Hepatitis C serosorting

HIV is, of course, not the only chronic and potentially fatal infection common amongst high-risk groups. Hepatitis C co-infection is the rule rather than the exception amongst injecting drug users with HIV, and is becoming an increasingly common STI amongst some groups of gay men with HIV. Chronic hepatitis B infection is spread sexually in a very similar way to HIV, although here the best means of preventing infection is vaccination.

Is there any evidence that people with hepatitis C and, especially, HIV/hepatitis C co-infection, are serosorting for hepatitis C status? An increase in publications and knowledge about sexually transmitted hepatitis C within the gay community suggests this might become more common, and support groups for co-infected gay men that could facilitate hepatitis C disclosure and serosorting have been set up in some cities. (For London groups, see www.hepctrust.org.uk/hepatitis-c/Hepatitis+C+and+HIV)

So far, the only evidence that people with hepatitis C are serosorting comes from US studies of injecting drug users.

A study from Seattle¹ of 337 injecting drug users (IDUs) found that 91% had been tested for hepatitis C.

Just over half (53%) of those who had shared injecting equipment in the last year reported knowing the hepatitis C status of the person they shared with. Amongst participants who had hepatitis C, 37% of their sharing partners were known to have hepatitis C and 7% were known not to have it. Conversely, amongst participants who did not have hepatitis C, 11% reported sharing partners who had hepatitis C and 23% had sharing partners who were hepatitis C negative. Thirty-nine per cent of participants reported that they had taken a partner’s concordant hepatitis C status into account when deciding whether to share injection equipment.

A study of 503 IDUs from Denver² found that the needle-sharing partners of those with hepatitis C were twice as likely to have hepatitis C themselves as the partners of those who were HIV-negative. This study also separated out those who were both needle-sharing and sexual partners. It found those who had hepatitis C were 3.2 times more likely to have a relationship with someone who was both a needle-sharing and sexual partner if that person also had hepatitis C.

Conversely, a study of 220 IDUs under 30 in San Francisco³ found that needle sharing was 50% less likely between people who did not know each other’s hepatitis C status, except when the needle-sharing partner was also a sexual partner.

So far, there appears to have been no published study of serosorting in gay men who have sexually transmitted hepatitis C. This may be because co-infected people find disclosure of hepatitis C status even more difficult than disclosure of HIV.

A small qualitative study of HIV/ hepatitis C co-infected gay men found that many experienced their hepatitis C infection as more stigmatising than HIV.⁴

One of the six co-infected men interviewed commented:

“I do serosort…I had been naïve in thinking that anyone who had been truthful about their HIV status would do the same for their hep C status too…the hep C situation on the scene is much like HIV was in the early days.”

“This hierarchical stigmatisation complicates the disclosure of hepatitis C infection, threatening the safety of HIV-serosorted unprotected sexual practice,” comments the researcher.

He adds that “health promotion initiatives are needed to counter hepatitis C stigma by raising awareness and facilitating greater empathic ownership of hepatitis C as a gay community issue.”