Living with HIV and Hepatitis C Co-infection


Protecting yourself, protecting others

How do HIV and hepatitis C pass from one person to another?

A major reason why co-infection with HIV and hepatitis C is common is that both viruses often pass the same way.

Both viruses can pass through blood-to-blood contact (when blood carrying the virus gets into another person’s bloodstream). Hepatitis C may also be passed through anal fluids. HIV can also be spread through semen (cum, including pre-cum), vaginal fluids, front hole1 fluids, anal fluids and breast milk.Blood to blood

Neither HIV nor hepatitis C can pass through dry kissing or casual contact such as hugging, shaking hands, sharing clothes or eating together.

During sex

The chance of HIV passing during sex depends on different factors, including:

  • The kind of sex you’re having – HIV passes most easily during anal sex, vaginal sex or front hole sex. The risk of HIV passing during oral sex is usually low. Cuts, sores or inflammation in the mouth or throat or on the genitals can increase the risk during oral sex.
  • Whether an effective prevention strategy is used – There are various ways you can significantly reduce the risk of passing HIV to a sex partner. For example:
    • being on HIV treatment and maintaining an undetectable viral load
    • using condoms consistently and correctly
    • the use of PrEP (pre-exposure prophylaxis) by the HIV-negative person. PrEP involves the HIV-negative partner taking pills that will prevent them from getting HIV. Your doctor can tell you more about PrEP.
  • If either partner has another sexually transmitted infection (STI) – STIs can affect the genitals, anus, mouth and throat. Having an STI can increase the chance of HIV passing during sex.

Although sexual transmission of hepatitis C is rare, it can happen, especially during condomless anal sex. Being co-infected with HIV and hepatitis C increases the risk of hepatitis C passing during condomless sex.

Safer sex involves thinking about the kinds of sex you want to have, learning about the risks and using different strategies for lowering the risk of HIV, hepatitis C and other STIs.

You and your partner(s) you can make decisions about the strategies that are right for you.

Looking for some safer sex tips to get you started?

  • External (male) condoms and internal (female) condoms are an effective form of protection against HIV, hepatitis C and most other STIs. Using a water-based lubricant with condoms can decrease the chances of the condom breaking. For information on how to use a condom, talk to a healthcare or community worker.
  • Learn about other effective prevention strategies, including HIV treatment for the person living with HIV and PrEP for the HIV-negative person.
  • You can reduce your risk of getting other STIs by learning how different STIs pass between people, getting tested regularly and treating any infections right away.
  • Sharing sex toys can allow HIV, hepatitis C and other STIs to pass. Putting a condom on the toy and changing it whenever a sex toy is passed from partner to partner or from one body opening to another—mouth, anus, vagina or front hole—can lower this risk.
  • Good oral hygiene, such as preventing sores in and around the mouth, can lower the risk of HIV, hepatitis C and other STIs passing during oral sex. Not brushing or flossing for at least 30 minutes before sex will also lower this risk.

Do you have to tell your sex partner(s) that you have HIV and hepatitis C?

Current Canadian criminal law states that people with HIV have a legal duty to disclose their status to their sex partner(s) before any activity with a “realistic possibility” of HIV transmission. This law can apply to other STIs. As of 2016, it is unclear whether people with hepatitis C have a legal duty to disclose their hepatitis C status before sex.

Your local HIV organization, the Canadian HIV/AIDS Legal Network (, or a lawyer or legal clinic in your area can help you understand when you have a legal duty to disclose your HIV status. They can also help you understand what consequences there could be if you do  not  tell your sex partner(s).

When using drugs

Sharing or borrowing equipment for preparing, injecting, smoking and snorting drugs can spread HIV and hepatitis C. This is because used equipment can have blood on it and even small amounts of blood carrying HIV or the hepatitis C virus can spread these viruses when there is contact with another person’s bloodstream.

If you use drugs, there are things you can do to lower the chance of HIV and hepatitis C passing to others and to protect yourself from other infections.

The steps you can take are forms of safer drug use, also called harm reduction.

  • If you inject drugs, including steroids, you can lower the risk by using new needles, syringes and other equipment (cookers, filters, water, swabs and ties) as often as you can, ideally each time. You can also have your own equipment and try not to share it.
  • If you smoke drugs, you can lower the risk by using your own equipment (pipes, mouthpieces) and trying not to share with other people.

    Pyrex pipes with mouthpieces are safest because they don’t break down as easily or get as hot as other materials when heated. This can prevent cuts, burns and sores on the lips, helping to stop HIV and hepatitis C from passing.

  • If you snort drugs, you can lower the risk by using your own equipment and trying not to share with other people. Consider items that you can use once then throw away, such as a rolled-up Post It note or a plastic straw.

You can have a healthy baby

People living with HIV and hepatitis C can have healthy pregnancies and healthy babies.

Although HIV can pass to a fetus or baby from an HIV-positive pregnant person, advances in HIV treatment and care mean you can have an HIV-negative baby.

Woman and childWhen it comes to hepatitis C, transmission between a pregnant person and their baby is not common. The chance increases when a pregnant person is co-infected with HIV.

Some people want to try to clear the hepatitis C virus before becoming pregnant. It’s important to be aware that ribavirin, one of the drugs sometimes used to treat hepatitis C, can cause severe birth defects and should not be taken during pregnancy. If it is possible for one partner to become pregnant, both partners should wait at least six months after finishing hepatitis C treatment that includes ribavirin before trying to get pregnant. Newer treatments for hepatitis C do not have a lot of safety information and should only be used during pregnancy when the benefit outweighs the risk. Speak with your doctor and pharmacist to find out more about which drugs are safe and which are not. Some people decide to get treated for hepatitis C before trying to get pregnant.

Breastfeeding is generally not a risk for hepatitis C transmission. However, it is a risk for HIV transmission. North American guidelines strongly encourage HIV-positive parents to use baby formula instead of breastfeeding. If you can’t afford baby formula, some provinces and territories provide it free.

  • 1. The front hole is a term used by some trans men to describe their genitals