Hepatitis C: An In-Depth Guide


How Hep C transmission happens

Hepatitis C is spread when the blood of a person with hepatitis C comes in contact with the bloodstream of someone else. The virus itself is small and resilient. It only takes a small amount of blood to transmit hepatitis C and the virus can live outside of the body in open air for at least four days. In certain conditions, such as the inside of a syringe, the virus can live for many weeks.

The riskiest activities are those with the highest potential and frequency of blood-to-blood contact. Those activities that have no chance of exchanging blood are considered no risk. Based on these distinctions, high-risk, some-risk and no-risk activities are outlined below.

High risk

  • Sharing drug-use equipment: The equipment used for preparing and injecting drugs, including steroids, can have microscopic amounts of blood on it and can transmit Hep C. Even a single event of sharing equipment (such as needles, syringes, cookers, water, filters, tourniquets and alcohol swabs) is cause for testing to be considered.
  • Sharing other drug-use equipment for smoking or snorting drugs, such as crack pipes or cocaine straws, because small amounts of blood from cracked lips or tiny nosebleeds can also be found on these items.
  • Sharing tattoo or body-piercing equipment: The needles, equipment and ink can be contaminated with blood and can transmit Hep 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 Hep C from the blood system is now very rare. Transfusions in Canada before 1992, the year that a highly sensitive test was introduced, are considered high risk.
  • Unsterilized medical equipment: Shared medical or surgical equipment can transmit Hep C if it is not sterilized between patients.
  • Blood or cutting rituals: Rituals that involve cutting with shared tools or the exchange of infected blood can transmit Hep C.

Some risk

  • Sharing personal hygiene and grooming supplies: Shared razors, toothbrushes, nail clippers and other household items that might have infected blood on them can transmit Hep C.
  • Unprotected sexual intercourse: Sexual transmission is rare, but Hep C can be transmitted sexually, especially when there is a chance that infected blood is present (such as during menstruation or certain sex practices like fisting). The presence of HIV or other sexually transmitted infections also increases the chance of transmitting Hep C sexually.
  • Transmission from a woman to a baby during pregnancy or childbirth (also known as vertical transmission). The risk of vertical transmission is about 5%. The risk increases if the woman is co-infected with HIV and Hep C.
  • Needle-stick injuries because of the possibility of exposure to HCV-infected blood.


  • Casual contact with a person living with Hep C, including sharing toilets, drinking glasses and eating utensils.
  • Hugging, kissing or touching a person living with Hep 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.
  • Using new or sterilized medical equipment during medical procedures.

Many of the activities that put people at risk for Hep C are similar to those associated with HIV, and therefore many of the steps to prevent Hep C also apply to preventing HIV. See Prevention & Harm Reduction for more information on how to reduce the risk of Hep C transmission.

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 consuming drugs or getting tattoos and piercings. Prison populations do not have access to needle exchange programs or sterile tattooing equipment and people in prison often must share personal hygiene items. Medical practices in some countries 20 or 30 years ago exposed numerous people to Hep C, some of whom have immigrated to Canada. Aboriginal people face the challenges of racism and its impacts, including isolation, poverty and the erosion of culture, which can lead some people to engage in risky activities.

Revised 2011.