Most HCV infections come from blood to blood transmission.

  • This is when HCV infected blood directly enters another person’s bloodstream. Saliva and tears are not infectious.
  • Semen and genital fluids may be infectious but there is less research on this.
  • As with HIV, you cannot transmit or catch HCV by touching, kissing, hugging, or from sharing cutlery, cups or dishes.
  • Unlike HIV, which dies in a few minutes outside the body, HCV remains infectious for at least a day even after blood has dried, and in some circumstances, perhaps for a week or longer. This is why you should not share items that may contain even tiny traces of blood.

Ways that HCV can be transmitted

  • Injecting, smoking or snorting drugs with shared, unsterilised equipment.
  • Tattooing or piercing when needles, ink, inkwells and other equipment are shared.
  • Medical or dental procedures with unsterilised equipment, including kidney dialysis.
  • Needlestick accidents to health workers.
  • Sharing items that may contain blood, such as razors, toothbrushes, nail scissors and nail files.
  • Sex with someone who has HCV but this is complex.
  • To a baby during pregnancy, labour or at birth.
  • From a blood transfusion or blood products before blood screening. This risk is now virtually zero in the UK, Western Europe and the US. However, up to 90% of people with haemophilia who were treated with clotting factors before 1985 were infected with both HIV and HCV.

In some countries, infections still occur from reused, unsterilised equipment or blood transfusions if blood is not screened thoroughly.

Injecting drug use and HCV

Worldwide, most HCV infections are related to injection drug use. This includes medical and non-medical settings, through sharing needles and other equipment.

HCV is a tougher and smaller virus than HIV. It can remain infectious for days to weeks in syringes, cookers, cotton, water, measuring syringes and ties.

Cleaning syringes with bleach reduces the risk of HIV transmission, but it is less effective against HCV.

Using clean needles and your own works each time you inject stops both HIV and HCV transmission (and reinfection).

It also reduces the risk of other infections.

If you caught HIV from drug use, you were probably infected with HCV first, before HIV. This is because HCV is a smaller virus that is not easily killed by bleach, making it more infectious than HIV.

More information on long-term coinfection and about HCV treatment for people who use drugs.

Sharing injecting recreational drugs including mephedrone and crystal meth in UK gay clubs and/or sex parties has a high risk of HCV transmission, see this link.

HCV and non-injecting drug use

HCV is more common among non-injecting drug users than the general population. It is not clear why. 

It may be possible to catch HCV from snorting drugs through shared straws or rolled bank notes, or from sharing pipes to smoke crack or methamphetamine.

Sharing these items is therefore not recommended.

Recreational drug use is one of the main risk factors associated with sexual HCV transmission in gay men, see this link. This is because these drugs can affect biological, physical and behavioural risk factors.

Transmission of HIV and hep C differ, particularly in terms of injection drug use … because hep C is not just transmitted by sharing a needle, and HCV is much more infectious than HIV. So, I know many people who are taking exactly the same measures to prevent transmission of both, but we know that’s not enough to prevent HCV. Sometimes people make decisions based on insufficient information, both in terms of HCV prevention and treatment. I also worry about sharing a rolled up note when I do coke – but it doesn’t stop me from doing it or my friends from being willing to share. I guess this all comes down to individuals agreeing to own and share risks that they feel to be acceptable … these risks feel ok most, but not all of the time.

1 November 2013