by Lucinda K. Porter, RN
I have written many articles addressing various
issues that women with hepatitis C face. When I think about writing an
article about men and hepatitis C, I am concerned that the absence of a
Y chromosome denies me entrance into forbidden territory. However, it
is June, the month that men’s clothing is on sale, and when better to
talk about men and hepatitis C.
Men account for two-thirds of the chronic
hepatitis C virus infections (HCV) in the U.S. Men are more than twice
as likely to die from HCV as women are. Approximately 5.4% of U.S.
Veterans, particularly from the Vietnam War era, have HCV—triple that
of the general U.S. population. The majority of Veterans with HCV are
I dedicate this article to all the men I have
known who have struggled with HCV. I’ll begin with a story about a
patient I’ll call Fred.
Hepatitis C and Fatherhood
Fred called me, clearly anxious as he told me that he was afraid that
his toddler had been exposed to HCV. Fred had cut his face while
shaving, dabbed at the blood with a washcloth, and put the washcloth on
the tub to dry. That evening, Fred wandered into the bathroom while
his wife was bathing their son. His precious boy was sucking on the
washcloth. This was especially upsetting to Fred, since he had acquired
HCV peri-natally from his mother.
I reassured Fred that it was incredibly unlikely
that his son was at risk. HCV is rarely transmitted via the digestive
tract. If his child had open sores, cuts, a bleeding gum from an
emerging tooth, then there was a theoretical risk. I referred Fred to
his doctor and his child’s pediatrician for advice. Fred needed
hard-core reassurance, the kind that comes from a blood test. After six
months, testing revealed that Fred’s son was HCV negative.
Point #1: Although men don’t bear
children, they become fathers and grandfathers. HCV is rarely passed
in families, but the presence of children is an opportunity to review
HCV transmission and prevention. Links to more information are provided
at the end of this article.
One potential risk that is associated with
fatherhood and HCV is during treatment. Since ribavirin may cause fetal
damage, men need to be sure that female partners do not get pregnant
during and for six months after taking HCV medications. This warning is
so important, that hepatitis C treatment carries a Black Box Warning.
Point #2: If pregnancy is a
potential issue for your sexual partner(s), be sure that you and your
partner use at least two reliable forms of effective contraception
during treatment and during the 6-month post-treatment follow-up
Hepatitis C and sex
Sexual transmission of HCV is extremely rare among long-term
monogamous heterosexual couples. Women may be more likely to acquire
HCV sexually from men than vice versa. Disease transmission is riskier
when sex involves blood exposure or rupture of skin or membranes.
Examples of this are anal sex, fisting, group sex, and sex with a woman
during menstruation. Whips, knives, and certain sex toys may cause
bleeding. A risky practice that is emerging in our youth is vampire
play, which involves biting each other and drawing blood.
The risk of sexual transmission of HCV is
increased in the following: men who have sex with men, gay men, sex
workers, and people with multiple sex partners. HCV risk is higher in
those who have other sexually transmitted infections, particularly HIV
or hepatitis B. People who are co-infected with both HCV and HIV are
more likely to transmit HCV; the same may be true for people
co-infected with both HCV and hepatitis B virus. HCV risk is higher
with a compromised immune system, such as with HIV.
Point #3: Sex is fun; hepatitis
C is not. Practice safer sex, and regularly review safer sex
information, even if you think you know everything there is to know
about minimizing HCV transmission during sex.
Hepatitis C and Occupational Risks
I have a firefighter/paramedic friend who has no known risk factors
other than his work. Paul had been a firefighter for a long time,
starting before disposable gloves were routinely used. Paul can’t even
begin to estimate the number of bloody accidents he had responded to,
many where he cut himself while aiding a victim.
Any occupation where there is potential
blood-to-blood contact carries a risk for hepatitis C transmission. In
addition to public safety professions, examples of predominately-male
occupations with the potential for blood exposure are military service
personnel, healthcare workers, correctional workers, dentists,
janitors, and tattoo artists. Barbers who use straight razors or other
sharp instruments may have a slight risk. Some sports, particularly
boxing, may expose participants to blood.
Paul was treated and no longer has hepatitis C.
However, he has been vocal in his community, educating fellow
firefighters, police, and paramedics about hepatitis C prevention.
“Discussing feelings, symptoms, and side effects are not a sign of weakness; they are information.”
Mike works construction. He contacted me because
he regularly nicks himself on the job, and he wants to get rid of HCV.
