for 20 to 30 years before symptoms start to show up. More than half of people with hepatitis C won’t experience any symptoms at all, which is why it’s so important to get tested because they may have been exposed so long ago that they’ve forgotten, or their healthcare provider doesn’t recognize them as being part of a high-risk group. This means the virus can go undiagnosed for years. When left undiagnosed and untreated, late-stage chronic hepatitis C can result in internal bleeding, jaundice and abdominal infections. This is why Canadian liver specialists now recommend that every Canadian born between 1945 and 1975 get tested.

Who is most at risk within LGBTQ2 communities?

Studies have found higher rates of hepatitis C among gay and bisexual men who are living with HIV, but cases are being reported among HIV-negative men as well. The risk appears to be higher among those who have another sexually transmitted infection, who have had group sex or rough sex without a condom or those who have used drugs — such as crystal meth and ketamine — while having sex (“party and play”).

There are limited data on hepatitis C infections among LGBTQ2 communities, but a Canadian study of gay and bisexual men found that one out of every 20 participants had evidence of a current or past hepatitis C infection. That was more than double the estimated prevalence among Canadian men in general. Sexual transmission of hepatitis C doesn’t appear to be occurring in other populations in Canada, which is why MSM have been identified as a priority population for prevention and treatment.

Does HIV-prevention treatment PrEP play a role in this?

There are new prevention strategies that don’t require the use of condoms to effectively prevent HIV transmission, like pre-exposure prophylaxis (PrEP) for HIV-negative people, as well as effective HIV treatment for people living with HIV. This is great news, and it gives people more prevention options. But condoms remain the only method that can also prevent the sexual transmission of hepatitis C. If people are having the kinds of sex that might put themselves at a higher risk of hep C transmission, PrEP and HIV treatment won’t protect themselves or their partners.

What specifically can be done to reduce the number of MSM contracting hepatitis C?

The first step is to become aware of the risk factors for hepatitis C, including the sexual risk factors. You can learn more on the CATIE website or by asking your healthcare provider. The next step is to consider prevention options that work for you and for the type of sex you’re having, such as using condoms and lots of your own lube if you’re having rough sex. Most importantly, talk to your healthcare provider about including hepatitis C as part of your STI screenings.

What is the current treatment for hepatitis C?

Current treatments, which come in pill form, are simple to take and cure more than 95 percent of people within eight to 12 weeks. As of last year, they are now widely available under the public drug insurance plans of every province and territory in Canada. Most people don’t pay out of pocket for hepatitis C treatment.

What is Canada doing to reduce the rates of infection?

Canada was one of 194 countries that signed on to global targets to eliminate hepatitis C as a public health threat by 2030. The federal government has also included hepatitis C within its action plan for sexually transmitted and blood-borne infections. But healthcare in Canada falls within provincial jurisdiction, so the federal government’s reach is limited. Canada’s leading hepatitis C experts published an elimination blueprint earlier this year to outline policy options for decision-makers at all levels of government. It includes recommendations to scale up prevention, testing and treatment.

How does that stack up against the plans of other countries?

Within one year of signing on to the global hepatitis C targets in 2016, 82 countries had already put elimination plans into place, and one-third of those had their governments’ full financial support. By contrast, Canadian governments have been slow to put real action plans into place. Based on our current progress, we are not even projected to eliminate hepatitis C by 2050, a full 20 years beyond the global target.