Updating the hepatitis C infection risk reduction hierarchy in prison settings

Abstract

Hepatitis C Virus (HCV) is blood borne pathogen that affects an estimated 125 million people; approximately 2% of the world’s population.1 Current major risk factors for infection include injecting drug use and other procedures requiring skin penetration, such as non-sterile injections, tattooing and other body art. The contribution of unprotected sex to hepatitis C transmission is difficult to quantify. However, given that hepatitis C RNA was found in the semen of hepatitis C RNA positive men, and that sexual partners of HCV infected individuals more often demonstrate HCV infection than spouses of non-HCV infected partners, this route of transmission might be at least as significant as transmission via tattooing.2 Over 80% of all newly acquired hepatitis C infections in Australia and most Western countries are associated with injecting (illicit) drug use. A modelling study inferred that the number of new hepatitis C infections in Australia decreased from a peak of 14,000 in 1999 to 9700 in 2005, mainly due to reductions in injecting drug use.3 In sub-Saharan Africa where unnecessary therapeutic injections and reuse of injecting equipment for immunization and other medical procedures are common, up to 10% of hepatitis C infections are thought to be iatrogenic. Globally, the poor are disproportionately affected by hepatitis C infections. It is a stigmatizing infection with major psychological and social consequences for sufferers.