By Christine Kukka
Around the world, the most common way hepatitis B is spread is through sex — and sometimes it’s not consensual.
In the United States, sexual transmission of hepatitis B accounts for nearly two-thirds of acute or new cases in adults. According to a U.S. Centers for Disease Control and Prevention (CDC) report, about one in five women and one in 71 men reported experiencing rape at some point in their lives. And abusers rarely use condoms.
One of the hardest things to talk about is the relationship between how hepatitis B is spread and sexual assault or coercion – defined as anytime a woman, man or child is forced to submit to sex either through rape or assault, or with a partner who refuses to use a condom.
About one in 20 women and men (5.6% and 5.3% respectively) experienced sexual violence, such as sexual coercion or unwanted sexual contact in the 12 months prior to the CDC’s survey; and 13 percent of women and 6 percent of men reported they had experienced sexual coercion at some time in their lives. Among women, most abusers were intimate partners, family members or acquaintances. Among males, most perpetrators were acquaintances.
Research suggests these figures under-estimates the true prevalence of sexual violence around the world, which endangers public health on many levels. There is the mental trauma victims experience and there is the spread of sexually-transmitted infections, such as hepatitis B and HIV.
Hepatitis B is 50- to 100-times more infectious than HIV and can be passed through the exchange of body fluids, such as semen, vaginal fluids and blood. The CDC recommends the following steps to protect against hepatitis B following sexual assault.
When the perpetrator has hepatitis B (is positive for the hepatitis B surface antigen-HBsAg):
- If the victim has never been vaccinated, he or she should receive the hepatitis B vaccine series and also receive a dose of HBIG (hepatitis B antibodies).
- If the victim has been vaccinated in the past, he or she should immediately get a hepatitis B vaccine dose (called a booster dose.)
When the perpetrator’s hepatitis B status is not known:
- If the victim has not been immunized against hepatitis B, he or she should received the hepatitis B vaccine series.
- If the victim has already been vaccinated against hepatitis B, no treatment is needed.
In South Africa, for example, women’s inability to control their lives sexually is fueling the HIV epidemic. One study that followed 1,500 pregnant women who were in married or stable relationships found an astonishing HIV infection rate of 38 percent. Many reported having been abused physically and sexually in the recent past, which helps explain why AIDS is now the biggest killer of young women in southern Africa.
Sexual assault is not always accompanied by physical violence. A woman may not have the power to require her partner to use a condom without risking physical or verbal abuse, or a person may not tell his or her sexual partner that they have hepatitis B. Coercion can be silent, and fueled by ignorance and low self-esteem.
Here is an email that the Hepatitis B Foundation recently received that illustrates this: “My boyfriend is hepatitis B and C positive, as he was a drug addict. We had unprotected sex often over two to three months. I want to ask, is there any chance of myself being infected?”
Sadly, this woman is at very high risk of infection, especially from hepatitis B. What stopped her from insisting he wear a condom or walking away from a relationship with a man who had little concern for her health and welfare?
Poverty, a lack of choices, resources and education, and a host of other factors stop victims from walking away from their abusers every day around the world.
To protect the health of people around the world, we need to fight in any way we can to stop sexual violence, protect women’s reproductive health, and enable everyone to control their lives.
In southern Africa, researchers have come up with a vaginal ring that contains anti-HIV drugs and discreetly protects a woman from HIV infection, without requiring her to negotiate condom use with an abuser inside or outside her marriage.
But this treats a symptom, not the disease of sexual violence that spreads trauma, fear and diseases such as hepatitis B. However we can, whenever we can, we must work to make a difference.
