Guides

HCV transmission during sex between men

HCV sexual transmission among HIV positive gay men has been reported in cities in the UK, as well as in Europe, Asia, Australia, Africa and the US. 

Limited research reported one or more of the following risks.

  • Being HIV positive.
  • Recreational drug use.
  • Group sex and sex parties.
  • Sharing sex toys.
  • Rougher sex (longer fucking or fisting).
  • Barebacking (insertive or receptive anal sex without condoms). 
  • Other STIs (especially syphilis).
  • Meeting partners online. 
  • Number of partners.
  • Rectal bleeding from surgical procedures and/or rough sex.

However, some men living with HIV have caught HCV sexually without any of these risks. For example, without fisting, using recreational drugs or taking part in group sex. 

A summary of safer HCV sex for gay men in included on page 12.

At the time I was diagnosed, I had been feeling really ill for about six weeks – tired all the time, pains everywhere. My GP failed to diagnose it but my HIV clinic picked it up straight away. In a way it was a relief because at last I knew what was causing it.

HIV as a factor

Even with effective ART, immune responses to HCV are lower in people living with vs without HIV.

People living with HIV have a lower rate of spontaneous HCV clearance. They also take longer to develop HCV antibodies. 

HIV positive people may also be more infectious, as HCV viral load is higher (by about 10 times) compared to HIV negative men. 

The good news is that HCV treatment is very effective.

It was like getting an HIV diagnosis all over again. It changes how you think about sexual risk.

Recreational drug use and HCV infection

Recreational drug use increases the risk of HCV transmission. 

This includes injection and non-injection use of crystal meth, cocaine, ecstasy and other drugs. 

Recreational drugs can:

  • Lower your immune responses so HCV is easier to catch.
  • Dilate blood vessels, making the the rectum less protected against cuts and bleeding. 
  • Act as muscle relaxants allow longer and more energetic sex. 
  • Reduce inhibitions, for example, during group sex. 
  • Carry a high risk of HCV transmission if needles and other equipment are shared.

Antidote

Antidote is an LGBT drug and alcohol service. It is based in London with a national phoneline. 020 7833 1674
http://londonfriend.org.uk

Type of sex, group sex and sex parties

Any risk for contact with traces of blood is likely to be significant for HCV transmission. This is rather than semen, which is the route for most STIs.

Semen may be infectious if a partner is in recently acquired HCV infection. People with chronic HCV (for more than 12 months) are likely to have higher levels of HCV in their blood than their semen. 

At least one study has reported high levels of HCV in rectal fluid.

Some recreational drugs, sharing toys and lube, rougher anal sex, fisting, and group sex are linked to higher HCV risk. 

Because HCV is so much more infectious than HIV, it is more easily transmitted during group sex. Rougher, longer sex, increases the chance of bleeding.

In group sex, someone who fists more that one partner can transfer HCV without having become infected themselves.

Recreational drugs increase risk in at least three ways: tissue is more vulnerable to damage, sexual inhibition can change behaviour, and sex may be rougher and go on for longer.

One study also reported that sex after recent surgery or treatment for anal warts was a high risk for catching HCV. This would be an easy route for the virus to enter the bloodstream. 

Other STIs, especially syphilis, are linked to recently acquired HCV infection. Routine health checks are important to protect your health and that of your partners.

The good news is that DAAs are safe and effective for people who are coinfected with HIV and HCV.

Last updated: 1 November 2024.