Hepatitis C Basics for People Who Use Drugs (PWUD)

including safer injection and harm reduction tips. This brochure explains the basics of Hepatitis C transmission for people who inject drugs and for people who take drugs through other routes of administration. You can read the pamphlet below, print out copies of the PDFs in English or Spanish.

You can take steps to prevent getting hepatitis C. If you have hepatitis C, new treatments can cure it and keep your liver healthy.

Injection drug use is the most common way people get hepatitis C. If you share injection equipment with someone who is infected with hepatitis C, this puts you at risk. Even a tiny amount of blood — so small you can’t see it — can contain the virus. This is why hepatitis C can be passed on (transmitted) by sharing any equipment that may have come in contact with someone’s blood while injecting.

If you are getting high, you can protect yourself and others from getting hepatitis C. Getting tested, talking about your status, and injecting safely can reduce your risk of contracting or passing the virus onto others.

What is Hepatitis C?

Hepatitis C (HCV) is a virus that can cause liver damage. Hepatitis C is spread through direct blood-to-blood contact, meaning the blood of someone who is infected with hepatitis C must directly enter your bloodstream. The most common way this happens is by sharing syringes and injection equipment.

“Hepatitis” is a general term for inflammation of the liver, which can be caused by heavy alcohol use, prescription medications, and other factors. Most commonly, hepatitis is caused by viruses, like hepatitis A, B, and C.

Hepatitis C and Your Liver

When someone first contracts hepatitis C, the virus travels to the liver, and causes inflammation. In some cases, the immune system “clears” the virus within the first six months of being infected; however, most people develop long-term (chronic) hepatitis C.

For people with chronic hepatitis C, some may experience no liver-related complications, while others may eventually develop serious liver scarring called cirrhosis. The more your liver scars, the less it can do, which can lead to problems. In few cases, people with cirrhosis may develop liver cancer or liver failure.

Because hepatitis C can impact how well our liver functions, it’s important to avoid things that can harm the liver, and take active steps to keep it healthy.

The liver filters everything we breathe, eat, drink, inhale, and inject into our bodies.

Chronic Hepatitis C: See Your Doctor: If you have hepatitis C, it’s important to see your doctor to check the health of your liver. Because hepatitis C often progresses slowly, routine follow up visits with your doctor can help address issues before complications occur. In partnership with your doctor, you will determine which tests need to be done and how often.

Getting Tested for Hepatitis C

Get tested if you have ever injected drugs, even once. If you test negative, this can be a big relief, and you can take steps to reduce your risk of contracting the virus. If you test positive, you can take steps to avoid passing the virus onto others, learn ways to care for your liver, and talk to your doctor about treatment options.

There Are Two Common Tests to Determine if You Have Hepatitis C

HCV Antibody Test: A positive result means at some point you contracted hepatitis C. This test is very accurate, but may not detect if you are still infected. To confirm your result, ask your doctor for a diagnostic test.
HCV RNA/Diagnostic Test: This confirms if you are currently living with hepatitis C by detecting the virus in your blood. These results are reported as undetectable or detectable. A detectable result means you have chronic (long-term) hepatitis C.

Treatment for Hepatitis C

There have been new advances in treatment for hepatitis C, including highly effective medications that show the majority of people can be cured. Treatment is also easier than in the past because it usually involves pills only (no injections), there are fewer side effects, and treatment typically takes only 8-12 weeks.

Hepatitis C Treatment: Things to Consider

There is a good chance treatment can cure hepatitis C, meaning after treatment, the virus is no longer present in your body. If you’re cured, you can no longer pass the virus onto others, but it’s important to take steps to prevent getting re-infected.
Treatment works best when you take all of the pills on schedule. If you skip or miss some pills, treatment may not cure you. Think about how you can adhere to your medications before starting treatment.
If you are HIV-positive, getting treated for hepatitis C can improve your overall health, make your HIV medications more effective, and increase HIV treatment options.
Some people may be initially denied access to treatment based on drug or alcohol use or degree of liver damage. If you are denied access to treatment by your insurance company, you have the right to an appeal!

Living with HIV and Hepatitis C

If you have HIV and hepatitis C, you may be at greater risk for liver inflammation and scarring. There are things you can do to stay healthy, such as getting routine follow ups with your doctor, taking all HIV medications as prescribed, and getting treated for hepatitis C.

