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Spotlight Series on Hepatitis C

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Hepatitis C Prevention for People Who Inject Drugs

Using New Insights and Best Practices to Prevent Infection

July/August 2016

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Best Practices for Staying HCV-Negative: Lessons on Staying Safe

Although it can feel like injecting drugs and HCV go hand-in-hand, it can be prevented, and there are people who have been injecting for years and years but who have never been infected with HCV. In addition to bleach and other disinfectants, there are a number of practices that people use to help minimize their risk of HCV.

If you're ready to stop injecting drugs, that's the most direct way to keep hepatitis C infection from happening. This is not always easy: Sometimes it can be hard to get into a treatment program, there may not be one that is a good fit for you, or you may not be ready to stop right now.

If you can't stop, and you want or need to keep injecting drugs, there are things you can do to prevent infection (these can also be used to prevent reinfection). There are several practices for preventing hep C that longtime injectors who have never been infected have used. Again, refer back to a principle of harm reduction, which says that drug users themselves are the experts and "the primary agents of reducing the harms of their drug use and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use." It is with this in mind that the "Staying Safe Project" sought to learn directly from people who inject drugs (PWID) on how people can potentially stay HCV negative while injecting drugs. The study was international in its scope, but the tips below come from an article published from the London study.

The following list describes a selection of strategies and practices that people who have stayed HCV negative use. You may be able to do some of these things, while others may be difficult. Do what you can and don't beat yourself up over the things you find challenging:


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Set Up Your Own Personal Rules About Not Sharing Injecting Equipment and Disposing of Syringes

If possible, don't share anything: syringes, cookers, water, cotton filters, and tourniquets for both drug preparation and injection. If you need to re-use a syringe, clean it out with bleach or other disinfectants (see above), and do the same with cookers. Cotton filters and water can't be disinfected if HCV blood gets in them. You'll need to discard them and get unused cotton filters and fresh water.

When done with syringes and works, dispose of them in a sharps container (those red containers people put syringes in) and/or take them to your local syringe access site to dispose of them.


Take Charge of Your Drug Preparation and Injection

Try to take time to slowly and carefully prepare for your injection. Wash your hands with soap and water before you begin. Wipe down the surface where your drug preparation is going to happen with bleach or other cleaners. If you don't have anything, lay down some newspaper or napkins to prepare on.

Prepare your own drug mix. If you're injecting with others, volunteer to do the prep and split it with them in a way that does not lead to blood getting into the process. For example, split the drug up before preparing it all so each person has their own. You can also use an unused syringe to draw up the prepared drug and use it to put into each person's syringe ("backloading" or "frontloading"; check out the Harm Reduction Coalition's "Getting Off Right" booklet for more safe injecting info).


Separate and/or Mark Your Drug Injecting Equipment

Mark your syringes and injecting equipment to avoid mixing your stuff with that belonging to others. You can use a permanent marker or scratch off a number on the barrel of a syringe and so on. Store your injecting equipment in a kit that is clearly yours.

If possible, keep an extra stash or two of unused syringes and injecting equipment. You can keep one for yourself, and have one for someone else who might need something.


Prepare and Plan Ahead

If you inject heroin, the need to avoid withdrawal symptoms and getting dope-sick can lead a person to take more injecting risks than they usually would. Snorting or smoking a little before injecting could take the edge off while you prepare your injection (remain mindful of the risk of drug overdose: inject less if you took a little before). Stockpiling a little methadone or buprenorphine to take when you need it can help during these times, too.


Take a Break From Injecting for a While

If you can sniff or smoke your drug, try that for a while. This can give your veins a break and make injecting later a little easier. If there's no unused syringes or injecting equipment, try sniffing or smoking the drug to avoid sharing works.

If you smoke, try not to share pipes, especially if you have cracked lips or sores in your mouth: Blood from a pipe is a less efficient way of HCV transmission, but it can happen. The same is true with sniffing: sharing straws can lead to blood-to-blood contact in the nose. Again, it's less efficient than injecting, but definitely possible. Grab a few extra straws from a coffee shop so you have some on hand when needed (see the box for more harm reduction tips to reduce risk).

Preventing hepatitis C is not easy, but there are things you can do to help minimize your risk. In addition to the strategies listed here, you can find more information in the resources listed below. Regardless of what you do, try to integrate HCV testing into your care, and test routinely, at least once a year, but you can do it more frequently too, if you like.

For more information and one-on-one support around hepatitis C harm reduction and prevention, you can call the HELP-4-HEP line at (877) HELP-4-HEP, (877) 435-7443.

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This article was provided by Test Positive Aware Network. It is a part of the publication Positively Aware. Visit TPAN's website to find out more about their activities, publications and services.

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