1. Test for HCV routinely. Testing for HCV alone is not prevention, but knowing your status so you can seek treatment and prevent transmitting it to others is very important. You should test at least once per year, but might consider more frequent testing depending upon your level of risk..
2. Talk to your partner(s) about hepatitis C. If they are HCV-positive, or they don’t know their HCV status, you might consider activities that are less likely to transmit HCV, such as oral sex, masturbation or wearing a condom for anal sex. Communication and awareness of your sex partner’s status is especially important if you are sero-sorting and only having sex with other HIV-positive men.
3. Wear a condom for anal sex. Both tops and bottoms are at an increased risk for sexual transmission of HCV. Condoms can provide an effective barrier to prevent blood contact during anal sex. Use water-based lube to make sex smoother and minimize the chance for micro tears and bleeding.
4. Practice safer fisting. As with anal sex, both tops and bottoms are at increased risk for sexual transmission of HCV. Check your hands for any cuts or bleeding cuticles. Wear latex gloves, and change into new, unused ones for each new partner. HCV is a tough virus and can live in water for up to 21 days, so although we may not know how long it can live in lube, it’s good practice to not share lube between partners, either.
5. Sequence your sex play. Avoid receptive anal sex after fisting or vigorous sex toy play that may have caused tearing and bleeding in the rectum, or you could be the top for anal sex.
6. Keep your sex toys clean. Cover your dildos and vibrators with condoms and change them for new ones with each partner. Do not use toys with more than one person before fully washing them.
7. Take a break from anal play. If you recently had anal warts removed, or had a case of hemorrhoids, take a break from bottoming to give yourself a chance to heal. The same is true following any type of receptive anal sex, especially if you see any blood or feel any discomfort or pain.
8. If you use drugs during sex, don’t share anything. Whether you use injectable or non-injectable drugs, don’t share anything. HCV can live on surfaces for a very long time in syringes, on surfaces, and in drug using equipment, and anything with HCV-infected blood on it can transmit the virus.
9. Screen for STIs regularly. Routine screenings for STIs that can cause sores—primary syphilis, herpes, anal warts, etc.—are an important part of your sexual health. If you are sexually active, aim for STI testing every 3–6 months. Perform self-exams, too, and check for any sores (especially if you have a history of herpes or anal warts). If you see something, check with your medical provider or go to an STI clinic to get it checked out. If you feel any rectal discomfort or see any rectal bleeding or other discharge, do the same.
10. Stay HIV-negative. Screen routinely for HIV and know your status. If you test positive, get into care, screen for HCV, and talk about HIV care and treatment. If you test HIV negative, continue to practice safer sex and safer drug use, screen for STIs regularly, and talk to your medical provider about PrEP.
Bonus Tip: Get cured of HCV. When you’re cured of HCV, you have no virus in your body, and thus no chance of transmitting HCV. “Cure as prevention” is an excellent tool for taking care of both yourself and your sex partners. After getting cured, stay mindful of HCV re-infection and continue to screen for HCV at least annually.