HIV is transmitted through the following body fluids: blood, semen, pre-cum, rectal fluids, vaginal fluids and breast milk.

Hepatitis C (HCV) is most easily spread through direct blood-to-blood contact and is transmitted when the blood of an infected person passes into the blood of an uninfected person.

To learn more about HCV transmission, click here.
To learn more about HIV transmission, click here.

People who use injection drugs and who have shared needles or other injection equipment—including cookers, cotton and measuring syringes—are at the highest risk of being infected with hepatitis C. Roughly 75 percent of people who are infected with HIV from injecting drugs are also infected with HCV. This is because both viruses can be spread easily through blood and blood products.

While sexual transmission of hep C is relatively rare, being HIV positive appears to increase the risk for acquiring hepatitis C sexually. Researchers have found some common risks—along with HIV itself—that are associated with these sexually transmitted outbreaks, such as:

  • Participating in group sex
  • Finding sex partners on the Internet
  • Rougher, longer anal intercourse (receptive and insertive)
  • Receptive or insertive fisting
  • Shared sex toys
  • Non-injection drug use (nasal or anal)
  • Having another sexually transmitted infection

HIV may increase the risk of sexually transmitted hepatitis C infection among women. HIV-positive women who have a male partner who uses injection drugs are more likely to be coinfected with hepatitis C than HIV-negative women who have a male partner who uses injection drugs.

Coinfected women can pass hepatitis C to their infants during pregnancy, labor and delivery. The risk for mother-to-infant transmission of HCV is around 6 percent in women with HCV alone. When HIV is present, the HCV transmission risk doubles or triples. Although antiretroviral therapy reduces the risk for HIV transmission from mother to child, it is not clear whether it lowers the risk of hepatitis C transmission. What’s more, delivering a baby via caesarean section, compared with vaginal delivery, does not appear to reduce the risk of mother-to-child HCV transmission. Breastfeeding is known to transmit HIV, and it may increase the risk of HCV transmission when the mother is living with both viruses.

Some HIV-positive people can clear HCV by a strong immune response, or with treatment. It is possible, however, for a person who ultimately clears the virus—either spontaneously or through treatment—to become reinfected with hepatitis C.

Last Reviewed: March 4, 2019