We're in!

City-wide Campaign Becomes National Hep B Model

National recognition, high-profile partnerships, in-kind donations and non-stop media buzz have the grassroots Hep B Free San Francisco Campaign looking attractive.

But if the campaign somehow lost momentum and funding dried up, organizers on the volunteer task force say they would still be working to spread the message: Hepatitis B can be eradicated.

"Nobody came into this campaign because of money," said Dr. Samuel So, director of the Asian Liver Center at Stanford University. "A lot of people don't actually do anything unless they're funded. We feel this is the right thing to do for the community and whether we get funded or not, we're going to do it."

The Jade Ribbon campaign started in San Francisco in 2001 with the goal of testing and vaccinating San Francisco residents for hepatitis B. Since then the campaign has morphed into Hep B Free SF, spread in popularity in the Bay Area and across the country and gained national recognition, highlighted by a press conference in October with House Speaker Nancy Pelosi and Deputy Assistant Secretary for Minority Health, Dr. Garth Graham. Federal representatives and government officials are now looking to replicate the program in cities with high Asian-American populations.

Hepatitis B is a virus that infects the liver and can be passed through bodily fluids via blood transfusions, sexual intercourse or tattoos or acupuncture with unclean equipment.

The virus causes yellowing of the skin, aching muscles and joints, fatigue and loss of appetite. But for people with chronic Hepatitis B, which often doesn't cause symptoms and is transmitted from mother to child, the end result can be liver cancer and death.

The campaign's intention has been to emphasize the positive messages surrounding testing through diverse outlets in order to drive more people to their own doctors for screening, vaccination and monitoring.

And now in the second phase of Hep B Free, organizers are encouraging people to visit a doctor who tests for Hep B and touting a clinician honor roll-to harness doctors' competitive nature -that will advertise a list of doctors who perform the test in major area newspapers.

Tests and subsequent vaccinations create the possibility of curbing the No. 1 health disparity in the Asian-American community.

"We really need to seize on this opportunity to address this health problem, which in the past has never received any attention," said So, a surgeon and self-proclaimed "passionate, evidenced-based advocate," who's found that some health professionals are not aware of what tests to administer for Hepatitis B.

"We have to go back to the ABC's of Hepatitis," he said. "This is a disease we can't assume they know."

The fact that not all clinicians in the Bay Area are aware of the need for Hepatitis B screening has become increasingly apparent to Dr. Lisa Tang, a primary care physician for Kaiser Permanente, who balances more than two thousand patients and has worked with the campaign for the past two years.

"It's not a standard of care with hepatitis B screenings and that's why people are not doing it," Tang said. "The risk to liver cancer is real, but is it on people's radar?"

And although Tang readily admits to moving at frenetic pace, she's determined to tackle the topic of physician awareness as she heads the clinicians outreach committee.

"Personally as an Asian American I find l do have a responsibility to do this and to make this change," Tang said. "Being a physician you change life one at a time, but for me to be able to act as a physician leader and change the behavior of my colleagues and to change how they practice— I think that implication can do so much good for the common good."

However, eradicating the virus from the entire city has taken more than a few partners in the health community.

"A lot of initiatives only work with community health centers but that's not representative of the whole community," So said. "You need everybody involved. We reached across the aisle to all the groups. So in a way it really created the opportunity for city-wide implementation and adoption."

Partnerships include the San Francisco Giants, City College of San Francisco, DAE Advertising, and Office of California Assemblywoman Fiona Ma. About 40 percent of partners are not health care organizations.

The campaign was modeled after a social movement with intentional decentralized collaboration and an approach that would be embraced by Asian cultures, according to Janet Zola, health promotions specialist of Communicable Diseases for the San Francisco Health Department .

"The thing about Hep B is we have everything we need to put this in a box," said Zola, founder of the San Francisco Immunization Coalition. "What we're lacking is public awareness by the general population of why this is important. It was clear we needed everyone involved to take true ownership of this."

With at least five major cities poised to adopt and adapt the Hep B Free campaign, original members in San Francisco are looking toward the challenge of bringing clinicians on board to enact their multifaceted approach.

"We had a much bigger picture from the beginning," said Ted Fang, director of Asian Week Foundation and fellow board member whose expertise resides in diversity issues. "We want the onus to be on the patients and the clinicians."

As billboards, bus ads and radio PSAs remind residents to ‘Be a Hero,' Fang continues to see the possibilities of the movement. From the original small dinner of ideas and listening ears in 2007 to use of the Hep B Free logo and adoption by other cities, the goal of making San Francisco the first Hepatitis B-free city is something he sees as obtainable.

"I do see it as a turning point in the history of the Asian-American community," he said, although he is quick to add, "we're not done yet-the great thing about this project is that it has an ending."

While the campaign seems to be "taking on a life of its own" Fang continues to remind people that this is a goal they must all work toward.

"We can eradicate this disease; we will eradicate this disease; someday it will be eradicated," Fang said. "When hepatitis B is eradicated, there will be a book written. And when that book is written it will say it started with the Asian-American community."

Fia Curley is a writer for the OMHRC. Comments? Email: fcurley@minorityhealth.hhs.gov

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