HIV Medications and Hepatitis C

Talk to your doctor about all medications you’re taking because HIV medications may need to be adjusted for people who have hepatitis C. Adhering to your HIV treatment can raise CD4 levels, improve immune function, and prevent liver-related complications from hepatitis C.

Hepatitis C Treatment and HIV

New hepatitis C medications show high cure rates in people co-infected with HIV, although treatment may take longer (up to 24 weeks), and your HIV medications may need to be adjusted while you’re being treated.

Safer Injecting Strategies

Use Sterile Injection Equipment. Avoid Reusing or Sharing.

Your blood may end up on any item you touch or use when injecting, including syringes, cookers, cottons, water, and ties. Use new, sterile equipment each time you inject.

Have a New Spare Sterile Syringe to Split Drugs.

Get an extra syringe for splitting drugs. Use an extra sterile syringe to split drugs, using your own cooker and cotton. Avoid drawing up from a cooker if someone else has used it. There may still be blood in it.

If You Must Reuse Equipment, Then Mark Yours.

Avoid sharing any injection equipment. The virus is alive outside the body. If you must reusee, keep a set of works with markings on it so you know it’s yours.

If You Must Share a Syringe, Then Bleach It.

If you must share a syringe, then clean it with bleach and sterile water.

Step 1: Rinse the syringe with sterile water.
Step 2: Rinse the syringe with bleach.
Step 3: Rinse again with (new) sterile water.

Additional Prevention Strategies

Use Sterile Tattoo and Piercing Equipment and Single-Use Inkpots.

Ensure sterile equipment, including inkpots, is used and not shared by others.

Avoid Sharing Toothbrushes, Razors, and Nail Clippers.

Household Items: Have your toothbrush, nail clipper, and razor clearly identified. Seek care if you have dental problems, including bleeding gums, abscesses, or other dental issues.

Use Your Own Snorting Straws and Crack Pipes.

Snorting Straws: Snorting drugs can cause irritation to the inside of your nose, which may lead to bleeding. To be safe, use your own straw when snorting cocaine or other drugs.
Crack Pipes: A hot step may burn or crack lips which can cause bleeding. Use your own pipe, or cover a shared pipe with your own rubber stem cover.

Use Condoms and Lubrication, and Get Tested.

Sexual Transmission: Hepatitis C can be transmitted through sex that involves blood-to-blood contact, such as during anal sex, rough vaginal sex, or while a woman is menstruating. Risks increase if you have multiple sex partners, or have been diagnosed with any STIs or STDs, including HIV. Using condoms and lubrication and getting tested or treated for STIs and STDs can protect both you and your sexual partners.

Liver Care Tips

Reduce Alcohol Consumption.

Moderate-to-heavy drinking can increase your risk for developing fibrosis and cirrhosis. Since there is no safe cutoff for people with hepatitis C, reducing the amount you drink, or not drinking at all, is the safest option.

Review Your Medications and Supplements.

Discuss all over-the-counter, prescribed medications, and herbal supplements with your doctor because some may be hard on your liver.

Get Hepatitis A and B Vaccinations.

There is no vaccine for hepatitis C, but there are vaccinations for hepatitis A and hepatitis B. If you have hepatitis C, get vaccinated for both hepatitis A and B to protect your liver.

Get Emotional Support.

Because of the stigma attached to hepatitis C and injection drug use, it’s not always easy disclosing your status to friends, family, and even healthcare providers. Accessing hepatitis C services and support groups can be helpful for gathering resources and sharing your feelings in a safe, non-judgmental, and confidential environment.

Distributed by Harm Reduction Coalition | www.harmreduction.org | 212-213-6376

About Harm Reduction Coalition
Harm Reduction Coalition is a national advocacy and capacity-building organization that promotes the health and dignity of individuals and communities impacted by drug use. Our efforts advance harm reduction policies, practices and programs that address the adverse effects of drug use including overdose, HIV, hepatitis C, addiction, and incarceration. Recognizing that social inequality and injustice magnify drug-related harm and limit the voice of our most vulnerable communities, we work to uphold every individual’s right to health and wellbeing and their competence to participate in the public policy dialogue.