H 10,000 new infections each year.'Transmission is predominantly via blood, with shared drug injection equipment being the major exposure.2 Little is known about the impact of HCV on behaviour or circumstance of infected individuals. Media reports suggest community concern regarding bloodborne viruses (BBVs) such as HCV, compounded by negative stereotyping of injecting drug users (IDUs). We report on the impact of HCV infection on behaviour, treatment choices and lifestyle in people notified with HCV on the NSW North Coast. MethodsStudy methods have been described prev i o~s l y .~ Briefly, all persons notified with HCV over a 21-month period during 1993 and 1994 were asked to complete a questionnaire examining exposures, therapies and behaviours. Subjects were asked specifically how their infection had influenced behaviours such as alcohol and tobacco intake, and personal circumstances such as relationships and working ability. Details of symptoms were requested on a separate questionnaire from attending medical practitioners with patients' written consent. ResultsKnowledge of potential risk factors for HCV infection varied. Of 467 resident cases who responded, 321 (69%) were aware of potential exposures. Of 398 IDUs, 238 (60%) identified this as an exposure. Forty-three IDUs believed they were infected via other means, 34 did not know and 83 did not state how they were infected. Of 30 non-IDU transfusion recipients, 24 identified this as an exposure. Only 9 of 176 tattooed subjects stated this as a potential exposure.The major reported symptom was fatigue affecting some aspect of daily life, e.g. relationship, work, sleep (n=212; 45%). Some 182 (39%) also reported reduced ability to perform daily duties, 50 (1 1%) nausea and 77 (16%) emotional disturbances (e.g. stress, depression). There was no association between symptoms and hepatitis B virus coinfection (x2=0.21, df=l, p=0.65).Symptoms observed by medical practitioners were reported for a sub-sample of 2 19 subjects (1 17 male, 102 female): 78 (36%) reported fatigue, 47 (21 %) nausea, 46 (21 %) abdominal pain, 28 (13%) loss of appetite, 14 (6%) vomiting, and 7 (3%) jaundice. Fifty-nine (27%) were asymptomatic.Many subjects (n=338; 72%) reported no treatment for HCV, many having not so far returned since diagnosis. Twelve (3%) had used interferon, 37 (8%) anti-emetics, 34 (7%) pain relief and 15 (3%) sedatives. A variety of complementary therapies were also trialed (Table 1). Other steps to improve health included stress management, exercise, reduced alcohol/drug intake, yoga, meditation and counselling.Many people reported n o change in circumstance due to their infection. Others reported negative effects on physical and mental health, and social interaction ( Table 2). Reports of isolation and discrimination related to community concern about HCV, stereotyping of people with H C V and adverse media portrayal of the disease. Respondents had concerns about commencing relationships, HCV infection having ended relationships, introduced fear and/or tension, a...

Objective To determine the routes of hepatitis C virus (HCV) transmission in an Australian community. Design Questionnaire‐based, cross‐sectional survey of notified HCV cases. Subjects and setting All cases notified to the New South Wales North Coast Public Health Unit between 1 January 1993 and 30 September 1994. Outcome measures Frequency of potential transmission exposures (parenteral and sexual); most likely primary exposure; HCV infection rates in sexual partners and offspring. Results 467 subjects responded (47% of resident cases). Of these, all but one reported actual or potential blood exposures (injecting drug user [IDU], 85%; IDU with sharing of injection equipment, 76%; pre‐1990 blood transfusions, 6%; other blood exposures, 8%). Most subjects reported multiple exposures and none reported sexual contact as the only potential exposure. Of 233 sexual partners tested for HCV, 83 were positive; 54 of these were questioned and all had other parenteral exposures. Only three children out of 91 children tested were positive for HCV (two expressing maternal antibodies). Conclusions In contrast with previous studies, possible HCV transmission modes were identified for almost all respondents. Most respondents in this community were IDUs. Non‐parenteral transmission appeared minimal. Novel approaches to preventing HCV transmission in IDUs are needed.