Deeper Look: Viral Hepatitis and Women in the U.S.

Viral hepatitis is a significant but often overlooked public health issue that can affect women across the United States. Hepatitis B and C, in particular, can lead to long-term liver damage, including cirrhosis and liver cancer, if left undiagnosed or untreated. Women face unique challenges related to hepatitis, such as increased risk during pregnancy, potential transmission to newborns, and barriers to testing and care in reproductive healthcare settings.

In the U.S., thousands of women live with chronic hepatitis—many without knowing it. Raising awareness, promoting screening, and improving access to treatment are key steps in protecting women’s health and preventing the spread of infection.

The most recent data highlight how viral hepatitis impacts women across the United States:

• Hepatitis A: Outbreaks have impacted both men and women, and data indicate that adult women who are unvaccinated remain vulnerable, particularly those with underlying health conditions or who are experiencing homelessness.
• Hepatitis B: Screening during pregnancy remains critical to preventing mother-to-child transmission. CDC recommends HBV screening for all pregnant women during each pregnancy, preferably in the first trimester.
• Hepatitis C: While men historically have had higher overall rates of hepatitis C, new infections among women have increased—particularly among young women of reproductive age. Hepatitis C screening is recommended for all pregnant women as maternal hepatitis C infection is associated with pregnancy complications (including preterm birth, cesarean delivery, being small for gestational weight, and NICU admission) and the virus can be transmitted from mother to infant.

Social Determinants of Health and Barriers for Women at Risk for Viral Hepatitis

Viral hepatitis affects women of all backgrounds and can be particularly challenging for women in underserved communities. Factors such as limited access to healthcare, language and cultural barriers, lack of insurance, and stigma related to both viral hepatitis and risk behaviors can delay diagnosis and treatment. In rural areas and some urban settings, limited availability of testing and treatment services make early intervention more difficult. These factors underscore the need for equitable healthcare policies and outreach programs that can reach women most at risk.

Women engaged in sex work and women who inject drugs are at increased risk for viral hepatitis due to a range of factors, including limited access to preventive healthcare, exposure to unsafe sexual practices and sharing of syringes and other injection equipment.  Structural barriers such as criminalization, discrimination, and stigma may further limit their ability to seek care or protect themselves. These women may fear legal repercussions if they are diagnosed or seek treatment, which in turn prevents them from accessing life-saving healthcare services. Addressing the needs of these populations through inclusive, nonjudgmental, and accessible services is crucial in broader efforts promoting viral hepatitis elimination.

Additionally, gender-based discrimination and cultural norms may place women in subordinate roles, limiting their autonomy and access to healthcare, particularly in settings where women face economic, social, or gender-based barriers. These environments may make it more difficult to seek healthcare without permission or support from spouses, partners, and other male relatives. Moreover, stigma often intersects with gender-based discrimination and can make women fear judgement for behaviors considered socially unacceptable, such as drug use or sex with multiple partners. . This fear of judgment and social ostracism can lead women to delay seeking diagnosis and treatment. Competing priorities, such as caregiving responsibilities for children or elderly family members, can also limit women’s ability to prioritize their own health needs. In societies where women are expected to put the needs of their families first, the time and financial resources necessary for healthcare may be inaccessible or deprioritized. These compounded obstacles contribute to a cycle of neglect for women’s health needs, especially for conditions that are often “silent,” like chronic viral hepatitis.

Women living with HIV are also at increased risk for viral hepatitis, and co-infection with HIV and hepatitis is not uncommon due to shared modes of transmission. HIV can accelerate the progression of Hepatitis B and C infections, leading to more rapid liver damage and increased morbidity.  Integrating HIV and viral hepatitis screening and treatment services is critical to improving health outcomes among women living with both conditions.

Furthermore, the involvement of women and girls in research related to hepatitis prevention, diagnosis and treatment remains limited, leading to a gap in understanding the unique needs and experiences of women. Without a clear focus on gender-specific factors in medical research, treatment protocols may fail to address the challenges women face in managing hepatitis, leading to sub-optimal health outcomes for women.

All these factors together create a complex web of challenges that disproportionately affect women, ultimately resulting in delayed diagnosis, inadequate treatment, and poor long-term health outcomes. Addressing these health determinants requires multifaceted interventions that address the intersections of healthcare access, stigma, gender-based discrimination, and criminalization while ensuring that women’s issues and needs are adequately addressed in viral hepatitis research and healthcare policies.

