Anyone can get hepatitis C, but certain groups face a significantly higher risk. The virus spreads through blood-to-blood contact, which means your risk depends largely on specific life experiences: whether you’ve ever injected drugs, received a blood transfusion before 1992, been on long-term dialysis, or were born between 1945 and 1965. Current guidelines recommend that all adults ages 18 to 79 get screened at least once.
People Who Inject or Have Injected Drugs
Injection drug use is the single most common risk factor for hepatitis C in the United States. Sharing needles, syringes, cookers, cotton filters, or any equipment used to prepare or inject drugs can transfer even tiny amounts of infected blood from one person to another. This applies whether you currently inject drugs or did so once, decades ago. Many people with hepatitis C were infected years before they knew it, because the virus often causes no symptoms until liver damage is well underway.
The Baby Boomer Generation
People born between 1945 and 1965 account for roughly 81% of all chronic hepatitis C infections in the United States. Their prevalence rate is about 3.25%, which is five times higher than among adults born in other years. The exact reasons aren’t entirely clear, but this generation came of age before hepatitis C was identified as a distinct virus in 1989 and before blood screening existed. Many were likely exposed through medical procedures, blood transfusions, or other routes during the 1960s through 1980s, when infection control practices were less rigorous. Both the CDC and the U.S. Preventive Services Task Force recommend that every adult in this birth cohort get a one-time screening, even with no other risk factors.
People Who Received Blood Products Before 1992
Universal screening of the U.S. blood supply for hepatitis C began in July 1992. Before that date, donated blood and organs could carry the virus undetected. If you received a blood transfusion, organ transplant, or blood components before July 1992, your risk is elevated. The same goes for anyone who received clotting factor concentrates produced before 1987, a group that includes many people with hemophilia. Since 1992, the risk from transfusions in the U.S. has dropped to near zero, but infections acquired before screening remain a concern because hepatitis C can stay silent in the body for decades.
Long-Term Dialysis Patients
People on hemodialysis face an outsized risk. Nationwide, about 9% of dialysis patients test positive for hepatitis C antibodies, and some individual centers have reported rates above 40%. The longer a person stays on dialysis, the higher the risk climbs: patients on dialysis for fewer than five years have an average infection rate of 12%, while those on dialysis for more than five years average 37%.
The reasons come down to the nature of the treatment. Hemodialysis involves repeated access to the bloodstream in a shared clinical environment. CDC investigations of outbreaks at dialysis centers have traced infections to contaminated equipment that wasn’t properly disinfected between patients, shared medication vials, unclean machine surfaces, and blood spills that weren’t promptly addressed. The virus itself is the link: a single chronically infected patient in a dialysis unit can become a source of transmission if infection control lapses.
Infants Born to Infected Mothers
A pregnant person with active hepatitis C can pass the virus to their baby during pregnancy or delivery. This happens in roughly 6% to 7% of exposed pregnancies. Among those with detectable viral levels but no HIV co-infection, the transmission rate is about 5.8%. Having HIV at the same time increases the risk further. There’s currently no way to prevent transmission during pregnancy, which is why screening pregnant people allows for early testing and monitoring of exposed infants.
Healthcare and Public Safety Workers
Anyone whose job involves potential contact with blood carries some occupational risk. Needle sticks and sharps injuries are the primary concern. That said, the actual transmission rate from a single needle stick involving hepatitis C-positive blood is low: approximately 0.2%, based on data from over 880 exposures tracked between 2002 and 2015. Older estimates put the figure closer to 1.8%, but improved safety equipment and infection control have reduced it substantially. Mucosal exposures (splashes to the eyes or mouth) carry an even lower risk, approaching zero in recent data.
People Living With HIV
HIV infection increases susceptibility to hepatitis C in a few ways. HIV weakens the immune system, making it harder to clear the virus after exposure. It also raises hepatitis C viral levels in co-infected individuals, which can make transmission to others more likely. Among men who have sex with men and are living with HIV, sexual transmission of hepatitis C has been documented repeatedly, particularly in the presence of other sexually transmitted infections like syphilis or herpes that cause open sores.
Sexual Transmission
Sexual transmission of hepatitis C is possible but uncommon in the general population. The virus is not spread efficiently through sex the way HIV or hepatitis B can be. The risk rises sharply, however, under certain conditions: having HIV, having multiple sexual partners, engaging in practices that involve blood exposure, or having concurrent sexually transmitted infections that cause ulcers or breaks in the skin. Studies of HIV-positive men who have sex with men found that those with a history of syphilis were nearly nine times more likely to acquire hepatitis C, and those with a history of gonorrhea were five times more likely, compared to matched controls without hepatitis C.
Tattoos and Piercings in Unregulated Settings
Getting a tattoo or piercing at a licensed, professional shop does not appear to increase your risk of hepatitis C. A study of more than 5,000 U.S. college students found no elevated risk from tattoos done in professional settings. The picture changes dramatically in unregulated environments. Tattoos done by friends, at home, or in prison settings carry two to 3.5 times the risk of hepatitis C infection compared to professional parlors. About 90% of prisoners who have tattoos received them in nonprofessional settings, which helps explain the elevated hepatitis C rates in incarcerated populations. The issue is sterilization: unregulated tattoo equipment is far more likely to carry traces of infected blood.
Medical Procedures Abroad
Medical tourism introduces risk that many travelers don’t consider. Dental work, cosmetic surgery, fertility treatments, organ transplants, and cancer treatment performed in countries with less stringent infection control can expose patients to hepatitis C through contaminated instruments, improperly screened blood products, or reused medical supplies. The CDC lists hepatitis C alongside hepatitis B and HIV as infections that can result from procedures performed overseas. The level of risk depends heavily on the specific facility, the country, and the type of procedure.
Sharing Personal Items
Hepatitis C can survive outside the body on surfaces for up to several days. Sharing razors, nail clippers, glucose monitors, or toothbrushes with an infected person creates a potential route of transmission if those items have traces of blood on them. This is a less common pathway than injection drug use or medical exposures, but it’s real, and it’s one that people in the same household as someone with hepatitis C should be aware of.