Hepatitis B (HBV)

Hepatitis B is the most common blood borne virus in Australia, and is transmitted through blood and genital fluids. While most adults clear the infection and develop natural immunity, for some people it becomes a lifelong condition that needs ongoing management. Hepatitis B can be acute, meaning it clears within six months, or chronic, meaning it stays with you for life.

Vaccination is the most effective way to protect yourself, and it gives you immunity for life. Babies born in Australia have been routinely vaccinated against hepatitis B since 2000, so a lot of younger sex workers are already immune. If you’re not sure whether you’re immune, a simple blood test can tell you.

Understanding hepatitis B

Hepatitis B is a nationally notifiable infection, meaning that all cases are reported anonymously to state or territory health departments. This is primarily to identify outbreaks and improve healthcare responses.

Acute infection is short-lived, and most adults fight it off within six months and are then immune.
Chronic infection is incurable, but very manageable with antiviral medication. Most people living with chronic hepatitis B go on to lead full, healthy lives with the right monitoring and care.
Most people with chronic hepatitis B acquire it at birth or during infancy, not as adults. About 95% of adults who catch hepatitis B recover and develop natural immunity.
Hepatitis B is often asymptomatic, which means plenty of people carry it without knowing. Left unmanaged, it can lead to liver scarring and liver cancer.

Signs and symptoms

Hepatitis B is often asymptomatic. If symptoms do show up, they usually start two to three months after infection and can last anywhere from six weeks to six months. Symptoms can include:

abdominal or liver pain (typically top right side of the abdomen),
loss of appetite, nausea and vomiting,
weight loss,
jaundice (yellowing of the skin and eyes),
rashes,
pale-coloured poo and dark urine,
fatigue, fever and feeling generally unwell; and
muscle, abdominal and joint pain.

Getting tested for hepatitis B

Below is some information about testing for hepatitis B. You can view a list of sex worker-friendly sexual health clinics on our Where To Test resource.

What happens during the test?

Testing is done through a simple blood sample, which you can get at a GP or a sexual health clinic.

Medicare card holders can access some newer online testing services for free such as SISTR, Stigma Health, Clinic365 and NewDoc. If you are not covered under Medicare, you can access online testing services for a fee, which could be useful if you live in a rural area. For information about online testing, click here.

When should I get tested?

Hepatitis B is usually undetectable until about four weeks after infection. It isn’t generally part of a routine sexual health screening, so if you suspect you have been exposed, you will need to ask to test for it specifically.

What happens if I test positive for hepatitis B?

What happens next depends on whether the infection is acute or chronic, and your health practitioner will be able to guide through treatment that is specific to you.

What treatment options are available for hepatitis B?

There is no medication for acute hepatitis B, as it is usually short-lived and clears on its own. Your health practitioner will most likely recommend rest, eating well and plenty of fluids while your body clears the virus.

While chronic hepatitis B isn’t curable, it’s very manageable. Treatment usually consists of a daily oral antiviral, often taken for life, which reduces the risk of long-term liver damage. In some cases, a weekly injection given for up to twelve months is used instead, which is very effective but carries a higher risk of side effects. Your healthcare provider can talk you through which treatment might work best for you.

Even when on effective treatment, people living with chronic hepatitis B can still transmit it to others, including sexual partners and unborn babies. Without monitoring or treatment, a person with chronic hepatitis B carries close to a one in four risk of dying from cirrhosis (a late-stage liver disease), liver cancer or failure. Ongoing care is important, and support is available through services such as Hepatitis Australia.

How much does treatment of hepatitis B cost?

Government-funded sexual health clinics are usually 100% free and confidential for everyone, including tourists and international students, regardless of Medicare status.
If you see a GP, you may pay a fee or be bulk billed. Your GP can talk you through what to expect for your specific treatment plan and medication costs.
Recent changes to medication availability mean that most people who were born outside of Australia can receive treatment without this impacting their visa status. ASHM has further information on hepatitis B and immigration.

Will testing positive for hepatitis B impact my ability to work?

Because hepatitis B affects the liver, some workers choose to cut back on drinking at work or skip party bookings to reduce the strain on their liver while managing the condition.

Legal considerations

As mentioned above, hepatitis B is a nationally notifiable infection, meaning confirmed cases are reported confidentially to state or territory health departments. This does not mean that your employer or clients will be notified.
Some states and territories also have laws that criminalise sex work or sexual contact while you have an STI or BBV. For more information specific to where you work, head to our BBV, STI and the Law resource, or contact your local sex worker peer organisation.
If contact tracing (partner notification) comes up, your peer organisation can advise on a process that accounts for your privacy and the specific transmission risks of sex work.

How can I prevent transmission?

Vaccination

Vaccination against hepatitis B provides lifelong immunity and is the single best protection available. If you aren’t sure whether you’re immune, or if you were vaccinated as a child, a simple blood test can confirm it. Sex workers who aren’t already immune should consider the combined hepatitis A and B vaccine. Government-funded sexual health clinics can vaccinate you for free regardless of Medicare status.

If you are exposed to blood or genital fluids and you are unsure of your vaccination status, see a doctor as soon as possible. Post-exposure care is available and works best when taken within the suggested time frame.

Safer sex strategies

Using protective barriers such as condoms, gloves and dams during bookings lowers the risk of transmission. Avoid touching your eyes or genitals if your hands have had contact with body fluids. You should also consider:

changing condoms between anal and vaginal sex or oral sex
changing condoms between partners or when moving from one body part to another (e.g. from the vagina to the mouth)
using condoms when sharing toys and changing condoms between partners or body parts
during hand relief, point the penis away from the face to keep semen away from the eyes, and hold the base of the condom when withdrawing so semen doesn’t spill out
if you provide any kind of BDSM or kink service involving blood like needle play, use gloves, keep a sharps bin close by, and cover surfaces that may come into contact with blood with a removable disposable covering like plastic wrap
check the skin for pre-existing breaks before impact play or biting, and cover any open wounds or abrasions on yourself and the client
if you engage in impact play with a client and their skin breaks and starts to bleed, you should stop immediately, clean any blood up and cover the wound before assessing the severity to see if you should continue
using a hospital grade disinfectant such as Viraclean to clean your equipment and any surfaces that will be reused.

Needle and syringe programs

If you are an injecting drug user, avoid sharing needles with others if you can. Always use fresh, sterile syringes and injecting equipment and dispose of them safely. You can use this website to find your nearest needle and syringe programs (NSP).