Hep B Blog

Facing the Threat of Hepatitis B Following Sexual Coercion or Assault

Image courtesy of tuelekza at FreeDigitalPhotos.net.
Image courtesy of tuelekza at FreeDigitalPhotos.net.

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.

Image courtesy of Sira Anamwong at FreeDigitalPhotos.net
Image courtesy of Sira Anamwong at FreeDigitalPhotos.net

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.

Comments on this blog are closed. If you have questions about hepatitis B or this blog post, please email info@hepb.org or call 215-489-4900.

13 thoughts on “Facing the Threat of Hepatitis B Following Sexual Coercion or Assault”

  1. Iam hbv carrier and I vaccinated all three shots before merry….can I pass hbv through sex….

    1. Hello: If you have had hepatitis B since childhood, getting vaccinated will not make the infection go away. You can still spread hepatitis B to your sexual partners or wife if you do not use a condom.
      When you find someone you love and want to marry, before you have unprotected sex, your partner must receive all three hepatitis B vaccine shots over the six-month period. About one or two months after the last vaccine, they must get tested for hepatitis B surface antibodies (anti-HBs). If they have at least 10 mIU/mL of surface antibodies, then they are forever protected against hepatitis B and you can have unprotected sex. Good luck.

    1. Hello: Unfortunately, there is no cure for hepatitis B yet. However, most people with hepatitis B lead long and healthy lives and never require treatment. Medical guidelines recommend treatment only if you are experiencing liver damage, which is indicated by a liver enzyme test for SGPT or ALT in your blood. The best thing you can do for yourself is eat healthy food, avoid alcohol and cigarettes, and get monitored regularly.
      We are optimistic that in the next few years a cure for hepatitis B will be developed. To keep up to date with the latest in drug developments, please visit our Drug Watch page at: http://www.hepb.org/treatment-and-management/drug-watch/
      Good luck.

    1. Hello: Yes you can, the CDC issues very specific guidelines explaining that hepatitis B-infected healthcare workers pose a minimal risk to patients or coworkers. See: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6103a1.htm?s_cid=rr6103a1_w
      The only exception is that if you are a surgeon performing surgeries that carry a high risk of sharp injuries, medical guidelines recommend that you take antivirals to lower your viral load to safer levels.
      Good luck.

    1. Hello: Our specialty is hepatitis B, not hepatitis C. However, it appears that detection of HCV quantitative results is an indication that you have recently been infected with hepatitis C. Generally, this result appears about two months after exposure. Hopefully you will not develop chronic hepatitis C. Please continue to see your doctor and get monitored. Good luck.

      Detection and confirmation of chronic HCV infection

      Quantification of HCV RNA in serum of patients with chronic HCV infection (HCV antibody-positive)

    1. Hello: Medical guidelines recommend treatment only if you are experiencing liver damage. This is indicated by an ultrasound and a simple blood test for the liver enzyme ALT (also called SGPT). Our liver cells release ALT when they are damaged or die. Healthy ALT levels for men are up to 30 and for women they are up to 19. Were you experiencing liver damage and is that why your doctor recommended treatment?
      Your doctor prescribed lamivudine. This antiviral is no longer recommended for hepatitis B because it causes a very high rate of drug resistance.
      If you ever do need treatment, there are two very effective antiviral medications that are recommended: tenofovir (Viread) and entecavir. Good luck.

  2. I was tested hepatitis B positive and the doctor gave me livolyn forte drugs. Please what should l do next

    1. Hello: Unfortunately livolyn forte is an herbal supplement that has not been proven to be effective against hepatitis B.
      There is no cure for hepatitis B, however if you experience liver damage, there are effective antivirals (either tenofovir or entecavir) that will help reduce viral load (HBV DNA) and the risk of liver damage.
      To find out more about herbal supplements and hepatitis B, please read: https://www.hepb.org/blog/buyer-beware-when-someone-claims-to-have-a-hepatitis-b-cure-its-a-counterfeit-drug/
      Good luck.

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