Hard-hitting images of fisting and drug-use are a key part of the UKC’s new hep C campaign. Susan Cole and Robert Fieldhouse explain why
PN: How did you get involved
? RF: We both felt the HIV sector’s track record around raising awareness of hep C among positive gay men was pretty poor. Many gay men with HIV, at risk of hepatitis C, remain unaware how it is transmitted. So when UKC asked us to do something, we jumped at the chance.
PN Why now?
SC: Until the end of 2002, new hep C infections in gay men attending London HIV clinics were fairly low and stable. But in the past two years the Chelsea and Westminster, The Royal Free, and University College hospitals have all reported increases in the number of gay men with HIV getting diagnosed with hep C. About one and a half per cent of the gay men attending the Kobler clinic have been recently diagnosed with hepatitis C.
PN: What are the key messages?
RF: Most recent transmissions have been in men who caught syphilis during the recent outbreaks, and maybe occurring within sexual networks of men who are into fisting. Hep C is more infectious than HIV and survives for longer outside the body; for up to six months in dried blood, and with fisting being more traumatic, this is where the risk increases.
SC: We also wanted to draw attention to the role that sharing notes to snort drugs may be playing, rather than concentrate on injecting drugs, simply because more gay men admit to it. Doctors we spoke to are adamant this represents a significant risk for hep C transmission. It only takes a microscopic amount of blood on a note to come into contact with the delicate tissue lining the nose for transmission to occur.
RF: Drug taking and rougher sex often go hand in hand and it is difficult to tease out whether it is the drug-taking or rough sex that is causing the transmission. Men who do ‘booty bumps’ - putting drugs in water and squirting them up your arse before fisting - may be potentially risky if using water from a central pot and sharing the syringe. The same goes for lube; if men are having group sex and sharing lube with other men, it is possible that hepatitis transmission could occur. Using your own lube and putting a new condom on your sex toys, if you are sharing them, should reduce the risk.
PN: How are you reaching people?
RF: We have addressed many conferences of health care professionals and people living with HIV. We have also stepped up coverage of co-infection issues in Positive Nation, and will continue to present the latest data as they emerge. We are also advertising our campaign in a range of gay magazines.
SC: And more than 100 people, including positive people recently diagnosed with hep C, came to an awareness-raising event in February. The UKC’s new gay men’s group has offered to help us get our campaign into local bars and clubs. CLASH and the gay men’s outreach team at Terrence Higgins Trust are also helping us to roll it.
PN: Do you think some venues will refuse to display the campaign?
RF: Postcards and posters are currently being sent out to clinics. I appreciate some of the images are not suitable for every environment. But we are trying to encourage clinics and support organisations to think creatively about where they can be displayed: perhaps a gay men’s HIV clinic, or the back of the door in the gent’s toilet.
PN: How did you put the campaign together?
RF: We recruited a great team of volunteers who helped us research, develop and design the campaign. Throughout we were supported by GMFA, the specialist gay men’s health promotion agency.
SC: We thoroughly pre-tested the campaign in gay bars, with groups of gay men living with HIV and a panel of men co-infected with HIV and hepatitis C and took their comments onboard.
PN: What did you learn?
RF: I was surprised about the low level of awareness among gay men with HIV that sexual transmission of hepatitis C was a real possibility.
SC: Doctors in the field have made us realise it is a live issue for gay men, especially those with HIV.
Susan Cole is special projects manager at the UKC and Robert Fieldhouse is the UKC’s treatment specialist.
