In a recent announcement, the Gay and Lesbian Medical Association (GLMA) stated that over half of America’s gay and bisexual men may be at risk of contracting hepatitis A and hepatitis B. Both are serious liver diseases, with hepatitis B having long-term consequences such as liver damage, liver cancer and even death.

“In the ’80s there was a lot of cases of hepatitis B and they were among men who have sex with men, gay men,” Dr. Robert Gunn, director of the county’s Sexually Transmitted Diseases and Hepatitis Prevention Program, told the Gay and Lesbian Times. “They were recruited into the vaccine trials for the initial vaccine that came out about that time, which was shown to be an effective vaccine; however, it’s never been well-utilized by the high risk populations.”

The GLMA is currently working with the CDC to help educate gay men about the risks of hepatitis and the need to get vaccinated against the disease in a nationwide campaign. San Diego is among the cities that are leading the way in hepatitis screening, vaccination and prevention. Currently, clients in high-risk groups that go to the San Diego County STD clinics are offered hepatitis A and B vaccination.

“That’s what we are trying to do here in San Diego, to improve coverage of hepatitis B vaccination amongst high risk adolescents and adults. And our primary group at the highest risk level are men who have sex with men,” Gunn added. “It’s just a shame not to have the vaccine be used. It should really be a standard vaccination for gay men.”

While hepatitis B is a blood-borne pathogen, it is considered a sexually transmitted disease, both for gay men and heterosexuals. Once infected, hepatitis B causes the liver to become inflamed and can make individuals very ill, putting them out of work for months at a time and causing a yellowing discoloration of the skin. Other symptoms include abdominal pain, fever, fatigue, lack of appetite and nausea, with acute symptoms lasting several months. While most people eventually clear the virus from their system, others don’t, and it can lead to a chronic infection that causes liver cirrhosis and even cancer. Individuals with a chronic infection are also at risk for spreading the disease to others.

According to the CDC there are over a million carriers of the hepatitis B virus in the United States and an estimated 200,000 people contract the disease each year.

Hepatitis B is more contagious than HIV, and can be transmitted through infected blood and other body fluids through unprotected sex or sharing of needles.

Additionally, the risk is high for transmission of hepatitis A among gay men.

“It’s not a blood-borne sexual transmitted infection like hepatitis B is, but it is a fecal-oral transmitted virus, and, considering some sex practices in some areas, there have been big outbreaks of hepatitis A,” Gunn added.

The symptoms of hepatitis A can include abdominal pain, fever, fatigue, lack of appetite, nausea, jaundice and dark urine. Symptoms can last up to five weeks and there is no cure, although bed rest and dietary changes can alleviate some of the symptoms. Among men who have sex with men, hepatitis A can be spread by direct anal/oral contact (rimming) or by contact with fingers, sex toys or condoms.

The best way to protect against hepatitis A is by vaccination. Other ways include avoiding rimming and other anal and oral contact with partners. While condom use is effective in preventing the spread of HIV, hepatitis B and other STDs, it does not prevent the spread of hepatitis A.

According to Gunn, “Vaccination is the way to go. There’s individual vaccines; hepatitis B is a three-dose series and hepatitis A is a two-dose series.”

In a resolution adopted in April 1999, the GLMA board of directors called for universal vaccination against hepatitis A and B among gay men. Both vaccines can be taken concurrently, and are offered along with regular STD screening through County Health Services for just $15 a visit.

“It’s a safe vaccine,” Gunn said. “It’s made up by just using the antigens that are necessary to make your antibodies go up. It’s a three-shot series, but one shot is better than no shots. We try to get the vaccine to this population because it’s a disease that is totally preventable.”

According to statistics gathered by county health, 20 percent of the cases of hepatitis reported in San Diego in 2002 were among gay men. Statistics for 2003 are not yet available. Hepatitis C, another form of viral hepatitis that can progress to chronic liver disease, is also a persistent health threat. While the transmission of hepatitis C is not completely understood, most cases can be traced to blood transfusion or organ transplant prior to 1992, when a screening test for the virus was developed, or to infected needles used for illicit drugs. There is some evidence that hepatitis C can be spread by shared use of “bullets” for snorting drugs, and through sexual contact. There is no cure for hepatitis C and no vaccine. Collectively, hepatitis is responsible for 15,000-17,000 deaths each year in the United States.