“People [who aren’t] as knowledgeable about the disease still associate it with IV drug use or assume their partner got it through sexual transmission,” explains Sonal Kumar, MD, MPH, director of clinical hepatology at NewYork-Presbyterian Weill Cornell Medical Center. “I have had to talk to multiple [patients’] partners on the phone — and then again sometimes in person, because they don’t believe me — about how hepatitis C is transmitted and how low the risks are for transmission to family members after cure.” Dr. Kumar says most hepatitis C specialists, including hepatologists and gastroenterologists, can help you learn what to say and, perhaps most important, how to say it. For example, when talking to your partner, you may want to emphasize that hepatitis C is a sexually transmissible disease — not a sexually transmitted one. According to Michael W. Ross, MD, PhD, MPH, a professor in the department of family medicine and community health at the University of Minnesota Medical School and a member of the board of directors for the American Sexual Health Association, this means that although hepatitis C can be transmitted by sexual contact, it most likely won’t be. (If your partner is worried about contracting the virus, you can further reduce the risk of transmission by practicing safe sex, including using condoms.) “With certain sexually transmitted diseases, you may have to start any conversation with your partner or family by talking about past sexual behavior, which partners may find emotionally threatening,” he explains. “Because hepatitis C can be transmitted in so many other ways, you don’t have to start off with a potentially stressful topic, which may make having that first conversation easier.” There’s no one way to share your status with the important people in your life, but there are some general guidelines that can help you navigate the conversation.
Starting a Conversation About Hepatitis C
When talking to sexual partners, honesty and openness are vital, advises the United Kingdom’s Hepatitis C Trust. Your partners have a right to know your status and request changes in current sexual practices in response. And so do you. Here are a few suggestions for how to broach this delicate subject. If you think the person will respond positively… What to say: “I have been diagnosed with hepatitis C. My doctors and I believe that I may have been infected with the virus as a result of…” Why it works: It’s important to clear up any misconceptions about how you acquired the virus and whether there are any risks to your partner’s health. Baby boomers, for example, may have received a blood transfusion from a supply with hepatitis C in the 1950s, before blood bank inventories were checked for the virus. If your partner is concerned about sexual transmission… What to say: “Hepatitis C is spread through contact with an infected person’s blood. While this may happen through genital sores, cuts, or menstruation, sexual partners of people with hepatitis C rarely test positive for the virus.” A study published in March 2013 in the journal Hepatology estimated that hepatitis C might be transmitted once in every 190,000 sexual acts for heterosexual couples. The risk is slightly higher among male same-sex couples, a study published in August 2019 in the Journal of the International AIDS Society reports, but it’s reduced if hepatitis C is diagnosed early and treated proactively and safe sex is practiced. Why it works: Kumar says it’s important to emphasize that hepatitis C is most often transmitted via blood-to-blood contact. Albeit rare, sexual transmission is still possible, so you should suggest that you start using condoms if you aren’t already. If you live with your partner… What to say: “It’s unlikely that I will give my hepatitis C to you, but we should still be careful. Please don’t use my toothbrush, razor, nail clippers, or other personal items, and don’t share your personal items with others.” Why it works: With friends, family members, and other loved ones, it’s important to emphasize safety, even though the risk of transmission is relatively low. Your explanations here should focus on the positives but still suggest caution, Dr. Ross says. It’s also good to remind those close to you that hepatitis C is not spread through casual contact. So things like hugging, kissing, shaking hands, and sharing foods and drinks — things we do every day with friends and family — are OK, Kumar adds. If you believe you’ve transmitted the virus… What to say: “I may or may not have transmitted the virus to you. My doctor recommends that you get tested.” Why it works: For anyone in your life who may be at risk for transmission, urge them to get tested. This is especially important if you use injection drugs and share needles with others, the U.S. Department of Veterans Affairs recommends. If you have a child… What to say: “My doctor says that I have an illness called hepatitis C. It’s serious, but with treatment I should be fine.” Why it works: Because children can often sense when something is weighing on their parents’ minds, it’s a good idea to tell them before their imaginations or their fears get the best of them, The Hepatitis C Trust notes. Given that their primary concerns may be focused on your health, try to be reassuring. If you’re a parent, it can be hard to tell your child that you contracted hepatitis C, but the Centers for Disease Control and Prevention recommends that family members who have risk factors for hepatitis C be tested. Talk to your child and their pediatrician about whether they should be screened. Of course, if your children are adults or old enough to give assent, talk to them about it directly. When you need a little more love… What to say: “You can support me by…” Why it works: Finally, once you’ve shared your status with your loved one, it helps to tell them what you’ll need going forward — namely, love and support. Consider what you need in order to cope with your diagnosis and take care of your overall health. Above all, be sure to have an open and honest conversation with your loved ones. While you might be tempted to think, Well, the risk for transmission is low, so I don’t need to tell them, your partner may think differently, says Ross. “It’s important to have these conversations with the people you care about,” he says. “If they care about you, they should be understanding and offer to help.”
