Annually, World Hepatitis Day is commemorated on July 28, bringing to consciousness the danger and severity of the disease, yet, some Nigerians continue to engage in risky behaviours that expose them to this infection. Janet Ogundepo writes about how piercing and tattoo parlours inadvertently transmit the virus
As of today, piercings and tattoos have become normalised fads made popular by artistes and celebrities.
With the rising trend of multiple piercings on the ear pinna, nose, tongue, belly button, and other body parts, numerous local beauty shops have sprung up like mushrooms, raising concerns and questions about the safety of the equipment used, the unhygienic practices involved and how the procedures are done.
Like every new trend, youths and young adults have jumped on it, taking the lead.
Many of them are now seen in various areas sporting diverse rings and tattoo designs that range from the artistic to the absurd and even the horrific.
Ironically, the older generation is not left behind in this trend either.
One of them is Farooq Oreagba, the cynosure of all eyes and the ‘king of steeze’ at the 2024 Ojude Oba festival.
Adorned in coral beads and a green and lemon striped aso-oke, he sat proudly atop his horse, dazzling the crowd with his horsemanship as the tattoos on his arms further captured the crowd’s admiration.
While Oreagba, a Business Management and Finance expert and the Managing Director of NG Clearing, can afford to patronize standard piercing and tattoo centres, many youths lack the resources to do so.
Findings from fact-finding missions to uncover practices in beauty parlours notable for their piercing and tattoo services by PUNCH Healthwise gave a more vivid description of the phrase “the good, bad, and the ugly.”
Going undercover as an enthusiast eager for the latest tattoo and piercing styles, this correspondent was directed to a dirty and unkempt street popularly known as Ghetto, around Amodu Street in the Mushin area of Lagos State.
In clusters stood young men and women in front of houses and shops, waiting for potential customers.
The day was still young but the men, whose arms and necks bore vivid designs and different shapes of tattoos, sat unfazed by the lack of activity around them.
Several requests for local piercing and tattoo parlours in the area landed this correspondent in ‘Ghetto’, a hub known for drugs and crime.
However, several searches for a beauty parlour yielded no results.
Due to the pervading stench from clogged gutters, clouds of heavy smoke from weeds and cigarettes, and the unwelcoming, stern faces, PUNCH Healthwise could no longer venture further into the labyrinths that passed off as streets.
“There are local tattoo artists who come around areas where many of the guys who wear tattoos hang out. One of them just left this place. So when someone wants a tattoo, they call the artist who comes with his equipment, draws the tattoo, and leaves. He can draw for as many people as want it that day,” enthused a teenager, who eventually spoke to PUNCH Healthwise after several attempts to ask about a good tattoo parlour were met with blank stares.
Before the visit, with the help of a fixer, PUNCH Healthwise had gathered that piercing and tattoo artists frequent the drug hotspots.
A fast-paced walk through the area revealed young girls, some appearing to be as young as 15 years old, wearing tattoos alongside several piercings, which seemed to be displayed as badges of honour indicating their belonging to the community.
Their skin looked ashen and unkempt, but their countenances were curious about the presence of visitors.
Tattoo, a growing fad
After several referrals and refusals, PUNCH Healthwise eventually got the contact of a tattoo artist in the area.
In a WhatsApp chat, he insisted that before coming out, the design of the tattoo must be sent to him first, after which he would inform them how much it would cost.
“The type of tattoo you want determines the amount you will be charged. Some could be as high as N32,000 and as low as N20,000. Where the tattoo would be drawn and size also determines the price,” the tattoo artist responded dismissively via a voice note in the Yoruba language.
Despite settling for a lesser amount, the artist never showed up.
Seeing the precarious security situation of the area and after several attempts to speak to another tattoo and piercing artist were unsuccessful, this correspondent and the fixer left.
Undoubtedly, drawing tattoos in an open and dirty environment would come at the risk of several infections.
Based on the explanations obtained from the area, minimal sterilization of the needles used is done after the procedure, leaving the next client exposed to infections during the procedures.
