Health, Community Leaders in San Francisco Campaign Against Hepatitis B

Rachel Silverman | San Francisco, VOANews.com

Public health officials in San Francisco, and leaders from its large Asian community, are mounting an aggressive campaign to eradicate hepatitis B from the city. They say demographics are largely responsible for San Francisco having the highest concentration of hepatitis B in the U.S, as well as the highest rates of liver cancer, which is usually caused by the virus.

Greg Zhang, 46, is recovering from recent surgery to remove a tumor from his liver...a result of his life-long infection with hepatitis B.

Zhang's surgeon is Dr. Samuel So, director of the Stanford University Asian Liver Center.

"Hepatitis B is the silent killer because most people who are chronically infected may not be aware of the infection," he said. "In fact you know two out of three of them don't even know they're infected because usually they feel perfectly healthy."

The hepatitis B virus is found in blood and bodily fluids. Many people can live with the virus and never get sick, but 25 percent of those infected eventually develop severe liver damage or cancer. The virus can be transmitted by unsafe sex and unsterile needles, but most people who suffer from the disease become infected at birth from their mothers.

Zhang, and his younger brother Haiyang, were born in China, one of several Asian countries where the disease is endemic. Haiyang died of advanced liver cancer shortly after he was diagnosed.

The American Liver Foundation says one in 10 Asian Americans have the virus, a disease that's 100 times more likely to strike Asian Americans than other ethnic groups. And in San Francisco, a full one-third of the population is of Asian descent.

The city's Hep B Free Campaign offers free testing, vaccinations, and treatment. There's no known cure for hepatitis B, although the virus can be kept in check with anti-viral medicines. Those infected need to have yearly ultrasounds and blood tests to screen for early stages of liver cancer.

Newborns need a vaccination within the first day of life to prevent transmission of the virus from their mothers, and babies need two more doses within the first six months for full immunity.

Public awareness is another part of the campaign. A controversial advertisement on television and billboards shows 10 Asian beauty pageant contestants and asks which one deserves to die.

Hepatitis B carries a stigma. And that is something California Assembly member Fiona Ma of San Francisco is working hard to change. She is Hepatitis B-positive.

"My cousin, who was born in China, actually got very upset and said, 'Please don't talk about it. People will think you are sick and they are not going to vote for you.' And my message was, 'I am a public figure and this is my responsibility,'" she said.

But Stanford's Dr. So - whose mother-in-law died from liver cancer - says changing attitudes is just a start. He says other diseases get more public attention and therefore more money.

"This is really tragic on a global scale, there's really major neglect about hepatitis B. About one in 20 people in the world are chronically infected. One in 20. Ten times more than people in the world infected with HIV," Dr. So said.

For now, the battle against hepatitis B is concentrated in communities with large Asian populations. Other cities, including Philadelphia, Washington and Los Angeles, are making plans to use the San Francisco program as a model.

Hepatitis B: An Asian-American Plague?

by Chris Santiago | Change.org

"In the Asian-American family, usually parents don't want to discuss if they have diseases," Albert Ng recently told NPR while attending San Francisco's Asian Heritage Street Fair. "They just want to discuss the good stuff, but never discuss the weaknesses."

Ng was at a booth getting tested for hepatitis B for the first time in his life. One in 10 Asian-Americans is chronically infected with the disease; when left untreated, hepatitis B can lead to liver cancer. San Francisco has the highest liver cancer rate in the country, and this is mostly due to the city's famously large population of Asian-Americans, for whom hep B has become an epidemic. Of the 1.25 million Americans who are affected by hep B, half are Asian-Americans.

Why is hepatitis B so common among Asians? The disease is thought to have originated in Asia centuries ago. It's passed down from infected mothers to newborn infants. While blood tests can detect the hep B virus, most physicians in the U.S. only test those who engage in high-risk behaviors, such as unprotected sex or intravenous drug use. Many doctors simply aren't aware that Asian immigrants, especially those from China, are much more likely to have been infected at birth.

To make matters worse, many Asian-Americans who could have been infected at birth may be completely in the dark about the matter. As Ng pointed out to NPR, traditional Asian values may be partly to blame: It's not unlikely that Asian immigrants who knew they were infected with hep B regarded that fact as something shameful, as something that was better not to be discussed.

Some Asian-Americans that I know well also take a fatalistic attitude toward histories of hep B and liver cancer in their families. "If it's going to happen, it's going to happen," is how the conversation often turns. "Better to live your life without worrying about it."

The thing is, hep B can be suppressed with medication, if it's caught early.

"This is a disease [for] which, unlike HIV, we have all the solutions," Samuel So, director of the Asian Liver Center at Stanford University, told NPR. "We know how to prevent it. We have a very effective vaccine; we have treatments which can help to suppress the virus, and yet we are not doing a good job."

Which brings us back to Albert Ng: In addition to a hard-hitting public awareness campaign, city health officials in San Francisco have begun offering free testing, vaccination and treatment to all residents. Ng was getting tested because it turns out that his own grandfather died of liver cancer caused by hepatitis B.

Nationwide, liver cancer and hep B are becoming an Asian-American epidemic. To combat this epidemic, the community needs to talk, and it also needs to shake a few trees. Take the city of New York, for example: 12% of the population of New York is Asian-American. But as recently as 2008, less than one percent of social services were channeled toward the Asian-American community. According to the Coaltion for Asian American Children & Families, Asian-Americans were 10 times as likely to develop liver cancer as the rest of the population of New York.

San Francisco's program is promising, and other cities plan to replicate its efforts. But to combat liver cancer and hep B, we're going to need to raise money — and our voices.

Photo Credit: San Francisco Hep B Free

Chris Santiago is a freelance writer and editor who until recently was an editor at McGraw-Hill.