Hepatitis C

Hepatitis C, like other forms of hepatitis, causes inflammation of the liver. The hepatitis C virus is transferred primarily through blood, and is more persistent than hepatitis A or B. Worldwide, estimates suggest 170 million people are chronically infected with hepatitis C, with 3 to 4 million people newly infected each year.²

How hepatitis C is spread

High-risk groups are the same in many societies and cultures. They include injecting drug users, people who receive transfusions of unscreened blood, haemophiliacs, dialysis patients and people who have unprotected sex with multiple sex partners.

The hepatitis C virus (HCV) can be spread in the following ways:

• by sharing drug-injecting equipment (needles, heating spoons, etc). This is the primary transmission route for HCV and HIV outside sub-Saharan Africa.
• by using non-sterilised equipment for tattooing, acupuncture or body piercing. This can be a problem in countries where tattooing or scarification is a traditional ritual practice.
• through exposure to blood during unprotected sex with an infected person. Blood may be present because of genital sores, cuts or menstruation. Sexual transmission is an uncommon way of becoming infected with hepatitis C.
• rarely, from an infected mother to her baby during childbirth. The risk may be greater if the mother is also infected with HIV.
• through blood transfusion. In many developing countries blood is not screened (tested) for the hepatitis C virus. All blood for transfusion in the UK and USA is tested.
• by sharing equipment used to snort cocaine. Usually this is a rolled banknote, which can become contaminated with blood from a person’s nose.

Hepatitis C cannot be passed on by hugging, sneezing, coughing, sharing food or water, sharing cutlery, or casual contact.

Hepatitis B

Hepatitis B is similar to hepatitis A in its symptoms, but is more likely to cause chronic long-term illness and permanent damage to the liver if not treated.

How hepatitis B is spread

The hepatitis B virus (HBV) is very common worldwide, with more than 350 million people infected. Those with long term HBV are at high risk of developing liver cirrhosis or liver cancer.

Hepatitis B is most frequently passed on through the exchange of bodily fluids with an infected person. HBV is estimated to be 50 to 100 times more infectious than HIV.¹

HBV can be spread in the following ways:

• by unprotected (without a condom) penetrative sex (when the penis enters the anus, vagina or mouth) with someone who is infectious. Also by sex that draws blood with someone who is infected.
• by sharing contaminated needles or other drug-injecting equipment.
• by using non-sterilised equipment for tattooing, acupuncture or body piercing.
• from an infected mother to her baby, most commonly during delivery. Immunisation of the baby at birth prevents the transmission of hepatitis B.
• through a blood transfusion in a country where blood is not screened for blood-borne viruses such as HBV.

Hepatitis B cannot be spread through sneezing, coughing, hugging or coming in contact with the faeces of someone who is infected.

Signs and symptoms of hepatitis B

Hepatitis A

Hepatitis A is the most common of the seven known types of viral hepatitis. Infection with the hepatitis A virus leads to inflammation of the liver, but complications are rarely serious.

How hepatitis A is spread

The hepatitis A virus (HAV) is found in the faeces of someone infected with the virus. It only takes a tiny amount of faeces getting inside another person’s mouth to cause hepatitis A infection. Personal hygiene, such as careful hand washing, can minimise the risk of the virus being passed on.

HAV is a common infection in many parts of the world where sanitation and sewage infrastructure is poor. Often people become infected with HAV by eating or drinking contaminated food or water.

Hepatitis A is also classed as a sexually transmitted disease (STD) because it can be passed on sexually, particularly during activities such as anilingus (rimming). The washing of genital and anal areas before sex, and the use of condoms or dental dams can help to prevent this risk.

Hepatitis A can affect all age groups. Once a person is exposed to the virus it takes between 2 and 6 weeks to produce symptoms.

Signs and symptoms of hepatitis A

It is possible to experience mild or no symptoms whatsoever, but even if this is the case the person’s faeces will still be infectious to others. Many people who become infected with HAV will have symptoms that include:

• a short, mild, flu-like illness.
• nausea, vomiting and diarrhoea.
• loss of appetite.
• weight loss.
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces).
• itchy skin.
• abdominal pain.

The infection usually clears in up to 2 months, but may occasionally recur or persist longer in some people. Once a person has been infected and their body has fought off the virus they are permanently immune. Occasionally symptoms may be severe and require monitoring in hospital.

