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Sex & Hepatitis C


Kiss and tell: Having 'The Hep C Conversation'

Your history with hepatitis C is not a bedtime story.

Telling a potential sexual partner about your disease should come well before an evening of passion. That's fair to the other person -- and it makes the talk much easier to manage.

"The Conversation" is tricky for several reasons, including the uncertain outcome. The good news: Your chances of successfully reassuring your partner are far greater than those of someone with, say, genital herpes (HSV2). The facts about hepatitis and the odds of sexual transmission are on your side.

I have had the talk with a dozen or so women over the years. None of them rejected me. None were ever infected, I firmly believe. Some of these were long-running relationships, including a marriage of 12 years.

If your concerns about spreading HCV inspire guilt or fear, there are options. As with herpes and other sexually transmitted diseases, you can join niche dating web sites to connect you with other HCV carriers. Bonus: You'll meet people who've ridden the same emotional roller coaster.

Here are some tips for the talk, tried and tested:

Pick a good time and place. Even at best, this is a startling piece of information for people to absorb. Talk during a car ride or when you're relaxing on the couch.

"Be an expert," says San Diego State University public health educator Angela Basham. "Get all the information you can. Check Web sites, go to health services, anything to learn about your (disease)."

Don't reveal the information prematurely. On the first few dates, you want to be seen as the interesting person you are -- not a disease carrier. Both parties usually have a good feel for when the relationship is about to go physical. That's the time.

Be of clear minds. Alcohol doesn't mix with the HCV conversation. Skip the liquid courage. Remember that women get high on booze much quicker than men. Same holds for when you're both hot-and-bothered.

Rehearse your opening. A fear of getting a negative reaction will scramble many people's thoughts. Some nerves are to be expected, but in this case fumbling for words can be spooky. As with speechmaking, if nervousness is painfully obvious it may be better to admit you're a bit rattled. Remember, this should be a fairly easy exchange of information once it gets going.

Do not adopt "The Voice of Doom." Your tone could be scarier than the facts about HCV and sex. Don't let that happen. Be upbeat. You have a sympathetic audience. Try to find a joke in there somewhere.

Don't do a sales job. Present the facts and go from there. You are going to have to reveal the worst-case scenarios. Don't dwell on the fact that hepatitis C is a potentially fatal disease, but get that information out there.

Emphasize the low chances of sexual transmission. Stay on-message. Don't let the conversation focus on your fears about the disease.

Talk about ways to lower the chances of hep C transmission. This includes using a condom and avoiding sex when cuts or scrapes are present in the genital area. Make it clear that rough sex is not in the playbook for safe HCV sex.

Cover basic prevention that reduces risks, such as not sharing razors or toothbrushes.

Encourage your friend to take his or her time with any decision on having sex. You might want to have web sites such as this one bookmarked for quick reference. A few years ago, a new girlfriend of mine heard the talk and consented to sex, but freaked out soon after. She vowed to never see me again. A few days later, she called with the news that she and her sister had verified what I'd said about the low odds of sexual transmission, via medical sources. We were together for a couple of happy years.

If you're rejected, take some time to replay the conversation in your mind. Perhaps try another approach to talking about your disease with a potential lover. "If you go into the next relationship, you have to know how to open up," SDSU's Basham says.

A sample script: 'I have this disease ...'

"It seems like we're getting along pretty well here, right? So I need to speak with you about something. It's a bigger deal for me than you, but I need to be up-front.

"A few years ago, I found out I had hepatitis C. It's a liver disease. Do you know what that is?

"Hep C is a blood-borne virus.

"I don't mean to be presumptuous, but this is probably a good time to share this:

"Most doctors agree it's not sexually transmitted. You'd have to be incredibly unlucky to get it from straight sex. Some doctors think that never happens, others think it does. Everyone seems to agree that if it's a sexual transmitter, it's incredibly inefficient at doing that.

"The danger seems to be with rough sex or anal sex that draws blood.

"It's not like herpes or HIV. Most people got it through blood transfusions or shared needles. And I don't think we'll be sharing any needles, do you?! (big smile for a bad joke).

"There are some things to know when you're in close contact with someone who has hep C. You can't use my toothbrush, for example, in case our gums are bleeding. Things like that. It's mostly common sense stuff.

"Doctors say most people outlive the disease, but some do develop cirrhosis of the liver and can die before getting a transplant. The disease usually progresses over decades. They're working hard on a cure.

"You probably need some time to process all this, but can I answer any questions?

"It's probably a good thing if you spend some time looking this up on the Web. I know some good sites. There are many studies about hep C sex. Or just run the searches. Maybe you want to talk to your doctor before we get involved.

"I want to make sure you're comfortable with this, OK?"