Unsterile tattooing can transmit the bloodborne hepatitis C virus (HCV), and though it is unclear exactly what percent of people with the virus got it through tattooing, a study last year found that people with hep C were almost four times more likely to report having a tattoo, even when other major risk factors were taken into account. What do you need to know to avoid giving or getting hep C during tattooing? We researched six common questions on the topic and found what might be some surprising results.

How can hep C be spread through tattooing?

Hepatitis C can be spread if poor infection control methods are used. Make sure you are visiting a licensed, professional tattoo parlor. When you receive a tattoo, your skin is being pierced by a needle and injected with small amounts of ink. Make sure that the needle is coming out of a new, sterile package, that the tattoo artist is wearing latex gloves, and that all other tattooing equipment has been sterilized.

What percentage of all people with hep C get it through tattooing?

There is not enough research to determine the percentage of people with hepatitis who got it through tattoos. However, a recent study discovered that people with hep C were close to four times more likely to report having a tattoo, even when other risk factors were accounted for. (Hepatitis C is transmitted mainly through injection drug use or blood transfusions given before 1992.)

Other studies have shown no evidence of an increased risk in infection if tattoos were given in a professional parlor with proper infection control. If the tattoo was done in a prison or non-professional setting, the risk was significantly greater.

How can I protect myself against hep C when getting a tattoo?

1.    Determine if the tattoo parlor and artist are reputable. (Licensing and certification laws vary by state.) One way to do this is to choose a parlor where people you know got tattoos and had a good experience.

2.    Ask tattoo artists what procedures they use for sterilizing their equipment and how often they do it. Their equipment should be tested and serviced routinely.

3.    Autoclaves (sterilizing machines) should always be used. And new sterile needles should always be removed from the autoclave bag in front of you.

4.    Artists must wash their hands before and after putting on a new pair of latex gloves. This should also occur every time the artist leaves or returns to the work area.

5.    Items that comes in contact with blood and cannot be sterilized—such as gloves, ink caps, cotton swabs, ointments, soap bottles, paper towels, etc.—should be disposed of immediately after tattooing and labeled as a biohazard.

6.     Ink- or water-based products should be thrown out after they are used and should not be put back into the container they came from.

7.    Surfaces and other areas the artist uses to work on should be cleaned regularly with a disinfecting cleaner.

I have a tattoo already. What are the chances I have HCV and don’t know it?

There is no evidence that there is an increased risk of hep C if you had your tattoo done in a professional tattoo parlor that practices good infection control. “If the tattoo was done by yourself, by a friend or in prison, the risk is much higher,” says Michael Duncan, clinical director of VOCAL NY (Voices Of Community Activists & Leaders), a statewide grassroots organization that builds power among low-income people affected by HIV/AIDS, the drug war and mass incarceration—one of its major campaigns involves hepatitis C prevention, care and treatment.

Your hep C risk is also greater if you got the tattoo before the early 1990s, when people first became aware of hepatitis C. Blood tests for hep C did not come out until 1992. (That’s why 75 percent of people living with hep C are baby boomers—those born between 1945 and 1965—they contracted the virus before it was even discovered.) Many people with hep C do not feel any symptoms until years after infection, so it is important to get tested if you suspect you may be at risk.

If I find out I have hep C, what should I do?

You should talk immediately with a doctor who specializes in hepatitis or liver disease. To find one, click here. You will likely need tests to assess your hepatitis viral load (the level of hep C virus in your blood) and the disease’s progression. Some people clear the virus on their own, without any meds. “One in five people exposed to hep C do not become chronically infected,” Duncan says. “If this is the case, you will only need to get take precautions to make sure you are not reinfected.” In other words, you do not become immune to hep C.

If you do have hep C, know that it can be cured. In the past year, hepatitis C treatment has advanced considerably, with fewer side effects, shorter treatment times and much higher rates of success, and these advances will likely continue in the following year. Work with a health professional who can help you decide whether treating the virus now or down the line makes sense.

I have hepatitis C. Can I still get a tattoo?

“Yes,” Duncan says. “Disclosing to your artist is entirely up to you, (but) they should always assume their client is positive and take the necessary precautions.”