The fixer revealed to our correspondent that the risk of contracting dangerous infections is quite high in the area, as about three people interested in getting tattoos could gather at a particular place and have the procedure done with the same unsterilized equipment.
Arguably, given the environment and the charges for even the least expensive piercings and tattoos, such unhealthy practices would be widespread in the area.
Undoubtedly, most of the young men and women seen with tattoos were unaware of infectious diseases such as HIV and Hepatitis, which can be transmitted through the sharing of sharp objects.
Ears, lips, eyebrow piercings
Piercing is making an opening in the body where jewellery can be worn.
Teenagers and young adults now find piercing their lips, various parts of their pinna, eyebrows, and belly button an irresistible fashion trend
According to Mayo Clinic, an American health blog, piercings, if done with equipment with infected blood, could lead to diseases that are spread through blood, including hepatitis B, C, and tetanus.
Other risks include allergic reactions, skin infections, and other skin problems such as keloids.
PUNCH Healthwise gathered from several piercing parlours visited that some make use of the ‘Ear Piercing Gun ’ or disposable needles, while a few first tenderize by locally rubbing the area vigorously before piercing with the sharp end of the ring.
In all, only a few of the operators said they protect put by putting on hand gloves.
A jeweller in the Osogbo area of Osun State, Olamilekan Samuel, told our correspondent that he wears gloves before using the piercing gun.
Confident in his skills, the jeweller said that the needles are mainly for single-use and saw no need to have them sterilized.
“I don’t sterilize because it is one needle per customer. If you are piercing, you buy your needle which is sealed. I tear the needle wrap in front of you and after the piercing dispose of it. I protect myself by wearing my gloves,” Samuel said.
Ignorant of Hepatitis status
However, when asked if he knows about Hepatitis, he responded, “I don’t know about that. As long as I am careful with my tools and myself, I am fine.”
Since Samuel has no idea of what Hepatitis is and has not been tested for the virus, therefore, does not know his status.
He is also unaware that the Hepatitis virus could survive in dried blood for many days and this could expose his clients who have open sores to infection when they come in contact with such blood.
Several beauticians and individuals, who had undergone piercings and tattoos told PUNCH Healthwise when asked if they protected themselves against Hepatitis during the procedures that they were unaware of the disease and their status.
Dangers posed by undetected Hepatitis
This further confirmed the position of the medical experts, who spoke with PUNCH Healthwise that many Nigerians have never been tested for Hepatitis.
They added that many lived with different variants of Hepatitis without knowing until they were present in the hospital with liver cirrhosis.
According to the Mayo Clinic, end-stage Hepatitis C indicates that the liver has been severely damaged by the virus causing irreversible scarring.
The World Health Organisation says Hepatitis is an inflammation of the liver caused by a variety of infectious viruses and non-infectious agents leading to a range of health problems, some of which can be fatal.
The National AIDS, Hepatitis, and STIs Control Programme under the Federal Ministry of Health lists unclean tattooing and piercing, sharing needles and other sharp objects among injection drug users, consumption of food or water contaminated by faeces from an infected person, unprotected sex, and exposure to infected blood, body fluids, and blood products as some of the modes of transmission of the virus.
The WHO notes that more than 90 million people in Africa live with Hepatitis.
According to NASCP, Nigeria accounts for 8.3 per cent of the global burden of chronic Hepatitis B and 4.5 per cent of Hepatitis C virus infections.
The WHO further notes that Nigeria has over 20 million people living with Hepatitis B, C, or both, yet about 80 per cent of this figure do not know their status.
The health agency asserts that many Nigerians who know their status got to know at the point of pre-employment, National Youth Service Corps screening, marital tests, and some others during pregnancy.
It further emphasized that the infection is preventable and treatable, adding that vaccination, prevention of mother-to-child transmission, blood and injection safety, harm reduction, and hepatitis B and C testing and treatment have been introduced in the country to prevent and treat viral hepatitis.
