Disease Transmission
Harm reduction and disease transmission
Preventing disease transmission and supporting the health of people with communicable diseases is a large component of harm reduction. Harm reduction refers to a variety of approaches that minimize the harms associated with “risky” behaviours, such as substance use, injecting, sex, and tattooing. Interventions that limit disease transmission often focus on STIs and blood-borne infections, such as HIV and Hepatitis B and C (CATIE, 2011). Research has shown that adopting a harm reduction contributes to decreased transmission rates of both HIV and HCV (CATIE, 2011).
Preventing disease transmission and supporting the health of people with communicable diseases is a large component of harm reduction.
Where to find supplies in Toronto
Hepatitis C Transmission
What is Hepatitis C and who is at risk?
Hepatitis C (or HCV) is a blood borne virus, meaning that it is spread through blood-to-blood contact with someone who has the virus and someone who does not (CATIE, 2019a). Hepatitis C can survive outside of the body in open air for approximately four days while it can survive in a syringe for a number of weeks (CATIE, 2019a). Healthcare inequities and systemic factors that contribute to poor access to social determinants of health produce disproportionate populations who are vulnerable to Hepatitis C transmission (CATIE, 2019a). This includes people who are experiencing homelessness, people without access to harm reduction education and supplies, people experiencing incarceration, First Nations, Métis, and Inuit peoples, and newcomers to Canada (ibid, 2019).
Activities that can possibly increase likelihood of transmission include:
Sharing or preparing equipment for injection substance use
Includes sharps, cookers, wash, water, and filters
Sharing or preparing equipment for smoking or snorting substances
Includes pipes, straws, cracked lips, or nosebleeds
Sharing tattoo or body-piercing equipment
Receiving blood transfusions prior to 1992
Unsterilized medical equipment
Blood or cutting rituals
Activities that may transmit the virus include,
Sharing personal care items such as razors, toothbrushes, and nail clippers
Condom-less sex
Sex where blood may be present
Transmission from parent to child during pregnancy or child birth
Needle-stick injury
Activities that will not transmit the virus include
Casual contact
Sharing toilets, drinking glasses, and eating utensils
Showing affection
Hugging, kissing, and touching
CATIE (2019a)
HIV Transmission
What is HIV?
HIV stands for human immunodeficiency virus. It is a virus that can weaken the immune system which over time can become too weak to fight off illness or infection (CATIE, 2016). If HIV is left untreated over time it can develop into Acquired Immunodeficiency Syndrome, also known as AIDS. You cannot get rid of HIV, but with treatment and regular medical support and screening, you can have a lower transmission rate, and be supported in living a healthy and long life (CATIE, 2016).
CAN you stop the spread of HIV?
Medications that treat HIV can also prevent HIV transmission. If you are HIV-positive and take HIV treatment that suppresses your virus to undetectable levels (you have an undetectable viral load), you will not pass HIV to the people you have sex with. In other words, undetectable HIV is sexually untransmittable (CATIE, 2019b). Note that even if your viral load is undetectable, you can still pass on HIV through breastfeeding - so bottle feeding is advised.
How is HIV Transmitted?
HIV can be transmitted through five bodily fluids which include: blood, semen (including pre-cum), rectal fluid, vaginal fluid, and breast milk. Transmission can only occur when one of these fluids becomes in contact with the bloodstream of another person which can include broken skin, the opening of the penis, or the wet lining of a body which include the vagina, rectum, or foreskin (CATIE, 2016). It is most commonly passed through sex or sharing injection equipment, but can also be passed through tattoos, body piercing, or through pregnancy, birth, or breast milk (CATIE, 2016).
It is important to note that HIV cannot be passed by talking, shaking hands, or eating something from someone who is positive (CATIE, 2016). This also includes hugs, kisses, cough, sneezing, swimming pools, toilet seats, water fountains, bed sheets, utensils, and animals (CATIE, 2016).
What can you do to reduce the risk of Contracting HIV?
When engaging in risky activities there are certain measures you can take to be safe. These include using new and sterile injection equipment every time you inject; using sterile tattooing equipment; and using latex, polyurethane, or nitrile condoms as well as water or silicone-based lubes when having sex (CATIE, 2016).
For people who do not have HIV and are at high risk of contracting the virus, you can take Pre-exposure prophylaxis medication (PrEP), prescribed by a doctor, or Post-expsoure prophylaxis medication (PEP), also prescribed, if you think you believe the virus may have been transmitted to you (CATIE, 2016).
HIV and the Law
Canada’s laws around HIV disclosure are highly criminalizing and oppressive. Currently, if you have HIV you have a legal duty to disclose your status to sexual partners if there is a possibility of transmitting the virus (CATIE, 2016). You must disclose your status if you are having vaginal or anal sex without a condom (regardless of viral load), and if you are having vaginal or anal sex when your viral load is not undetectable, even if you use a condom (CATIE, 2016).
You do not need to disclose your status before having vaginal sex if your viral load is undetectable and if you use a condom (CATIE, 2016). It is not currently clear whether or not this translates to anal sex or oral sex with or without a condom (CATIE, 2016).
Safer Tattoos and Piercings
Viruses can also be spread via body art setting and equipment (CATIE, 2011). If items are not sterile there may be a possibility for blood to blood contact (CATIE, 2011).
When picking a piercing or tattoo artist, individuals should consider places that:
Have a good reputation or positive feedback
Have an inspection certificate from a local public health department
Has an autoclave and autoclave spore-test calendar
Uses new, sterile needs every time
Uses latex or vinyl gloves every time
Uses new ink and inkpots
Uses new support equipment
Has an autoclave for metal equipment
Uses Stainless steel jewelry
Provides aftercare instructions
For stick-and-poke tattoos, and tattoos using piercing needles, safety pins, or sewing needles individuals should consider
New equipment and new ink
A space that is accessible to sterilize
Sharps disposal
Refraining from consuming alcohol or substances until afterwards
(CATIE, 2011).
References
CATIE. (2019a). Hepatitis C: An In-Depth Guide. Retrieved from Canadian AIDS Transmission Information Exchange: https://www.catie.ca/en/practical-guides/hepc-in-depth/what-hep-c/what-is-risky
CATIE. (2019b). The Power of Undetectable. Retrieved from https://www.catie.ca/sites/default/files/Catie_Power_of_Undetectable_EN_2019-V9_web.pdf
CATIE. (2016). HIV BASIC FACTS. Retrieved from Canadian AIDS Treatment Information Exchange: https://www.catie.ca/sites/default/files/hiv-basics-en.pdf
CATIE. (2016). Safer Sex Guide. Retrieved from Canadian AIDS Transmission Information Exchange: https://www.catie.ca/sites/default/files/CATIE_SaferSexGuide_2016_English_WEB.pdf
CATIE. (2011). Safer tattooing and piercing. Retrieved from Canadian AIDS Transmission Information Exchange: https://www.catie.ca/en/practical-guides/hepc-in-depth/prevention-harm-reduction/safer-tattooing-piercing