There are rarely any complications with hepatitis A infection. Permanent damage to the liver is very unlikely, but in extremely rare cases the infection can be fatal, particularly in older people.

AIDS Lifecycle Includes Protest in Closing Ceremonies

AIDS/LifeCycle
Leaders of L.A. Gay & Lesbian Center and San Francisco AIDS Foundation, with 2,150 Cyclists, Decry Proposed Cuts in HIV Funding at Conclusion of AIDS/LifeCycle 8

Participants in 545-mile trek from San Francisco to Los Angeles Raise $10.5 million

LOS ANGELES, June 6, 2009—Cheered by fans, friends, family and local residents, about 2,150 bicyclists streamed into Los Angeles today for the conclusion of the eighth annual AIDS/LifeCycle, a seven-day, 545-mile journey from San Francisco that raised $10.5 million for the HIV/AIDS-related services of the L.A. Gay & Lesbian Center and the San Francisco AIDS Foundation.

At the closing ceremony at the Veteran's Administration Center in West Los Angeles, the riders and 500 volunteer roadies from 41 states and 14 nations celebrated their heroic accomplishment. Led by San Francisco AIDS Foundation Chief Executive Officer Mark Cloutier and L.A. Gay & Lesbian Center Chief Executive Officer Lorri L. Jean, the participants decried the massive cuts in HIV/AIDS-related services in the governor's proposed budget and agreed to carry their message to communities across California.

"Elected leaders in our state government are poised to make massive cuts in essential health and human services, including $80 million for vitally needed HIV/AIDS services," said Jean. "We cannot allow them to balance the state budget at the expense of so many lives! We call on the elected leaders of our state to exhibit the same amazing compassion and courage that you all have shown over the past week, to appreciate the dire consequences of their proposals, and to fund the HIV/AIDS services that literally save lives."

Holding their helmets or hands over their faces during the ceremony, the cyclists and roadies represented the scores of lives that will be lost if legislators approve the proposed $80 million reduction in HIV/AIDS-related services—a roster of cuts which would deny life-saving drugs to low-income Californians, eliminate HIV testing, counseling and education programs, and turn the clock back on years of progress in fighting the AIDS epidemic.

"The proposed budget will put the most vulnerable Californians at risk and jeopardize the health and safety of communities we've long rallied to protect," said Cloutier. "The heroes of AIDS/LifeCycle 8 stand in unanimous opposition to potentially disastrous elimination of vital HIV/AIDS services."

The AIDS/LifeCycle participants ranged in age from 18 to 78 and included novice cyclists as well as event veterans, all of whom raised at least $3,000. They traveled through eight California counties, occasionally outnumbering the populations of the communities through which they rode. In many towns along the route, local residents applauded and displayed signs welcoming and encouraging the riders.

At the closing ceremony, actor Leslie Jordan, best known for his role as Beverly Leslie on the hit series Will & Grace, led a Riderless Cycle procession to commemorate all those lost to AIDS.

AIDS/LifeCycle's presenting sponsors were Shopoff Properties Trust, FedEx Corporation and Gilead Sciences.

Photographs from the AIDS/LifeCycle Closing Ceremony will be available for downloading at 8 p.m. (PDT) on Saturday, June 6 at http://www.aidslifecycle.org/press/.

Event photos and cyclists' journals can be viewed at http://experience.aidslifecycle.org. Additional information can be found on the AIDS/LifeCycle website at www.aidslifecycle.org/press-room/.

hiv aids India and China

India harbours two quite separate HIV epidemics. In the south, where heterosexual sex is the main transmission route, prevention projects have largely focussed on sex workers and their clients. This approach is credited with reducing HIV prevalence among all young women in southern states from 1.7% in 2000 to 1.1% in 2004.⁴⁰ By contrast, the main driver of HIV in the northeast is injecting drug use, and responses there have been lacking. As in many parts of Asia, men who have sex with men have also been neglected.

