Author:
Fran Henry Plain Dealer Reporter, Cleveland , Ohio
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Date Posted: Mon, September 23 2002, 16:23:26 PDT
In reply to:
HA Aronow, MD Medical Director & Teresa Hanbey Exec Director
's message, "Hepatitis C Outreach Project on Tattooing" on Mon, March 25 2002, 11:50:54 PST
09/10/02 Cleveland Plain Dealer ( page A1)
Fran Henry
Plain Dealer Reporter
Joe Bowen's face is smiling, but his fists tell another story. They're clenched in pain as a pulsing needle, wielded by tattoo artist Jeff Hacker, injects black ink into the skin on the upper left side of Bowen's chest.
Beads of sweat form on Bowen's upper lip as Hacker, owner of Skin Flix Tattooz in Brunswick, meticulously follows the elaborate design covering a botched tattoo of an American Indian that Bowen got at a private, unlicensed tattoo party.
It will take about 15 hours of tattooing, spread over several days, before the Brunswick man can bare his chest without embarrassment. "I keep my shirt on," said Bowen, 31.
And repairs are going to cost him $600 beyond the $75 he originally paid.
But shoddy artwork can be the least of the problems at increasingly popular tattoo parties like the one Bowen attended.
Unlicensed tattoo artists risk spreading blood-borne diseases, particularly hepatitis C, by failing to follow sterile procedures, said Kris Bosworth, program manager at the Cuyahoga County Board of Health.
"There's a massive, huge underground of tattooing going on," Bosworth said. His efforts to reach illegal tattooists to discuss sanitation have been futile.
Some who have attended tattoo parties say the conditions are hardly sanitary.
"People invite people who are drinking, and people are blowing smoke in [the tattooist's] face," said a Cleveland woman, whose boyfriend is a tattoo artist who has worked such parties. "And when the artist goes to the bathroom, he comes back and things are missing."
The woman asked that she and her boyfriend not be named. He later said he wouldn't be doing parties anymore.
Under state law, tattooing must be done in a controlled, sterile environment approved by the local health department, and the tattooist must be trained in first aid and sanitation to prevent transmission of infectious and blood-borne diseases. With an unlicensed tattooist, there are no guarantees health standards are met.
Hepatitis C is the main concern, although hepatitis B and HIV are also blood-borne. However, hepatitis B can be prevented with a vaccine, and HIV is very delicate and lives very briefly outside the body. Hepatitis C, on the other hand, can live outside the body for a week. There is no vaccine for hepatitis C, which is the leading known cause of liver disease.
About 35,000 new hepatitis C infections occur each year, two-thirds from injection drug use, according to the National Institutes of Health's new consensus statement on hepatitis C.
At least one medical expert calls the hepatitis C outbreak an epidemic. It's "bigger than the AIDS problem," said Dr. Robert Haley, chief of epidemiology at the University of Texas Southwestern Medical Center at Dallas. "AIDS affects one per thousand, but hepatitis C affects five per 100 in the working-age population, 25-55."
The risks associated with tattooing have been recognized since the late '50s, when a dirty tattoo parlor in New York's Coney Island was blamed for a hepatitis outbreak, causing most states to ban the practice. The ban remains in effect in Oklahoma and South Carolina.
Currently, the Cleveland Department of Public Health grants only four-day tattoo licenses, which are renewable for $25, and the city does not require that licensees be trained in blood-borne pathogens. That will change soon, said the health department's Ron Smith. He said the city is close to adopting new policies that will allow for permanent tattoo parlors but also will require more training.
Even a scrupulously sanitized shop presents risk, said Dr. Howard Aronow, medical director of the Hepatitis C Outreach Project, based in Portland, Ore. "You can change the needles and vials of ink, but you cannot sterilize the internal equipment that draws up the ink," he said.
Although the Centers for Disease Control and Prevention warns that any procedure that pierces the skin has the potential to spread hepatitis C, it has stopped short of formally listing tattoos as a risk factor for hepatitis C. The CDC is conducting a large study to evaluate tattooing as a potential risk.
"The problem is semantics," said Miriam Alter, of the CDC's hepatitis branch. "We apply 'risk factor' in a scientific way. We mean it has been shown scientifically to be associated with infection."
Haley takes issue with the CDC's position. In a study, published in the journal Medicine in March 2001, he found tattoos to be the leading risk factor for hepatitis C, followed by intravenous drug use. People who had received a tattoo in a commercial tattoo parlor, he said, were nine times more likely to be infected with hepatitis C than people who did not have a tattoo.
Alter discounts Haley's study because "the time frame between the infection and the tattoo is unknown."
Haley argued that a tattoo customer is unlikely to make a connection between a tattoo and hepatitis C because the virus has a very long incubation period, and it is likely to take 20 to 30 years before symptoms develop. Very few people with a new infection develop classic symptoms of hepatitis, including jaundice, fatigue, abdominal pain, loss of appetite and vomiting, he said.
Very few people also know about the dangers of unlicensed tattoo operations, experts said.
"People go price shopping," said Joe Colantonio of C&G Tattoos in Willoughby. "They're not looking for experience or cleanliness. You're risking your life to save money."
Bowen, who had to have his tattoo repaired, said he "took it for granted" that the unlicensed tattooist used sterilized equipment. "All the equipment looked professional," he said.
Brett Klingerman, a Skin Flix artist, said repair customers come with tales to tell. He recalled a professional woman in Medina who threw a tattoo party so she and a friend could get their husbands' names on their legs. However, the tattooist got confused and put the wrong name on the woman's leg before she noticed.
She sought help at Skin Flix. "It was funny," Klingerman said. "We just covered it with another tattoo, something dark and busy."
© 2002 The Plain Dealer.
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