How hepatitis C transmission happens

Hepatitis C is transmitted when the blood of a person with hepatitis C comes in contact with the blood of another person. The virus itself is small and resilient. It only takes a tiny amount of blood (which may not be visible to the eyes) to pass on hepatitis C. The hepatitis C virus can survive outside the body, in open air, for at least four days. In certain conditions, such as inside a syringe, the virus can survive for many weeks.

Activities with the highest potential and frequency of blood-to-blood contact have the highest likelihood of passing hepatitis C. Activities that have no chance of exchanging blood are considered to have no chance of passing hepatitis C.

Activities with a higher likelihood of passing hepatitis C

• Sharing equipment for preparing and injecting drugs: The equipment used for preparing and injecting street drugs, including steroids, can have microscopic amounts of blood on it and can pass hepatitis C. Even sharing equipment one time (such as needles, syringes, cookers, water and filters) is a good reason to consider testing for hepatitis C.
• Sharing equipment for smoking or snorting drugs: The equipment used for smoking or snorting drugs, such as crack pipes or cocaine straws, can pass hepatitis C because small amounts of blood from cracked lips or tiny nosebleeds can be found on these items.
• Sharing tattoo or body-piercing equipment: The needles, equipment and ink can be contaminated with blood and can pass hepatitis C. This usually happens in places and situations where proper sterilization techniques or single-use equipment are not available or cannot be used.
• Blood transfusions or transfusion of blood products in a country where the blood supply is not routinely screened for hepatitis C: In Canada, routine blood screening began in 1990 and the risk of acquiring hepatitis C from the blood system is now negligible. Receiving a blood transfusion in Canada before 1992, the year a highly sensitive test for hepatitis C was introduced, is considered high risk for hepatitis C.
• Unsterilized medical equipment: Shared medical or surgical equipment can pass hepatitis C if it is not sterilized between patients. This is very rare in Canada.
• Blood or cutting rituals: Rituals that involve cutting with shared tools or the exchange of infected blood can pass hepatitis C.

Activities that can pass hepatitis C

• Sharing personal care items: Shared razors, toothbrushes, nail clippers and other household items that might have infected blood on them can pass hepatitis C.
• Condomless sex: In general, sexual transmission of hepatitis C is not common. The risk increases when certain factors are present, such as condomless anal sex, HIV, sexually transmitted infections, sex where blood is present, group sex and chemsex (using specific drugs to enhance or prolong sex). Thus, the risk of transmission may be higher among some groups of men who have sex with men (MSM).
• Transmission from a parent to child during pregnancy or childbirth (also known as perinatal transmission): The risk of perinatal transmission is about 5%.
• Needlestick injuries: An injury caused by a needle that punctures the skin can pass hepatitis C because of the possibility of exposure to hepatitis C from contact with blood in the needle or syringe.

Activities that cannot pass hepatitis C

• Casual contact: Hepatitis C is not passed through casual contact with a person living with hepatitis C, including sharing toilets, drinking glasses and eating utensils.
• Hugging, kissing or touching a person living with hepatitis C
• Following harm reduction principles: Using sterile, unused drug use equipment for injecting, snorting or smoking drugs and using new and sterile tattoo and piercing equipment prevents hepatitis C from being passed.
• Using new or sterilized medical equipment during medical procedures

Many of the activities that increase a person’s chances of getting hepatitis C are similar to those associated with HIV, and therefore many of the steps to prevent hepatitis C also apply to preventing HIV. See Prevention & Harm Reduction for more information on how to reduce the chances of hepatitis C transmission.

Higher rates of hepatitis C

Increasingly, in Canada, people living with hepatitis C are disproportionately affected by poverty, substance abuse, racism and limited access to healthcare. People living on the streets often do not have access to sanitary environments for using drugs or getting tattoos and piercings. People in prison often do not have access to new needles, drug use equipment or sterile tattooing equipment and people in prison often must share personal hygiene items. Indigenous people face the challenges of colonization, racism and its impacts, including isolation, poverty and the erosion of culture, which can lead some people to engage in activities that have a higher chance of passing hepatitis C. Medical practices in some countries 20 or 30 years ago exposed numerous people to hepatitis C, some of whom have immigrated to Canada.

Resources for service providers

• Hepatitis C Basics – eduCATIE online course
• The epidemiology of hepatitis C in Canada – CATIE fact sheet

Revised 2019.