Hep C… and Me?
The conversation began normally enough. I asked how he was doing. We talked about the weather. Then I asked what got him hard. He cooed, “You know, I like making out, cocksucking, rimming a hot hole. Love a slutty bottom.” God bless a frank trick. After pleasantries were exchanged, the conversation turned, as they always do, to matters of health. “You clean, bro?” I forgave him (and his fat eight inch cock) the crass phrasing. I told him I was HIV-negative, on PrEP, and that I got tested regularly for other sexually transmitted infections (STIs).
“Cool. HIV, HCV, STI free here,” he replied.
It’s not unusual for a potential hookup to prattle off a list of STIs in these conversations. But what was unusual in this case was his insertion of HCV (hepatitis C). It made me question my life. Should I be getting tested for hep C? Did I need to be asking tricks about their status? Was my blissful ignorance about hep C a problem?
As hepatitis C is most often transmitted through blood-to-blood contact, injection drug users are the population most at risk for contracting the disease in the United States. The virus can survive in used syringes, on needles and on other injection drug use equipment for several weeks and gets easy access to the bloodstream during injection drug use when equipment is shared.
Over the past 15 years, however, the number of hep C infections among gay men who do not use injection drugs has been on the rise. So far, the growing epidemic is mostly limited to HIV-positive gay men, although small numbers of HIV-negative gay men reporting no injection drug use have tested positive for HCV infection in a few research studies. Because the disease has not been known to spread sexually in the past, scientists say that these recent outbreaks represent a “significant change in the epidemiology of HCV.” That’s science speak for “Molly, you in danger, girl.”
May is Hepatitis Awareness Month. Should we all be calling our doctors? Before people go freaking out and running to grab their phone, it seems pretty clear that if any gay men are at risk, it’s primarily HIV-positive gay men. But as I have talked about it previous columns, my partner happens to be HIV-positive. So I wondered: should HIV-negative guys in relationships with poz guys think about getting tested?
Major health organizations like the CDC don’t address this issue directly in their guidelines. Even the best reporting on the latest HCV science—like Liz Highleyman’s—can be hard to follow for most of us. So I turned to some experts in the field for guidance.
First, I asked my doctor. He’s an HIV and PrEP specialist and sees both HIV-negative guys on PrEP and HIV-positive guys on treatment. He deals with patients like me and my partner on a regular basis. When I asked him whether HIV-negative gay men should be getting tested for HCV, his answer was pretty straightforward. “I think it’s warranted on an every 6-12 month basis for anyone who is not in a stable monogamous relationship.”
To get a sense of whether others share my doctor’s opinion, I then reached out to Project Inform, a cutting edge San Francisco-based advocacy organization that provides education and information on both HIV and hepatitis. I spoke with Andrew Reynolds, Project Inform’s hepatitis C education manager. Reynolds started off by reaffirming that HIV-negative gay men are not at any increased risk when compared to the general population. “A lot of people think there’s risk, but the research does not bear it out,” he said. But if you think you may be at risk, of course you should talk to your doctor. “If a person wants to be screened and has access to it, I’ll tell them to go for it.” Basically, find out what your doctor thinks.
It’s a different story for HIV-positive guys, however. Reynolds pointed to recommendations from the United States Preventive Services Task Force, which sets standards for hepatitis C testing. Reynolds explained, “this agency calls for HIV-positive persons to be screened regardless of gender or sexual orientation. It does not call for HIV-negative folks to be screened.”
So… does this mean I don’t have to think about testing for hep C if I’m not HIV-positive? Not quite. For one, my doctor thinks it’s a good idea to get tested every six to twelve months. And I trust his judgment. But Reynolds noted that there are some situations in which he would specifically recommend getting tested for HIV-negative guys. “I would say, if you have condomless anal sex, and there is visible blood present, one should test for HCV. If someone tests positive for an ulcerative STD [such as herpes or syphilis], they should test. If one practices fisting or uses sex toys in a way that might lead to bleeding, they should test.” Got that down boys?
Most guys don’t have hep C on their radar. May is an excellent time to think about how hep C fits in your sex lives—or if it doesn’t.
Jake Sobo is a pen name used for anonymity. Jake has worked in the world of HIV prevention for nearly a decade. He previously published a 19-part series documenting his experiences on pre-exposure prophylaxis (PrEP), “My Life on PrEP,” for Positive Frontiers magazine, which was picked up by Manhunt, translated into French, and widely read in the HIV prevention world. He has spent the better part of his adult life having as much sex as possible while trying to avoid contracting HIV.
Laar, T. and others. Acute hepatitis C in HIV-infected men who have sex with men: an emerging sexually transmitted infection. AIDS. 2010.