When it comes to healthcare in the queer community, messaging about hepatitis awareness sometimes falls through the cracks, despite the fact that hepatitis C is the most common blood-borne infection in the country. Up to five million people in the U.S. are living with hepatitis C, with the majority unaware they have the virus.
Philadelphia FIGHT is one of multiple LGBTQ-inclusive healthcare organizations in Philadelphia that provides hepatitis testing, as well as education for patients and partnering organizations, one-on-one support, and linkage to care for people living with chronic hepatitis C.
“Philadelphia FIGHT has recognized the need for both clinically-based and community-based testing because we know that many people do not visit their doctors regularly,” said Stacy Trooskin and Lora Magaldi, FIGHT’s chief medical officer and viral hepatitis department manager, respectively. “We want to be sure that there is plenty of opportunity for testing that does not require a formal doctor’s visit.”
People who seek hepatitis testing and treatment can do so via FIGHT’s C a Difference viral hepatitis program, which offers “comprehensive, patient-centered, whole-person” services to people in and around Philadelphia who are at risk of acquiring viral hepatitis, HIV and STIs. The program also caters to people experiencing complexities that stem from housing instability, poverty, substance use disorder and other social determinants of health.
“More than half of all people infected with hepatitis C are unaware of their status,” Trooskin and Magaldi said. “It is important for everyone to know their hepatitis C status because [it] is curable.”
Early detection and treatment of hepatitis C is vital because advanced stages of the disease cause scarring to the liver, which can develop into cirrhosis, and raise the likelihood of liver cancer and liver failure.
Although hepatitis C is commonly transmitted via intravenous drug use, there are other ways of contracting the disease.
“There is less messaging in regards to the general population,” said Alvin Kingcade, physician assistant at Bebashi’s wellness clinic. “Hepatitis C is very contagious because it can live outside on surfaces. Any blood exposure with sexual intercourse, people that are sharing tooth brushes or sharing towels that may potentially have blood on it, these are ways that people get it. You just want to be highly aware of these types of ways that it’s potentially transmitted. Screening is important, and we try to get the word out for our patients that we see and test.”
Along with FIGHT and Bebashi, people who think they may have been exposed to hepatitis C can also find testing and treatment at Mazzoni Center’s primary care and sexual health clinics.
Transmission from sharing contaminated objects like towels and toothbrushes can only happen if the second party has an exposed wound.
The risk of spreading hepatitis C via sexual contact is relatively low, according to the National Institutes of Health, but the risk goes up in people living with HIV. PGN reported in 2012 that 20-30% of people living with HIV were also infected with hepatitis C, and that liver disease was becoming a more frequent cause of death for people living with HIV. The CDC reported that spreading hep C through sex “is an important mode of acquisition among MSM with HIV who also have other risk factors, including those who participate in unprotected anal intercourse, use sex toys and use non-injection drugs.”
Although hep C is the most common type of hepatitis, people also need to be informed about the other versions of the disease, Trooskin and Magaldi said. Hepatitis A is a viral liver disease that does not cause long term or chronic infection, though it can cause serious illness and has the capacity to be life-threatening. Ingesting food or water contaminated by feces can lead to hepatitis A infection. People experiencing homelessness who live in communal settings without proper sewage disposal or hand-washing facilities can be at higher risk for hepatitis A.
Hepatitis B is incurable, but it sometimes clears up on its own. It is transmitted through the blood, semen or vaginal fluid of an infected person. Both hepatitis A and B can be prevented through vaccination.
People who have hepatitis B can sometimes develop another infection in the form of hepatitis D. It is only possible for a person to get hepatitis D with an existing hepatitis B infection, so healthcare workers should test hepatitis B-positive people for hepatitis D, the FIGHT team pointed out.
Though less common in the U.S., hepatitis E is transmissible from eating raw or undercooked pork, game meats like venison and wild boar, and shellfish. In places with higher rates of hepatitis E, drinking waste-contaminated water is the most common mode of infection.
As for hepatitis C, “it’s one of those things where if you don’t test, you won’t know,” Kingcade said. “You may take a test somewhere down the line that shows that your liver functions are abnormal. And it’s because a person has hepatitis C and they’re unaware they even had it.”