Preventing Viral Hepatitis

To prevent Hepatitis B and C, women can take several targeted steps that address the primary modes of transmission and promote personal and community-based prevention strategies. Here’s an expanded look at specific prevention methods for these two viral infections:

1. Sex Education and Safer Sex: Hepatitis B can be transmitted through condomless sex. Although, in theory, hepatitis C can also be transmitted through heterosexual intercourse, the risk is quite low, since infection with hepatitis C requires exposure to blood. Comprehensive sex education that teaches women about the risks of hepatitis transmission and emphasizes the importance of safe sex practices, such as using condoms, can reduce the risk of transmitting viruses like HIV and hepatitis B.  Condoms are especially important for women who may be at risk due to multiple sexual partners, sex work, or partners with known risks for hepatitis. In addition, understanding the potential for blood-borne transmission during sex—especially for hepatitis C—can also aid in reducing transmission risk.
2. Vaccinations (Hepatitis B): Hepatitis B is preventable through vaccination, which is highly effective at protecting individuals from contracting the virus and helps to reduce the overall burden of viral hepatitis in high-risk populations. It is currently recommended that all adults between the ages of 19 and 59 years be vaccinated against hepatitis B. This is especially important for women at higher risk, such as healthcare workers, persons with multiple sexual partners, and those who come in close contact with family members who are infected with hepatitis B. The vaccine is typically given as a series of three doses, and it provides long-lasting immunity. Some vaccine formulations also provide protection against hepatitis A virus.  Unfortunately, there is currently no vaccine to protect against hepatitis C.
3. SyringeServices Programs (Hepatitis C): Hepatitis C is most commonly transmitted through blood-to-blood contact, particularly from sharing syringes or other drug injection equipment. Women who inject drugs are at significant risk of hepatitis C transmission. Syringe services programs play a crucial role in reducing the transmission of hepatitis C by providing access to clean syringes, safe disposal of used syringes, harm-reduction education, and testing for hepatitis C and other bloodborne viruses like HIV and hepatitis B These programs can also offer an opportunity for women to access substance use treatment, counseling, and support services, which can further help reduce the risks of hepatitis C transmission.
4. Testing: It is currently recommended that all persons be tested for both hepatitis B and hepatitis C at least once during their lifetimes. Persons who are at increased risk should be tested periodically as long as their risk persists (for example, continued drug injection). Both of these viruses can be present without symptoms in the early stages, and individuals may unknowingly transmit the virus to others.  Women who come from regions of the world with a much higher prevalence of hepatitis B (for example, Western Pacific region, Southeast Asia, and Africa) should also be considered at higher risk for infection.

In addition to personal preventive measures, community-based efforts to promote awareness, education, and access to healthcare are essential in empowering women to protect themselves from hepatitis B and C. By focusing on education, vaccination for hepatitis A and hepatitis B, harm reduction, and regular testing, women can reduce their risk of contracting these viral infections and improve their overall health outcomes.

Criminalization of Viral Hepatitis and Its Impact on Women

The criminalization of certain behaviors linked to viral hepatitis transmission (e.g., substance use, sex work) further exacerbates the challenges that women face when living with hepatitis B or C. In some places, laws exist that criminalize the transmission of infectious diseases, including viral hepatitis. These laws disproportionately affect women who may engage in high-risk behaviors such as injecting drugs or sex work, both of which are linked to higher rates of viral hepatitis transmission.

• Legal consequences: Women who are arrested or incarcerated for drug use may face harsh penalties and restrictions on their access to healthcare, including viral hepatitis testing, vaccination, and treatment. In some cases, pregnant women with viral hepatitis may even fear prosecution if they unknowingly transmit the virus to their child. This criminalization can deter women from seeking prenatal care, testing, or treatment for hepatitis B or C out of fear of legal repercussions.
• Impact on healthcare access: Criminalization leads to marginalization and may prevent women from accessing necessary healthcare services, including reproductive health care and maternal care. This can further exacerbate health inequities and limit access to preventive services that could reduce the transmission risk of viral hepatitis. Additionally, the legal fear around disclosure of viral hepatitis status can limit trust between women and healthcare providers, which ultimately impacts health outcomes.