The next epidemic?

Before the advent of the AIDS epidemic, public health experts were warning gay men about a different, potentially fatal disease sweeping through their community: hepatitis. Twenty years later experts are sounding the alarms all over again. With rates of infection for hepatitis A, B, and C on the rise, the illness is having a devastating impact among men who have sex with men.

"The long-term consequences of hepatitis going untreated or unrecognized are pretty significant in terms of liver failure, liver cancer, organ transplants, and death," said Tony Rodriguez, an openly gay physician in private practice in the Philadelphia area. "Gay men especially are at higher risk for hepatitis A and B because of their sexual practices. We need to get the word out. "At a conference earlier this year, former surgeon general C. Everett Koop cited estimates that in 1998 more than 15,000 people will die of complications from viral hepatitis.

Both hepatitis A and B are sexually transmissible, although through different methods. Hepatitis A is passed along through feces and spread through anal-oral contact. In addition, fellatio can present a risk because perspiration can spread microscopic fecal matter to genitals. Hepatitis B is spread through infected blood, semen, or saliva. Using condoms for both oral and anal sex can prevent transmission of the disease.

Moreover, vaccines for both hepatitis A and B can provide immunity from the diseases. "There are vaccines to prevent this," Rodriguez said. "It does make a big difference. "However, he notes that insurance companies are often reluctant to pick up the cost for the series of three hepatitis B shots, which run about $150. In an effort to raise awareness about the growing hepatitis infection rate, the American Liver Foundation and the American Digestive Health Foundation sponsored a conference in February. Among the panel discussions was one titled "The Lessons Learned from AIDS." "One of the interesting things about the summit is that they actually had some intelligence and went to the gay community for expertise," Rodriguez said. Among the skills to be learned from AIDS activists are patient advocacy and the need to focus on sexual behaviors, not orientation.

While gay men were alerted to the threat of hepatitis 20 years ago, the AIDS epidemic quickly consumed everyone's attention, obscuring the lingering problem of viral hepatitis. "This really was coming up on the horizon as a major public health issue, and because of the resources the community needed, it got lost," Rodriguez said. Safer sex campaigns meant to reduce HIV transmission also had the side benefit of reducing hepatitis transmission. However, with evidence that commitment to safer sex is eroding among some gay men, health care providers are concerned that hepatitis will quickly become a major health issue once more.