SWOP: Sex Workers Outreach Project. Inclusiveness, Respect and Self Determination.

Hepatitis

Hepatitis is a general term for inflammation of the liver, usually caused by a virus.

Hepatitis A

How do you get it?

The virus is transmitted when small amounts of faeces (poo) from an infected person are transferred to another person’s mouth.

This can happen when:

• food or water is contaminated
• handling condoms after anal sex
• rimming without dams
• sharing some household utensils.

Infected people can transmit the virus from two weeks before they develop symptoms until one week after they develop jaundice, approximately three to four weeks in total. Following acute hepatitis A, most people develop immunity. This means they have lifelong protection against hepatitis A virus and they are not infectious.

Signs and symptoms

• There may be no signs or symptoms.
• Mild flu like illness including aches and pains.
• Loss of appetite.
• Nausea and/or vomiting.
• Abdominal pain.
• Dark urine.
• Jaundice (yellowing of the skin and whites of the eyes).

The average time between exposure to the hepatitis A virus and developing symptoms is about 28 days.

These symptoms will go away after a few weeks to several months and the person will develop immunity. Most people recover fully from this type of hepatitis.

Prevention

Wash hands with soap and water after going to the toilet and before preparing food. Wash towels and bed linen in warm soapy water. Wash eating utensils in detergent and warm water. Always use dams when rimming (licking a client’s anus) and wear gloves when fingering or fisting.

Immunisation is available from doctors and sexual health centres. Two injections, 6-12 months apart, will protect you for at least 10 years.

Hepatitis B

What is it?

Hepatitis B is a virus that causes inflammation of the liver.

How do you get it?

• Through blood, semen and vaginal fluids.
• Vaginal, anal or oral sex without a condom.
• Sharing injecting equipment.
• Sharing piercing and tattooing equipment.
• Sharing toothbrushes and razors.
• From a mother to child during birth or breastfeeding.

Signs and symptoms

• Loss of appetite.
• Mild stomach pain or fever.
• Nausea and vomiting.
• A rash often followed by jaundice (yellowing of the skin and the whites of the eyes).
• Fatigue.

Symptoms (if there are any) usually develop within three months. Many people have no symptoms. Others may have any or all of the above.

Most people who get hepatitis B will recover and develop immunity. They are no longer infectious and will not get the virus again. But 3-5% of people will remain infectious for many years.

For people that don’t clear the virus, it may cause damage to the liver over time, occasionally leading to cirrhosis (scarring of the liver), liver failure and liver cancer. There are treatments available to help clear the virus from the liver and prevent liver damage - see your sexual health centre or doctor for more information.

Prevention

There is a free, very effective and safe vaccine available to prevent hepatitis B. All sex workers can access this through sexual health services. You will need three vaccines over a six month period - some places do a quicker version of this if you need it done faster—with a blood test 6-12 weeks later to check the vaccine has worked. This gives immunity for life.

If you have been exposed to hepatitis B, you can get hepatitis B immunoglobulin, which needs to be given within three days of exposure. Contact a sexual health centre or Emergency Department if you think you have been exposed to hepatitis B).

Hepatitis C

What is it?

Hepatitis C (HCV or hep C) is a virus that is transmitted through blood and can cause inflammation and damage to the liver. Hepatitis C is not considered to be a sexually transmissible infection as it needs blood-to-blood contact to be passed on. But there is still a risk it could be passed on during sex work - such as in BDSM activities involving blood play.

When a person is infected with hep C, their body produces antibodies to stop the virus. Approximately 25% of people will clear the virus from their bodies within two years of exposure, and 75% will develop chronic (long-term) hep C infection.

For more info on hepatitis C visit hepatitisc.org.au

How do you get it?

It is transmitted by hep C infected blood getting into another person’s bloodstream. The virus needs an entrance to the blood stream like a cut, sore, or bleeding gums, or to be introduced directly to the blood stream through a needle, syringe or implement with infected blood on it. Hep C can be passed on by tiny amounts of blood that may not even be visible, and it can survive in traces of blood outside the body for days or even weeks.

