Hepatitis C is spread when the blood of an infected person comes in contact with the blood of someone else. The virus itself is quite resilient. Although there is not a lot of research in this area, there is some evidence that HCV may survive outside of the body for four days or more (anecdotal evidence suggests up to two weeks).
The riskiest activities are those with the highest potential and frequency of blood-to-blood contact. Those activities that have no chance of exchanging blood are considered no risk. Based on these distinctions, high-risk, some-risk and no-risk activities are outlined below.
High Risk
- Sharing drug-use equipment: The equipment used for preparing and injecting drugs, including steroids, can have microscopic amounts of blood on it and transmit Hep C. Even a single event of sharing equipment (including syringes, cookers, water, filters, tourniquets, and alcohol swabs) is cause for testing to be considered
- Sharing other drug-use equipment for smoking or snorting drugs, like crack pipes or cocaine straws, because small amounts of blood from cracked lips or tiny nosebleeds can also be found on these items
- Sharing tattoo or body-piercing equipment: The needles, equipment and ink can be contaminated with blood and transmit Hep C, usually in places and situations where proper sterilization techniques or single-use equipment are not available or cannot be used
- Blood transfusions prior to 1992: In 1992, routine blood screening began and the risk for Hep C from the blood system is now very rare, but transfusions before 1992 are considered high risk
- Unsterilized medical equipment: Shared medical or surgical equipment can transmit Hep C if it is not sterilized between patients
- Blood or cutting rituals: Rituals that involve cutting with shared tools or the exchange of infected blood can transmit Hep C
Some Risk
- Sharing personal hygiene and grooming supplies: Shared razors, toothbrushes, nail clippers and other household items that might have infected blood on them can transmit Hep C
- Unprotected sexual intercourse: Hep C can be transmitted sexually, especially when there is a chance that infected blood could be present (like during menstruation or certain sex practices, such as sex that involves fisting) or when other sexually transmitted infections are present
- Mother-to-child transmission during childbirth (also know as vertical transmission)
- Needlestick injuries because of the possibility of exposure to HCV-infected blood
No-Risk Activities
- Casual contact with a person living with Hep C, including sharing toilets, drinking glasses and eating utensils
- Hugging, kissing or touching a person living with Hep C
- Following harm reduction principles: using sterile, unused drug-use equipment for injecting, snorting or smoking drugs, and using new and sterile tattoo and piercing equipment
- Using new or sterilized medical equipment during medical procedures
Many of the behaviours that put people at risk for Hep C are similar to those associated with HIV, and many of the steps to prevent Hep C also apply to preventing HIV. See Prevention for more information on how to reduce the risk of Hep C transmission.
Increasingly, in Canada, people infected with hepatitis C are disproportionately affected by poverty, substance abuse, racism and limited access to healthcare. People living on the streets often do not have access to sanitary environments to consume drugs or get tattoos and piercings. Prison populations do not have access to needle exchange programs or sterile tattooing equipment and they often must share personal hygiene items. Medical practices in some countries 20 or 30 years ago exposed numerous people to Hep C, some of whom have immigrated to Canada. Aboriginal people face the challenges of racism and its impacts, including isolation, poverty and the erosion of culture, which can lead some people to engage in risk activities.
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