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HIV and Hepatitis C Coinfection

pipe and play

Injecting party drugs and / or bareback sex or fisting (especially in groups) increases your risk of catching hepatitis C.

The incidence of hepatitis C has grown 18-fold in the last fifteen years amongst HIV+ gay men. The risk of contracting hepatitis C comes from any activity that can allow infected blood into the bloodstream. This can be from bareback sex, fisting or sharing equipment to take drugs – especially if this is done in threesomes or groups.


This website isn’t about telling you what you should or shouldn’t do – our intention is to give you the facts so you can make a more informed decision in the future.

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Click for:

Party drugs and the risks
Fisting and bareback sex
What is hepatitis C?
Studies and academic papers on coinfection prevalence

Studies and academic papers on coinfection incidence

Coinfection with HIV and hepatitis C
Treating hepatitis C Information on treating hepatitis C if coninfected with HIV courtesy of National Aids Map

Party Drugs and the Risks (PnP)

Party and play (or pipe and play) is often online shorthand for sex on drugs, which can open up the risk of catching or passing on hepatitis C. This virus is passed on through infected blood, even in very tiny amounts. That means sharing any equipment to inject party drugs, such as crystal meth, or even sharing a note for snorting coke (if one of you has just a minor nosebleed), can put you at risk. And you don't need us to tell you that the hornier these drugs make you feel, the more likely you are to engage in riskier activities such as bareback sex or fisting, which can be very high risk factors for hepatitis C transmission.

Fisting and bareback sex (Bb + ff)3

Having group bareback sex or fisting with multiple partners can put you at very high risk of catching hepatitis C. If just one of the group suffers even mild bleeding then this blood can easily be spread from one member of the group to the next. If you are fisting in groups, it is vital that you use gloves and change into a new pair each time someone new gets fisted. This is because studies have shown that if you are HIV positive, then it is even easier to contract hepatitis C than those who are negative.

What is Hepatitis C (HCV)

The hepatitis C virus (HCV) is a blood borne disease that if left untreated can go on and attack the liver, leading to cirrhosis and potential failure or even cancer. If you are HIV positive then the rate of liver deterioration seems to be quicker then with people whose immune systems haven't been compromised. For this reason, most centres test HIV positive people once a year for hepatitis C. If you are HIV + and think you’ve been at risk of hep c it may be worth double checking with your clinic that you have been tested. If you are HIV negative and have engaged any behaviour that may have allowed even small traces of someone else’s blood into your body then it is worth considering getting a test. You can get a test at either your GP, sexual health clinic (anonymously) or, if you are positive, your HIV centre.

If you do have hepatitis C, then you can make lifestyle changes to help protect your liver or there are effective treatments available that actually cure the virus. The treatment has to be taken over several months and can be unpleasant – however, if you clear the virus, it will be worth it.

Coinfection with HIV and hepatitis C

It is estimated that 4-8% of gay men in the UK have been conifected with HIV and HCV. While the disease progression of hepatitis C is generally quite low, it is much more serious for those with HIV, as it’s more severe and progresses more rapidly due to the body’s immune system not being able to control it. Being coinfected can lead to a much quicker cirrhosis of the liver or even liver cancer. And just because your HIV treatment may be keeping your viral load low, with coifection, HIV medications are less effective than usual and can cause different side effects.

How to test for hepatitis C

The only way to know whether you have hepatitis C is by getting a test. It’s important to first make sure you have enough information so you can explore the implications of a positive or negative test result, and you feel confident that you are fully prepared.

The process of getting a diagnosis involves 2 tests, but usually these will be done from a single blood sample.

A hepatitis C antibody test is the first test undertaken which determines whether the blood’s ever been exposed to the hepatitis C virus. It checks for the presence of antibodies which would be generated by the immune system if the virus ever entered the blood stream. If this is negative the chances are you’ve never had hepatitis C. However, antibodies can take 3 months to show up so if you’ve recently put yourself at risk and are HIV-positive, you should get re-tested at a later date.

A positive hepatitis C antibody test means the virus has entered the blood stream at some time. It does not show current infection: up to 25% of people clear the virus from their bodies naturally. If an antibody test is positive a second test checks if the virus is still present. This is done with a PCR (polymerase chain reaction) test, which determines whether there is the genetic material of the virus in the blood. This genetic material is called RNA and this test is sometimes referred to as an RNA test. A positive PCR test indicates current hep C infection.

Where to go to get tested/treated?

If you think you are at risk, get tested. Across the whole country most GPs, Sexual Health or GUM Clinics are able to provide hepatitis C testing.

For more information or advice contact: / helpline: 0845 223 4424 / 020 7089 6221