I'm pretty well-informed (I think) about new trends in HIV research and treatment. However, I'm baffled (I must be dense) by reports I've read over the last couple of years (on this site and on several others) about the connection between Hep C (for which there is no vaccine yet) and fisting. The reports are mostly in statistical jargon and report confidence intervals, risk associations (correlations) and the like.

I know this is not the safe sex forum. But could you explain, with your trademark brevity, and without too much statistical jargon, just why fisting as a sexual practice is considered a risk factor for Hep C -- for both the receptive AND the insertive partner?

Thanks.

A complex question to answer specifically. Indeed fisting turns out to be a very significant risk factor for acquiring HCV for the receptive partner. This practice can certainly lead to mucosal trauma of the rectum which can then be vulnerable to various infections (HIV, HCV, other STDs). The other major risk factor is having multiple partners. Fisting may therfore be the injury, after which having unprotected anal sex and getting "inoculated" with HCV infected semen is probably the mechanism and not the fisting specifically itself. I can't specifically explain why the insertive (if you mean the fister) would acquire infection from the act of fisting, unless there was obvious trauma to the hand whereby someone who was fisting could get inoculated from the receptive partner who was already HCV infected. It is more likely a result of the insertive partner getting infected via HCV shed from rectal mucosa that was traumatized in someone who is HCV infected, or possibly from HCV infected semen already present from a previous sexual partner.