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HEALTH-U.S.: City Takes Aim at Hepatitis Among Asian Americans

Ngoc Nguyen

SAN FRANCISCO, Apr 27 2007 (IPS) - This west-coast city has earned a reputation as a health trendsetter. Last year, San Francisco unveiled a plan to offer universal health care to all its residents (to take effect Jul. 1). Now it has become the first U.S. city to launch a plan to test and vaccinate all Asian and Pacific Islander American residents for hepatitis B.

In the heart of San Francisco’s Chinatown, the mayor, other elected officials, medical professionals and representatives from community-based organisations kicked off the city’s new “Hep B Free” campaign Wednesday before sitting down to a sumptuous Chinese banquet.

The goal of the campaign is to raise awareness and increase collaboration amongst clinics, hospitals and community groups in offering free or low-cost testing, vaccinations and screenings to the public.

Hepatitis B virus (HBV) is a serious infection of the liver, and can lead to premature death from liver cancer or liver failure. At a press conference before the banquet, Mayor Gavin Newsom said HBV is a global problem, but one that hits close to home for San Francisco. The city has the highest liver cancer rate in the United States, largely due to its sizable Asian-Pacific Islander population, who are particularly susceptible to the disease.

Newsom said the city has a special responsibility to raise awareness and encourage testing, because “a consequence of having it and not knowing it… is that you can pass it on to other people. Therein lies the challenge.”

HBV can be passed to a newborn baby from an infected mother, through unprotected sex or through contaminated blood through sharing toothbrushes, razors or hypodermic needles. The virus can live in the body for a long time without causing any symptoms, and, if left untreated, can lead to liver cancer or failure.

Asian and Pacific Islander Americans (APIs), who comprise about one-third of San Francisco’s population, are being encouraged in particular to get tested for HBV.

In the United States, about 60 percent of the 1.2 million people living with chronic hepatitis B infection are APIs. And the disparity doesn’t stop there: Asian men are four times more likely to die from liver cancer than are white men.

If the test is positive, there are medications to reduce the harm done by the virus and regular screenings are recommended to detect and treat cancers early. If the test is negative, there is a vaccine against HBV that is so effective the World Health Organisation has called it the “first anti-cancer vaccine.”

Dr. Mitch Katz, head of the San Francisco Public Health Department, said the city is tackling the hepatitis problem because it is treatable and manageable.

“We don’t see any polio, why? Because polio had a vaccine that prevented it, so over time, if you put great effort into making sure that every person who could be affected is vaccinated, you eradicate a disease. Sometimes. Hepatitis B can be eradicated,” said Katz.

Dr. Samuel So founded the Asian Liver Centre at Stanford University more than a decade ago, when he first recognised that HBV was a big Asian American problem that no one was addressing.

“You would think that doctors routinely test patients,” he said. “We found in over 3,000 screenings in the (San Francisco) Bay Area, two out of three people who were found to have chronic hepatitis B weren’t even aware they were infected. So a large percentage of Asian Americans walking around the streets of San Francisco, who are chronically infected, are not aware until the day they get sick with advanced liver cancer. We have to put a stop to this.”

Commander Bok Pon, 65, is an active member of the American Legion Cathay Post # 384, a group of Chinese American post-World War I veterans.

He first learned that he had hepatitis B two months ago when blood test read abnormal. Several tests later, Pon learned he had liver cancer and that he had an estimated six months to live.

Pon is using the time to get educated about HBV and to share his story, in the hope of convincing others about the importance of getting tested, and then vaccinated or treated.

“A lot of people I know, some veterans, have hepatitis B and they talk to me privately about my experience,” he said. “They want to know about medications and how to manage it.” He said he uses humour to help people get past fears and to demystify the medical technology and treatments.

“I tell them that an ultrasound doesn’t hurt and that getting a CAT scan is like going through the time tunnel at Disneyland,” Pon said.

He is currently undergoing chemotherapy and, depending on how he responds, may become a candidate to receive a liver transplant. His advice is to develop a positive attitude, exercise to maintain health and get good health insurance. “In the last two month, my medical procedures have totalled 90,000 dollars, and a liver transplant can run half a million dollars.”

In the coming months, a number of community organisations, clinics and hospitals will be offering HBV testing and vaccination services at sites across the city. Testing is offered free or at a cost of 10 dollars. A vaccination – a series of three shots over the course of six months – runs about 60 dollars. At an Asian heritage street fair in the city last year, organisers said they were able to vaccinate about 500 people in five hours.

One site where locals will be able to get tested and vaccinated is Chinese Hospital, a 59-bed acute care non-profit facility that was founded in response to racism against Asian Americans in the 1920s. Dr. Stuart Fong operates the hepatitis B vaccination clinic the first Wednesday of every month. The clinic screened about 800 people last year. He said having diverse staff has helped provide culturally competent care – an important aspect in addressing HBV in the API community.

Incidence rates – the number of new cases in a given time period – are highest among Asians of Cambodian and Laotian origin, followed by Korean, Vietnamese and Chinese, according to Fong. Cultural barriers are a particular challenge when it comes to outreach efforts aimed at new API immigrants.

“I don’t believe hepatitis B can be completely eradicated from the city due to global travel and immigration, not just from Asian countries, but from countries in Latin America and the Caribbean,” where HBV is also a health problem, he said.

Community clinics help to remove some of the obstacles to receiving care, said Fong, explaining that one of the barriers to getting vaccinated is the lack of or inadequate health insurance. “They can get (the vaccine) cheaper and faster at a community hospital or clinic,” he said.

And hepatitis B also exists in the broader population. “We need to expand HBV prevention and treatment services to more than the API community. Other groups will be targeted down the pike, but everything has to be done incrementally,” said Fong. San Francisco first promoted hepatitis B awareness in the homosexual community.

San Francisco’s Hep B Free Campaign could be a model for the state and the rest of the nation. State lawmaker Fiona Ma, a Democrat from San Francisco, has authored legislation that would set up pilot programmes to test, vaccinate and treat HBV in the broader Los Angeles and San Francisco areas. The bill has already passed its first hurdle and is working its way through the state legislature.

“In a year or so, perhaps anybody who walks through the door should be screened,” said Dr. Fong.

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