Neighbouring China has a much lower HIV prevalence than India, but some parts of the country are much worse affected than others. In central China, tens of thousands of people became infected during the 1990s when they sold their blood to commercial agencies. Authorities eventually reacted by enforcing tighter regulations, and the blood donation system causes far fewer new infections than before. In 2005, around 94.5% of blood came from volunteer donors, compared to just 22% in 1998. Today, most HIV transmission takes place during drug use or unprotected sex.⁴¹

China has traditionally taken a zero tolerance approach to drugs; the police are used to arresting drug users and sending them to compulsory rehabilitation centres. Recently, however, that attitude has started to change, and schemes providing methadone treatment and clean needles have been set up in several provinces. Some regions have also altered their approach to sex workers by introducing a 100 per cent condom use programme, peer education and treatment for sexually transmitted infections.⁴² On a national scale, the government has introduced routine HIV testing of people thought to be at high risk of infection, including drug users, sex workers, former blood donors and patients at sexual health clinics. This has led to many more people being diagnosed, though some experts have voiced concern that some people may be pressured not to refuse testing.⁴³ Overall, China’s response to HIV is improving, but coverage is still too patchy to have a substantial impact.

Europe

Like the USA, most Western and Central European countries have greatly reduced the rate of HIV transmission in medical settings (through blood screening and universal precautions) and from mother to child (through routine screening, use of preventive drugs and avoidance of breastfeeding). Countries that have implemented comprehensive harm reduction programmes, such as the UK, Germany and the Netherlands, have also maintained a very low rate of infection among injecting drug users. In some cases, the mass media have been used to reach the general population - for example in the UK's "Iceberg" and "Tombstone" campaigns, which were launched in 1987.

Yet despite these successes, the rate of new HIV diagnoses in Europe has risen over recent years. In the UK, the number more than doubled between 1999 and 2003. Although most of those diagnosed acquired their infections in Africa, the rate of transmission within the UK also appears to be rising.¹¹ To arrest this trend, campaigners are calling for better sex education in schools, greater resources for sexual health clinics, and more HIV prevention in the UK targeted at the most vulnerable groups, including immigrant communities.

In Eastern Europe, Ukraine is experiencing an extensive and rapidly expanding HIV epidemic. Most infections are among injecting drug users, but the virus is rapidly spreading from these people to their sexual partners and onwards to the rest of the population. Around 1.4% of Ukrainian adults were living with HIV at the end of 2005 – the highest rate in Europe.¹² Ukraine has one of the most developed harm reduction programmes in the region with over 350 needle exchanges and it has offered opioid substitution therapy since 2004.¹³

Though there are still barriers to accessing HIV prevention in Ukraine, it is a vastly better picture compared to Russia, another country where injecting drug use is driving the HIV epidemic. Little over 60 needle exchanges serve an IDU population of up to 2 million and substitution therapy is illegal.¹⁴

HIV prevention around the world

Since the early 1980s, most countries have attempted to prevent the spread of HIV, but some have been much more successful than others. This page looks at some of the more interesting examples from around the world.

The technical terms used in this page are explained in our overview of HIV prevention and our guide to understanding HIV and AIDS statistics.

HIV testing - a personal view

This page has so far contained some factual information about HIV and different types of tests. But testing is also about the lives people lead, and the personal views they hold, as Jenny explains below.

"Hi, I am a 30 year old heterosexual woman and I currently have no children. I am not an intravenous drug user or a haemophiliac. However, I have had unprotected sex with a number of heterosexual men. I know this behaviour can produce deadly results and I have had 2 negative HIV tests in the past 10 years with the last one being in 1996. Since my last HIV test I have had unprotected sex 5 times.

I hadn't recently given the subject much thought until I received notice that a local family had contracted HIV. I started thinking about my behaviour and how I have been gambling with my life and also putting the lives of others at risk, since I did not know my current status. I have been blessed with two prior negative HIV results. For the past two weeks I have been reading articles on HIV/AIDS, reading the stories of women who have contracted the virus and are courageously battling the disease, and also reading the signs and symptoms. I have prayed for guidance and for a repeated chance to begin a new pattern in my life if only my test would come back negative just one more time.

This morning I went for another HIV test and, thank god, it came back negative. I urge everyone black, white, gay, and straight to be tested. I also want to thank the women, men and children who have contributed their stories to this site. I must have read your words a thousand times over. You have made a difference in my life." Signed Jenny in America

What about home testing?

Using an HIV test kit at home means that the results are learned on the spot without any counselling. Reactive test results must be confirmed by further testing at a clinic. If purchased over the internet, there is no guarantee that the test kit is genuine or will provide accurate results. In the event of an incorrect result, there may be no legal recourse.

In many countries it is illegal to sell HIV test kits to the public. There is currently some debate about allowing them to be sold in the USA and the UK. AVERT opposes the legalisation of the sale of home testing kits in the UK because of the lack of post-test counselling.

