You look great. You've got the body, the tan, the hair, and the Old Navy accessories. You are a sexually active gay man. You use condoms and water based lubricant. You don't screw on the first date (and if you do you always use a condom.) If you take these precautions, you are safe, right? Wrong, you forgot your shots. With increasing sexual activity among gay men, it's important to remember that AIDS isn't the only sexually transmitted disease out there. If you are sexually active, you are at high risk for Hepatitis.

Gay men should be concerned about viral hepatitis, a term used to describe liver inflammation. There are many forms of viral hepatitis, but sexually active people are most at risk for forms A and B. Hepatitis C is a less-well understood disease spread through intravenous drug use, and before 1990, through the blood supply. 

Both Hepatitis A and B exhibit the same symptoms. Early infections cause flu-like symptoms, along with nausea, vomiting, stomach pain and headaches. In the later stages, the lymph nodes of the body swell and patients complain of profound fatigue and pain on the right side of their abdomen (where the liver is.) Dark urine and discolored stools are symptoms. Jaundice is also possible, giving a yellowish tinge to the skin and/or eyes, though this doesn’t always occur. Hepatitis A (Hep A) and Hepatitis B (Hep B) may look the same symptomatically, but they are different diseases.

Hep A is a highly contagious virus, which you can catch from food handled by an infected person, or by water or food which was in contact with that person. It can also be transmitted by oral/genital and oral/anal contact. Hep A infection will make you very sick, 15-45 days after exposure. This disease can last for weeks, but is normally not fatal. Once you recover, with a great deal of rest, you are immune from future Hep A infections.

Hep B, like HIV, is a virus transmitted through the exchange of bodily fluids. Hep B infections cause similar symptoms to Hep A, but have a longer incubation period of 45-160 days, and you are also immune once recovered.

Most people mount an immune response to these viruses, and after a severe illness, recover completely. In the US between 150,000 and 300,000 people annually are infected by Hep B. Nearly a tenth of these are hospitalized, and 300-400 people die of the infection. There is no cure for either of these forms of hepatitis, but treatment is available for the nausea and other symptoms.

You can recover from Hep B, but remain a carrier of the virus, and pass it on to others. If you get a chronic Hep B infection, you are at risk for several liver ailments, including cirrhosis (degradation of the liver) and liver cancer. There is no known cure for chronic Hep B, and roughly ten percent of people infected with Hep B get a chronic infection. In the US, nearly one out of 250 people are carriers for Hep B. Chronic Hep B infections are incurable, but treatments can prolong and enhance life.

Gay men are especially at risk because of the kind of sex we have. Some of us tend to have multiple partners, and engage in risky behavior (rimming, oral sex, and anal intercourse,) which increases the chance of many sexually transmitted diseases, HIV and Hepatitis included. A recent outbreak of hepatitis in the Atlanta gay community has triggered a prevention/immunization campaign.

Besides safer sex precautions, the best way to prevent both Hep A and Hep B is vaccination. In the 1990s, routine Hep B vaccination began for children and will also protect adults. If your job brings you in contact with blood on a regular basis, you should be eligible for employer-sponsored vaccination. Otherwise, you should make a trip to the county health department or your doctor. 

Why should you be concerned? If Hep B is transmitted like HIV, don't the same precautions apply? Epidemiologists and virologists agree, Hep B is vastly more infectious than HIV. Which means it is MUCH easier to catch. There have been cases of Hep B transmitted through toothbrush sharing, razor sharing, and even tattoo and body piercing needles. One out of twenty people in the US will be infected with Hep B in their lifetime. Hep B is one of the most commonly reported, vaccine-preventable, diseases in the US.

Joe Jableki, Disease Intervention Program Manager for the Jefferson County Department of Health, believes sexually active gay men should be immunized for both Hep A and Hep B. While not a problem yet, the health department sees between 40 and 60 cases of Hep B a year in Jefferson County. But many people with hepatitis don't go to the doctor, either because their symptoms aren’t extreme or they don't know any better. This means the occurrence of the disease is underreported. The health department reports between twenty and thirty new chronic infections a year - which based on percentages indicates that there may be many unreported cases of Hep B each year.

Hep A is not currently a problem in Birmingham, but other cities in the Southeast, like Atlanta and Mobile have much higher incidences. Ms. Larry Wafer, Hepatitis and Disease Control nurse for the Jefferson County Department of Health, recalls an outbreak of Hep A in Birmingham as recent as 1994-95, which led to an outreach and education program of free condom and literature distribution at local bars.

Mr. Jableki admits that the vaccines for Hep A and B are costly, running between $34 to $47 per injection, based on your income. Hep A vaccination requires two injections, but there are three injections required over a six month period for Hep B. This means vaccination will cost between $100 and $150 for each virus. He recommends you shop around for the best price. When compared to the illness of Hep A and the long-term risks with Hep B, the cost is small. 

Dr. Melissa Black, director of the UAB student health program, says enrolled students at UAB can get the Hep B vaccine from Student Health for $45 per injection.

If you had sex with someone infected with Hep B, and you think you might be infected, there is a treatment available. If you see a doctor within 10 days of exposure, a course of antibody treatment and vaccination can help prevent your becoming ill.

The Jefferson County health department offers Hepatitis vaccinations  (charges scaled to your income) and many other services including a walk in clinic with free confidential HIV counseling and testing, as well as referrals for those who test positive. The staff wants to welcome and encourage the gay community to use the facilities available. You can call them at 933-9110.

Enrolled UAB students can contact Student Health at 934-3580.

Tod Companion is a graduate student in the Department of Biochemistry at UAB, and is getting his shots. He can be reached via email: todc@geocities.com. Past articles and references are archived at www.geocities.com/~todc.
 

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