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Hepatitis C virus is primarily spread by direct contact with human blood. Routes of transmission vary between countries. In developed countries, most people get infected via previously unscreened blood products and organs or by intravenous drug use (WHO, 2000). In many developing countries, the primary routes of HCV infection are from blood transfusions, as unscreened blood products are still used, and from unsterilised injection equipment. Ritual practices (eg scarification and circumcision), traditional medicine (eg blood letting) and other activities that break the skin (eg tattooing and piercing) where unsterilised tools are used, represent additional sources of HCV infection. Mother-to-infant transmission of HCV has been observed globally, but the risk is regarded as low – approximately 5% (Dienstag, 1997).
As a result of shared routes of transmission, HIV–HCV co-infection is particularly common among intravenous drug users and those who acquired HIV through receipt of contaminated blood or blood products, such as people with haemophilia (Eyster et al, 1993).