HIV testing

There are three main types of HIV test.

The first type of test is the HIV antibody test. This test shows whether a person has been infected with HIV, the virus that causes AIDS. Information on this page concentrates mainly on HIV antibody testing. Antibody tests are also known as ELISA (Enzyme-Linked Immunosorbent Assay) tests.

The second type of test is an antigen test. Antigens are the substances found on a foreign body or germ that trigger the production of antibodies in the body. The antigen on HIV that most commonly provokes an antibody response is the protein P24. Early in the infection, P24 is produced in excess and can be detected in the blood serum by a commercial test (although as HIV becomes fully established in the body it will fade to undetectable levels). P24 antigen tests are sometimes used to screen donated blood, but they can also be used for testing for HIV in individuals, as they can detect HIV earlier than standard antibody tests. Some of the most modern HIV tests combine P24 and other antigen tests with standard antibody identification methods to enable earlier and more accurate HIV detection.

Blood supplies in most developed countries are screened for HIV using an RNA PCR test, which can produce positive results several days before a DNA test.

The third type of test is a PCR test (Polymerase Chain Reaction test). The whole process of extracting genetic material and testing it with a PCR test is referred to as Nucleic Acid-amplification Testing or 'NAT'. PCR tests detect the genetic material of HIV itself, and can identify HIV in the blood within two or three weeks of infection.

PCR tests come in two forms: DNA PCR and RNA PCR. Babies born to HIV positive mothers are usually tested using a DNA PCR because they retain their mother's antibodies for several months, making an antibody test inaccurate. Blood supplies in most developed countries are screened for HIV using an RNA PCR test, which can produce positive results several days before a DNA test. When a person already knows that she or he is infected with HIV, they may also have a viral load test to detect HIV genetic material and estimate the level of virus in the blood. This can be performed using either an RNA or DNA PCR test. PCR tests are not often used to test for HIV in adults, as they are very expensive and more complicated to administer than a standard antibody or P24 test. However they may be offered in special circumstances, or by private clinics where patients are willing to pay.

What is the connection between HIV and AIDS?

HIV causes AIDS by damaging the immune system cells until the immune system can no longer fight off other infections that it would usually be able to prevent.

It takes around ten years on average for someone with HIV to develop AIDS. However, this average is based on a person having a reasonable diet, and someone who is malnourished may well progress from HIV to AIDS more rapidly.

How is HIV treated?

Antiretroviral drugs keep the levels of HIV in the body at a low level, so that the immune system is able to recover and work effectively. Antiretroviral drugs enable many HIV positive people to live long and healthy lives.

Starting antiretroviral treatment involves commitment – drugs have to be taken every day, and for the rest of a person’s life. Adhering to treatment is important, particularly because not doing so increases the risk of drug resistance. Side effects can make adherence difficult, and are sometimes very severe. There are ways of reducing the impact of these side effects, but sometimes it is necessary to change to an alternative treatment regime.

There are more than 20 approved antiretroviral drugs in the US and Europe, as well as many new drugs currently undergoing trials. Although treatment for HIV has become more widely available in recent years, access to antiretroviral treatment is limited in some parts of the world due to a lack of funding.

HIV and AIDS Introduction

The Human Immunodeficiency Virus (HIV) is a sexually transmitted virus that attacks the body's immune system. A healthy immune system provides a natural defence against disease and infection.

HIV infects special cells, called CD4 cells, that are found in the blood and are responsible for fighting infection. After becoming infected, the CD4 cells are destroyed by HIV. Although the body will attempt to produce more CD4 cells, their numbers will eventually decline and the immune system will stop working. This leaves a person who is infected with HIV with a high risk of developing a serious infection or disease, such as cancer.

There is no cure for HIV and no vaccine to stop you from becoming infected. However, since the 1990s, treatments have been developed that enable most people with HIV to stay well and live relatively normal lives.

What is HIV?

HIV stands for: Human Immunodeficiency Virus

HIV is a virus. Viruses cannot grow or reproduce on their own, they need to infect the cells of a living organism in order to replicate (make new copies of themselves). The human immune system usually finds and kills viruses fairly quickly, but HIV attacks the immune system itself – the very thing that would normally get rid of a virus.

With around 2.7 million people becoming infected with HIV in 2007, there are now an estimated 33 million people around the world who are living with HIV, including millions who have developed AIDS.