One fourth of transgender women in San Francisco test positive for hepatitis C, according to study results published in PLOS ONE.

Between 2011 and 2016, hepatitis C cases rose in the United States, largely affecting people who inject drugs, those who are incarcerated or unhoused and other marginalized groups. Oftentimes, trans women experience circumstances that increase their risk of contracting HIV or hepatitis C, such as being incarcerated or experiencing homelessness.

Based on previous research, almost half of the unhoused population in San Francisco has had hepatitis C. While a 2016 study reported that nearly one fourth of trans women in San Francisco tested positive for antibodies against hepatitis C virus (HCV), indicating that they have ever been exposed, the presence of the virus in the blood, which indicates current infection, has not been studied in this population.

“This study was conducted to fill gaps in what we know about HCV among trans women,” wrote Erin Wilson, DrPH, of the Center for Public Health Research in San Francisco, and colleagues.

The researchers used data from the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance survey to assess hepatitis C antibodies, detectable HCV in the blood and risk factors for the viral infection in a diverse group of trans women in San Francisco.

Between June 2019 and February 2020, the researchers evaluated 201 trans women; 48 (24%) of them tested positive for hepatitis C antibodies, and 12 (6%) had detectable HCV RNA in their blood. A majority were trans women of color; only 18% were white.

Older age and a history of injection drug use significantly raised the likelihood of testing positive for hepatitis C. The presence of antibodies against the virus was highest among women who were at least 50 years old (43%), followed by women between 40 and 49 years old (19%) and those between 30 and 39 years old (10%), with no positive cases seen in women between 18 and 29. Many more trans women with a history of injection drug use tested positive for hepatitis C antibodies (60%) compared with women who had not used injection drugs (8%).

Some 37% of participants who were living with HIV tested positive for hepatitis C, compared with 15% of HIV-negative women.

Overall, the prevalence of hepatitis C antibodies among trans women was nine times higher than the rate for San Francisco’s general population.

“Trans women are highly impacted by HCV and could benefit from access to regular and frequent HCV screening and treatment access,” wrote the researchers. “HCV screening could be offered regularly in trans-specific health services, in the community, in jails and prisons, and integrated syringe exchange programs where treatment access or referral are also available.”

Click here to read the study in PLOS ONE.

Click here to learn more about hepatitis C.