Be a liver

Pub date September 26, 2006

Dear Andrea:
Many years ago, I contracted the Hepatitis C virus (HCV). I had many partners before tests became available. None, to my knowledge, has contracted HCV from sexual contact with me. I know it’s possible to pass it through sexual contact but it’s very rare. It requires blood to blood contact: someone would need to stick their bloody penis in some equally bloody orifice on my body — not gonna happen! I’m always safe when it comes to anal sex. As for oral, well, that does give the opportunity to examine my partner more closely. Am I obligated to tell every partner I have about my HCV status?
The Centers for Disease Control and Prevention (CDC) consider HCV to be a sexually transmitted disease, but health departments of other countries — Australia for example — do not. My faith in the truthfulness of an agency of the US government in the current political climate is doubtful, especially when it comes to sexual matters.
I’m not a slut, but I satisfy my needs when they arise. I’ve never had an STD of any kind. I don’t know if it matters, but I’m a transsexual woman.
Liver It Up

Dear Liv:
Nope, doesn’t matter a bit!
It is maddening that we still know so little about sexual transmission of hep C. There are studies, but they contradict each other, are too specific to generalize from, or are otherwise just not capable of answering the big question: can you for sure get this from fucking? Seeing as the virus is pretty common though, there really ought to be more cases of transmission between monogamous non-drug-injecting partners. The cases just aren’t there, so it is tempting to shrug and say, “Guess it isn’t sexually transmitted after all.” If hep C were the common cold, I’d be cool with that, but seeing as it’s the leading cause of liver transplants in the United States and can totally kill you, we can’t be quite that cavalier about it.
It’s worth noting that while the CDC groups HCV with the sexually transmitted diseases on its Web site, it has little to say about actually getting it through sex. Click on the link and you get a list of risk factors (transfusion or organ transplant before routine testing was implemented, injection drug use, etc.) with nary a mention of sex of any sort. And when you dig a little deeper you find this: “HCV can be spread by sex, but this does not occur very often. If you are having sex, but not with one steady partner: You and your partners can get other diseases spread by having sex (e.g., AIDS, hepatitis B, gonorrhea or chlamydia).”
This is really a nice bit of legerdemain: “Sure, it could happen, but we don’t want to be quoted saying it could happen to you, so, uh, don’t get the clap.” I was guilty of the same sort of sleight of hand way back when I was working as a women’s safer-sex educator but really didn’t believe that the population we were reaching was actually at the slightest risk of contracting HIV through sex. No matter how stridently the AIDS establishment insisted that everyone was at equal risk, it wasn’t and still isn’t true, so I’d hand the girls the AIDS-prevention pamphlet I was paid to distribute and then tell them how not to get warts. Win-win, as far as I was concerned.
So do you have to tell everyone? This may be more of a question for that ethics guy than for me, but I kinda want his job anyway, so I’m going to have to say yes. You can play it down, you can say the chances of exchanging enough blood during sex are extremely low and you’ll be using condoms anyway, but since there have been cases of sexual transmission (no, we don’t really know what those people were doing, only what they say they were doing), we can’t pretend that there’s zero risk. “Almost zero” isn’t zero. I’m really sorry.
I had to do this, kind of. I discovered that a forever-ago partner had developed the disease, and as much as I would rather have sporked my own eyes out, I called the people I’d seen since (thankfully, there weren’t many of these) and informed them of the teensy-weensy risk. Nobody cared. I do hope I called them back after I finally got tested … um … all clear, guys, OK?
As for the right-wing antisex conspiracy, well, I’m with you as far as not trusting this administration as far as I could throw them — and really, really wanting to throw them — but the CDC is not so bad (and anyway the World Health Organization agrees with it about HCV). Look up Dr. Julie Gerberding, the Bush-appointed director of the CDC, and you’ll find her support for safer-sex education reviled and her appointment tsk-tsked on the Web sites of Focus on the Family, Concerned Women for America, and Accuracy in Media, among others. The enemy of your enemy is your friend.
Andrea Nemerson has spent the last 14 years as a sex educator and an instructor of sex educators. In her previous life she was a prop designer. And she just gave birth to twins, so she’s one bad mother of a sex adviser. Visit to view her previous columns.