Mike is afraid that he is exposing his co-workers who touch wires and
tools that may have residual blood. Although theoretically this could
be a risk factor, it is likely low. We talked about some prevention
techniques. Mike now carries clean up materials in his toolkit and
always has a Band-Aid in his wallet.
Point #4: If you work in an
occupation with a risk for blood-to-blood contact, be sure to know what
safety precautions are required for your work. Review these regularly,
even if you think you know all there is to know about keeping yourself
and others safe.
Hepatitis C and Psychosocial Issues
Steve has HCV and his best friend is a liver specialist I know. The
two have talked about Steve’s disease over the course of twenty years.
Steve is open with this highly regarded hepatologist, but Steve has
never talked about his feelings about living with HCV. When I met Steve,
I shared that I had HCV. I was the first person he had ever met who
had this virus.
At the end of our appointment, I asked Steve if
he had any questions. He asked, “Tell me what I can expect when I die
from hepatitis C.” I was stunned. Steve had no fibrosis and minimal
inflammation. He didn’t drink alcohol and statistically, he was more
likely to die from something other than HCV. However, for many years,
he lived his life stoically, assuming that this virus would eventually
take his life.
The tendency to “grin and bear it” is frustrating
to me as a nurse. During HCV treatment, patients, particularly men,
would not report a side effect until it became intolerable. Brian, a
patient with a rash, called me, wondering if he should come in to the
clinic or wait for his next regular appointment. I knew Brian well
enough to know that if he was calling, he should be seen immediately.
When he took off his shirt, he revealed an angry brilliant rash
covering his torso. It was the worst rash I had seen up to that point,
and apparently, my facial expression was not a “poker-face.” Brian
said my reaction was an affirmation that he made the right decision to
come to the clinic, and he said, “I thought you were going to tell me
to ‘buck up Buttercup.’”
Men are less likely to talk about their feelings
than women are. They may ignore or keep complaints to themselves. Some
men don’t have experience with putting words to feelings, and even if
they can identify a feeling, they may not know how to explain it. This
seems to occur most frequently when men are depressed.
Men’s experience of depression may differ from
that of women. The chief complaint among men with depression is fatigue
or other physical symptoms, such as sleeping problems, sexual
dysfunction, stomachache or backache. Men are more likely to have
trouble concentrating and making decisions. They may feel stressed and
irritable, and act angry and hostile when depressed. They may worry
more and use alcohol or drugs to cope.
Suicidal thoughts clearly indicate depression.
Women are more likely to attempt suicide, but men are more likely to
succeed. Thoughts of hurting yourself or others are serious problems
requiring immediate medical help.
Don’t be afraid to seek medical help for
depression; it is a treatable condition. Millions of men battle
depression. Those who have publicly talked about their own struggles
with depression are Buzz Aldrin, Johnny Carson, Terry Bradshaw, Louis
C.K., Jon Bon Jovi, and Jon Hamm, to name a few. Depression is not a
character defect—it is a medical problem.
Point #5: Discussing feelings,
symptoms, and side effects are not a sign of weakness; they are
information. There are no bad data. Always report thoughts of hurting
yourself or others. Seek medical advice for depression.
Special Populations: Hemophilia, Incarceration and Violence
There is an increased risk of hepatitis C in special
populations that are predominately male. This includes those with
hemophilia, a rare bleeding disorder in which the blood doesn’t clot
normally. The most common form is inherited, passed from mother to son.
Every year, about 1 in 5,000 males is born with hemophilia. Anyone who
received clotting factors before 1987 or a blood transfusion prior to
1992 needs to be tested for hepatitis C.
More men than women are in prisons and jails. The
Centers for Disease Control and Prevention estimates that 12%–35% of
prison inmates are chronically infected with HCV, compared to 1%–1.5%
in the uninstitutionalized US population.
Men are more likely to be exposed to violence,
and thus blood. There is not much research about violence and risk for
hepatitis C, but common sense suggests it needs to be examined.
Point #6: Know your risk
factors. Even if you do not have hepatitis C risk factors, if you
wonder if you have a history of exposure based on blood-to-blood
contact, it is reasonable to request an HCV test.
Men’s health is beginning to make headlines.
Health activists are raising awareness about men’s risk of prostate
cancer and other medical issues. Let’s add hepatitis C to the list.
Lucinda K. Porter, RN, author of Free from Hepatitis C
is a long-time contributor to the HCV Advocate. Her blog is http://lucindaporterrn.com
This article appears in the June 2013 edition of the HCV Advocate Newsletter
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