Hepatitis C information for MSM

HIV co-infection

Numerous studies demonstrate that the prevalence of hepatitis C is higher among the population living with HIV (particularly among MSM) than people who are do not have HIV.

The greater likelihood of coinfection with hepatitis C if you are living with HIV has been linked to the HIV virus in two ways:
•    Research indicates that coinfection with HIV increases the viral load of hepatitis C, therefore potentially increasing the risk of you transmitting the virus to someone else when engaging in certain sexual activities.
•    The apparent connection between HIV infection and risk of contracting hepatitis C has also been linked to a low CD4 cell count. CD4 cells are a type of white blood cell that fights infection. Although it is not well researched, studies have reported higher hepatitis C incidence among HIV-infected people who have lower CD4 cell counts.
However, if somebody is on HIV medication and has an undetectable viral load for HIV neither of these issues is likely to affect them.

The greater likelihood of coinfection could also be explained through behaviour. If somebody is having unprotected, rough or extreme sex and/or using drugs, they are more likely to come into contact with both of these blood-borne viruses.

It is also important to remember that neither serosorting for HIV nor taking PreP will protect somebody from contracting hepatitis C.


Chemsex: the name given to the rising phenomenon which refers to the use of drugs in a sexual context. It also refers to group sex that can last for days.

Chemsex can present a number of situations in which hepatitis C transmission is possible. These are either through sharing the paraphernalia used to take drugs or through sexual activity.

The following forms of drug use pose a risk:
•    Sharing needles and syringes to inject drugs poses the highest risk of hepatitis C infection in any situation.
•    Sharing notes or straws that are used to snort drugs.
The increased risk of sexual transmission under the influence of drugs is due to the greater length of time that sex can go on for and as a result the increased likelihood of blood to blood contact through damage to the skin or membranes.

The following sexual activities pose a risk:
•    The highest risk sexual activity is unprotected fisting. Damage to the cuticles (skin around the finger nails) is very common, as is damage to the lining of the rectum.
•    Irrespective of whether you are top or bottom, it is possible to contract hepatitis C through unprotected anal intercourse.
•    Sharing tubs of lube or sex toys is also risky. The hepatitis C virus is fairly robust and can survive potentially up to forty-eight hours on the surface of a sex toy or in a tub of lube.

There are reports of MSM becoming reinfected with hepatitis C after successful treatment. This is probably happening because of the continuation of the behaviour that led to the first infection going on to lead to the second.
At present, if you have already completed treatment you are likely to find it hard to access another course of treatment on the NHS if you get infected again.

If you need support or information, please call the helpline on 0207 089 6221.