Hepatitis is called a silent killer because the signs and symptoms do not show at the early stages, experts say.
The yellowing of the skin and eyes, fatigue, abdominal pain, weight loss, headache, low fever, and diarrhoea are some of the signs that a person with Hepatitis exhibits.
However, NASCP notes that most patients who have this symptom are at the stage that could indicate significant liver damage.
Growing patronage
Some of the jewellers, who spoke to PUNCH Healthwise noted that although many people are scared of needle pricks, the business was still growing.
More visits to local beauty parlours in the Mokola area of Ibadan, Oyo State revealed the presence of several roadside vendors.
Since the business requires few and easy-to-carry equipment, it affords the beauticians the luxury of doing the business without opening a shop or stall.
It was, however, noticed that some vendors do their piercings and tattoos in dingy make-shift stalls and under umbrellas, which serve as protection from the elements
Some of them, it was learned, pierce uncomplicated areas of the body for as low as N2,000, without regard to hygienic practices and safety.
Some of the women, who spoke to PUNCH Healthwise, also said they usually rub a soothing balm on their fingers and continuously rub it on the part of the body to be pierced.
One of them, identified as Iyawo, seated by her makeshift store along the Iwo Road area, appeared to care less about her safety.
“Together with the earring, I charge N1,200. It doesn’t hurt; I will rub on the part continuously and then pierce with the ring. It doesn’t bring out blood. I pierce my ears myself,” she responded in Yoruba.
Another, who refused to give her name, said that a pain-relieving ointment, popularly known as Robb, was applied to make the area soft and to reduce the pain.
Showing the numerous piercings on her ears, she asserted that the procedure she used was safe and not bloody.
Further contradicting herself, she added, “Even for those who use machines, a little bit of blood will come out, but this is cleaned with a cotton bud and Robb is added to reduce the pain.”
While a few beauty and piercing parlours make use of the hand-held ear-piercing gun, others simply use needles.
Some others, who spoke with PUNCH Healthwise, also said needles are only used for one customer and disposed of.
Meanwhile, a few admitted wiping the “small blood” that comes out with cotton wool, mentholated spirit and hand sanitiser.
But the General Secretary of the Society for Gastroenterology and Hepatology in Nigeria, Dr Abubakar Maiyaki, who spoke with PUNCH Healthwise, noted that sodium hypochlorite, popularly known as bleach, is the approved agent to clean surfaces that have come in contact with dried blood.
“To sterilise sharp objects, what you need is five per cent sodium hypochlorite, like the household bleach called Jik. If you see a blood sample on the ground, it is not water that will kill the virus, you will need hypochlorite.
“If you see a blood drop on the floor, however long it has been there, put sodium hypochlorite. That is what will disinfect the virus and deactivate it,” he said.
Cheap beauty, high infection risk
Due to the low level of sanitation and hygienic practices exhibited by those operating under umbrellas and in roadside stalls, the risk of contracting blood-transfused infections such as HIV and Hepatitis is high.
Yet, many beauticians, when asked, said they knew nothing about Hepatitis and the modes of contracting it.
Further posing as someone who wants a piercing on her nose and ears, PUNCH Healthwise approached another piercing shop in the Alakia area of Ibadan.
The attendant, who preferred to be called Mummy Kola, said she makes use of the ear-piercing gun.
She initially said blood does not out during the procedure but later admitted that the blood flow can be minimal.
The woman refused to talk about wearing gloves for protection or sterilising the equipment after using it on a client.
To her, since she does not use the needle form of piercing, there was no need to protect herself from coming in contact with a customer’s blood.
Another beautician, identified only as Habibat, revealed that she pierces noses for customers at the cost of N8,000, while the ear cost N5,000.
For her, using needles for piercings was the safest and she painstakingly tried to convince our correspondent about her belief.
“When I mean needle, I mean cartridge. I dispose of it after using it for one person. Some people may reuse the needle for someone else, but I don’t,” Habibat maintained.
An internet search of what a cartridge is showed that it is also used for tattoos.