Very high risk activities

• Sharing or reusing other people’s needles or syringes.
• Sharing or reusing other people’s injecting equipment; such as spoons, water, tourniquet.
• Fisting without gloves.
• Unsterile tattooing and body piercing.
• Using unsterile equipment in play piercing or blood play.

Moderate to low risk activities

• Needle stick and sharps injury.
• Sharing razor blades and toothbrushes.
• Blood transfusion and blood products before 1990 in Australia.
• Sharing or reusing snorting equipment.
• Unsterile vaccinations and medical procedures.
• Mother to baby, before or during birth.
• Breastfeeding (only if nipples are cracked and bleeding).

Prevention

Because hep C is transmitted from blood-to-blood, prevention involves being ‘blood aware’—avoiding or minimising the risk of blood contact. Some strategies include:

• Swallow, snort, shaft or smoke drugs rather than inject, but don’t share straws or snorting   equipment.
• Only use sterile, single-use disposable injecting equipment, including syringes, spoons, water and tourniquets, and don’t inject hits prepared by other people.
• Wash hands before and after shooting up.
• Dispose of fits in sharps safe containers.
• Dispose of other injecting items in leak-proof plastic bags.
• Treat all blood and bodily fluids as potentially infected—wear disposable gloves and clean surfaces with disposable cloths or paper towels and cold soapy water; dispose of any contaminated items in leak-proof plastic bags.
• Look after your own cuts, and cover them with waterproof dressings.
• If getting a tattoo or piercing, always make sure the body artist is qualified/approved and uses only new, single use disposable items including gloves, safety razors, skin wipes, spatulas, and containers for dyes and lotions. Needles and piercing jewellery need to be new (disposable or autoclaved) and in individual sterile packaging.
• Don’t share personal items such as razor blades, nail scissors, hair clippers, dental floss or toothbrushes because they may contain infected blood.
• Breast feeding mothers with hep C should check their nipples before each feed, make sure the baby is properly attached, and avoid breast feeding if nipples are cracked or bleeding.

Phone the Hep C Helpline for more info on: 1800 803 990

Testing

An individual’s decision to be tested for hep C should be made with informed consent. Pre-test and post-test discussion should take place in order to provide information and support and ensure good management and treatment of the infection.

Antibody test (HCV test): The initial screening test is the HCV antibody test, a blood test that shows if you have been exposed to the virus by tracing the existence of hep C antibodies. It can take up to six months for the body to develop antibodies, so someone who has acquired hep C could show a negative result in this time period.

Polymerase Chain Reaction test (PCR): A PCR test can detect the actual hep C virus in the blood. A negative PCR test means the person has either cleared the virus or has not been exposed to the virus. A positive PRC test means the person presently has hep C.

Signs and symptoms

Symptoms and effects of the hep C virus may include:

• tiredness or vagueness
• headaches
• a flu-like illness
• abdominal pain
• nausea or loss of appetite
• muscle and joint pain
• depression
• altered sleep patterns
• itchy skin
• menstrual irregularities
• irreversible scarring of the liver (cirrhosis)
• liver cancer
• liver failure.

The risk of developing advanced liver disease complications such as liver failure and liver cancer is relatively low, with an estimated 5-10% of people progressing to these complications over 20-40 years of infection.

Treatment

There are free treatments available for people with hep C, but these need to be discussed with a doctor and a hepatitis specialist.

Disclosure and discrimination

Hep C is not classified as a sexually transmissible infection (STI), so any worker who has been diagnosed with hep C should not be prevented from working. Sex industry employers have no valid reason to know your hep C status. Disclosure of hep C to management or co-workers within the sex industry can trigger discrimination and sanctions including dismissal. If you unfairly lose your job, you may wish to seek legal advice.