January 31, 2012

Awareness, Testing Needed to Curb Hep C Infections Among HIV-Positive Gay Men

A new report by the National AIDS Trust (NAT), a leading HIV organization in the United Kingdom, concludes that much more needs to be done to address the burgeoning epidemic of hepatitis C virus (HCV) infection among gay men living with HIV.

“The rate of HIV-positive gay men coinfected with hepatitis C in the U.K. is too high,” noted Deborah Jack, chief executive of NAT, in an accompanying announcement. “It is crucial for this to be addressed as a strategic priority in gay men’s health promotion.”

The NAT report, published in January and available online, explores HCV coinfection among HIV-positive gay men and the United Kingdom’s response to this growing health challenge. Like HIV, HCV is a blood-borne infection; about 7 percent of gay men living with HIV in the United Kingdom are coinfected with the virus.

Of those who successfully clear HCV through treatment, a significant percentage are reinfected within a short time, the report illustrates. 

Infections among gay men are largely due to sexual risk factors, thought to include unprotected anal sex, fisting, use of sex toys and group sex, the report highlights, also noting that drug use may have a role.

A number of public health shortcomings help explain the ongoing transmission of HCV among gay men, the report notes.

First, there is no explicit national strategic approach to tackling this issue.

Second, HCV testing recommendations for gay men at risk are not being adequately implemented.

Third, and importantly, a wide range of possible sexual risk factors are cited, which can detract from focusing on what are clearly higher risk behaviors.

Finally, the authors stress, stigma around HCV infection in the gay community—and among people living with HIV—hampers prevention efforts and harms gay men living with the liver disease.

“It is vitally important that, as recommended, all people diagnosed with HIV are annually screened for hepatitis C infection, and this should be made a requirement in the commissioning of all relevant services,” said Jack, adding that a recent audit suggests only 66 percent of people living with HIV are being tested for HCV annually. “Clinics and health promoters need to provide intensive advice and support to gay men at significant risk of hepatitis C transmission. To that end, consensus is urgently needed on the key risk factors for sexual transmission so clear and appropriate recommendations can then be made.

“We also strongly urge gay men not to rely on their sexual partners’ disclosure of their HIV or hepatitis C status as a high proportion are unaware they are infected, which is certainly fuelling onward transmission. And even when diagnosed, disclosure can be difficult—we need to start challenging hepatitis C stigma as well as HIV stigma—both are unfair, ill-informed and destructive.”

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Previous Comments:

Scott, , 2012-02-04 01:08:19
Ditto for ron. "Gay health" begins and ends with the HIV test, and we're basically viewed as walking corpses by other gays, our doctors and our families once we seroconvert. Its hard NOT to adopt a fatalistic attitude once that happens. In a world where 1/5 of gay men are already poz, and HIV is not the worst thing that can happen, we're sorely overdue to re-evaluate this model of thinking. For that, we need the negative community we all come from, to change first. Good luck with that one.

Ron, , 2012-02-03 07:44:44
The most obvious public health shortcoming is not listed in the article, that is, many HIV+ gay men practice unprotected sex because they feel "they already have the disease." In many HIV+ circles, unprotected sex is expected. There is extremely limited public health outreach specific to the HIV+ community about the benefits of protected sex (or dangers of unprotected sex).

James, , 2012-02-02 11:38:17
Early detection is KEY to successful treatment. I wish articles like this would summarize risk factors, for those who don't read the report. The obvious reason why HIV+ are getting HCV sexually is because HIV is easier to get (sexually) than HCV. It's blood-borne, so fisting and sex toys are obvious. However, tops with multiple bottoms (taking the blood/virus from one bottom to another) is a primary mode-it happened to me. It's much riskier than 1on1,even unprotected, and no so hard to avoid