Habibat later disclosed that there would be minimal blood flow during the piercing process but when asked how she cleans the blood, she said, “Normal cleaning. I clean with sanitiser.”
The piercing/tattoo beautician also said she had never gone to the hospital to test for Hepatitis B.
More Hepatitis Awareness Needed – Experts
Dr Maiyaki, the consultant physician and a gastroenterologist, who is also an associate professor, decried the low awareness of Hepatitis B among Nigerians.
He explained that although there were Hepatitis A, B, C, D, and E, the common and problematic ones were Hepatitis B and C, which could co-exist in an individual.
“We have Hepatitis A, B, C, D, and E. But the one that is causing a lot of problems is mainly Hepatitis B, Hepatitis C, and occasionally when Hepatitis B and C co-exist in one individual. People are not aware that there are over two billion people with past infections worldwide. And now, as we are talking, about 240 million are affected by this virus.
“They have the virus chronically in them. This causes about one million deaths annually. You see, people are not aware of these statistics. Hepatitis B can be gotten through different means. It is also the same route as how people get transmitted with HIV. So blood and blood products, meaning anything that will cause the admixture of infected blood or body fluid from one person to another can cause the transmission of this virus,” Maiyaki said.
The secretary general of SOGHIN further stated that unlike HIV, which dies once it gets out of the human body, the Hepatitis B and C virus can live outside of the body for over a month and still be active.
“So, for example, if you see a drop of blood on the ground and you think whatever is there is dead, don’t be surprised, the virus is there and can enter the body through even trivial injuries that one may not be aware of,” he revealed.
The gastroenterologist said to prevent exposure to infectious viruses, health workers should always ensure to wear gloves and be cautious during medical procedures to prevent accidental needle pricks.
He added that babies, during circumcision and separation of the placenta with unsterilised instruments, were also at risk of Hepatitis B or C.
The doctor further noted that the rise in tattoos and piercings could subsequently fuel the rise in Hepatitis B and C cases.
Maiyaki stated that symptoms of the virus could appear in some people as fever, which would go away after treatment, while some people would not develop any symptoms until it becomes chronic hepatitis B or C, depending on the one acquired.
He said, “Unfortunately, it takes several years, 15, 20, 30 years for it to cause what we call liver cirrhosis or liver cancer. And by the time it has reached that stage, it becomes very problematic. If it is even a bit early, then one can even think of a liver transplant.
“If it is late, you just mandate the patient to what we call conservative management. And of course, it causes a lot of deaths, and that is what is killing about a million people yearly worldwide. The prevalence of hepatitis B in Nigeria is so high,” the doctor said.
The Associate Professor urged Nigerians to know their Hepatitis status by undergoing both the regular test and the hepatitis B profile test.
“The importance of doing that is so you can see some small group of patients who have what we call hepatitis B infection, where they have this hepatitis B surface antigen being negative, but they have what they call the core being positive. So we call that occult, but occult means hidden, so hidden hepatitis B infection. If not managed effectively, this hidden infection can result in fatal diseases like either liver cirrhosis or liver cancer. That is the point nobody wants to reach.
“So, once an individual feels he wants to get tested, voluntary testing and counselling, you go do the test, even if it is negative, go ahead, and do the hepatitis B profile.
“When it is negative, you go for vaccination. Once you’ve gone for the vaccination, it makes you become highly protected against the virus. That’s for hepatitis B. For hepatitis C, most patients by the time they even go for it, if it is negative, fine. And for both B and C, you avoid risky behaviours that predispose you to the infection,” Maiyaki advised.
He further noted that there is a cure and medication for Hepatitis C; however, the cost of the drugs makes it unaffordable for many Nigerians.
The expert called for increased advocacy and awareness about the disease.
Urgent Need for Regulation
A professor of General and Internal Medicine at the University of Jos, Plateau State, Professor Edith Okeke, decried the lack of regulation of beauty parlours, especially those offering pedicure, manicure, and piercing and tattoo services.
She stated that most beauticians do not sterilize their instruments and use the same instrument on several clients.
The don described the harmful practice as a ticking time bomb that would lead to the spread of other infectious diseases.
She noted that the rise in tattoos and the lack of regulation of the practices further expose louts, who are mostly commercial blood donors, to the virus.
“Now, most hospitals will test individuals who present themselves to donate blood, but not all hospitals do that. Even the ones that do, some only test for Hepatitis B; they don’t test for Hepatitis C.
“So, patients are still prone to catching these viruses. The fact that there are no regulations concerning these practices is a big problem for us in this part of the world,” Okeke said.
The researcher on Viral Hepatitis & Irritable Bowel Syndrome, noted that there was a lack of awareness about hepatitis, noting that most Nigerians have not been tested and do not know their status.
She noted that if nothing was done to curb the spread of hepatitis, it could further increase the prevalence of liver cancer cases in the country.
Speaking on what needs to be done, Okeke said, “There’s a vaccination for Hepatitis B and there’s a cure for Hepatitis C. If we can change our lifestyle and have regulation for practices like that beauty piercing, and tattoos, it would help.
“So, there’s a need for regulation of dermatology, beauty parlours, and everything in Nigeria, and I don’t think we have that.
“If you enter a salon anywhere in the United Kingdom and in the United States of America, you will feel comfortable. Because, number one, you will see that in some high-end proper salons, they reduce the number of sharp objects that are used. And then, each client brings whatever and all the things used, and goes away with them. So, the sharp objects are used for one person only.
“I think, in the first place, we can at least stop those people who do it outside, along the road, and so on. We can stop that for a change. And then work towards doing something about the people that have shops where they work.”
Rise in Liver Cancer
Also speaking with PUNCH Healthwise, a Radiation Oncologist, Dr Charles Okwonna, said liver cancers related to Hepatitis B and C were on the rise.
He said, “What are the cancers that are associated with Hepatitis B and C? It would be mostly liver cancer, which we call hepatocellular carcinoma, which Hepatitis B and C cause over 80 per cent of. And then the second example of the cancers that are associated with Hepatitis B and C would be what we call biliary cancers.
“These are basically gallbladder cancer, cancer of the bowel ducts, and other aspects of the biliary tract. So that’s the number one infection-related cancer. The second infection-related cancer is HIV-associated cancer.
“So these are things like Kaposi’s sarcoma, and then some forms of lung cancer, and then there’s also cancer known as non-Hodgkin lymphoma. So in terms of infection, these are the ones that are associated with unhealthy piercings of the skin. Then the second example of cancers that are associated with unhealthy piercings of the skin apart from infection would be what I term cancers due to immune modulation.
“So when there’s destruction of the immune system, there are cancers that are associated with it. These are melanoma and some other skin cancers. And then the second example would be Hodgkin lymphoma and other blood cancers.”
He noted that piercing and unhealthy tattoos in some people, who are either hypersensitive or prone to immune hyperactivation, set up a chain reaction that ends up with them having cancer.
The cancer expert further confirmed that cancers associated with piercings and unhealthy practices are on the increase.
The oncologist stated that liver cancer was responsible for 8.5 per cent of new cancers in Africa and 5.2 per cent of new cancers in males in Nigeria.
He noted that the data presented a steep rise in cancer cases when compared to previous statistics before 2022.
“So we can extrapolate to say that since there is an increase in the incidence of these cancers associated with unhealthy piercings and tattoos, it’s not out of place to say that many of them could be related to AIDS, and then we also anticipate that there will be an upsurge in the incidence of all these cancers in the near future,” Okwonna said.
He also called for the regulation of piercing and beauty parlours, noting that the government must accredit beauticians and aesthetics and ensure that the chemicals and inks used for tattoos are not carcinogenic.
The radiation oncologist further noted that most Nigerians had not been tested for Hepatitis and called for a mass screening of the population for the disease.
Okwonna commended the efforts made to vaccinate infants against Hepatitis B and urged the government to set up policies to ensure free screening for preventable cancers.
