Alliance Against Hep B

San Francisco Hep B Free could save thousands of lives in San Francisco, and millions more around the world if the campaign becomes a global model to prevent transmission of the deadly hepatitis B virus.

Those numbers are impressive. But there is something equally as impressive and important happening quietly within San Francisco Hep B Free, in the ways the campaign is organizing people and developing a road map for community-based coalitions to affect health care change and reform.

“To watch an entire community — non-profits, local government, academic centers and industry — take on hepatitis B prevention as a public health mission and really own it is exhilarating,” says Dr. John W. Ward, director of the Division of Viral Hepatitis at the Centers for Disease Control and Prevention. “It’s one of the finest examples of community mobilization that I can think of.”

San Francisco Hep B Free is not just another health care campaign. In fact, it represents the largest organizing effort ever in the Asian and Pacific Islander American (API) community. No other initiative in any field — from healthcare to social causes and politics — has been able to bring together so many diverse groups and tap into their energy and resources to bring about change. Over 150 community groups are supporting the cause, including virtually every API group in San Francisco.

Building trust
With advances in research, the treatment options for Hep B patients are expanding. The newest approved drug, Viread from Gilead Sciences, for example, is showing even greater effectiveness than some prior approved medications from Gilead.

It became clear to the organizers of San Francisco Hep B Free from the get-go that, in order for the campaign’s prevention message to reach those communities most impacted by the disease — particularly immigrants with little English — and really stick, a sense of trust had to be developed. So, elected officials, local non-profits and businesses with strong ties to those communities were called upon and invited to partner with San Francisco Hep B Free to present a united front against the disease.

“We don’t have the ability to screen people for hepatitis B. But we have a long history of serving the API community, and we can help get the message to those who need it,” says Kavoos Bassiri, CEO of Richmond Area Multi-Services, Inc. (RAMS).

Mental health has remained the focus of this non-profit agency since 1974. But Bassiri says that hepatitis B’s impact on the general well-being of RAMS’ clients was impossible to ignore.

“This is a very serious matter,” he explains. “So what we decided to do is train our staff about hepatitis B so that they could share this information at the client level. The clients trust us. We’re known as an organization that serves the [API] community, so we lend a sense of credibility. I think that’s important to people. If they don’t know who is providing the information, they won’t take it seriously.”

Pooling resources
For Rudy Asercion, executive director of West Bay Pilipino Multi-Service Center, Inc., which serves the various needs of San Francisco’s Filipino community, the decision to partner with San Francisco Hep B Free was more personal.

“A very good friend of mine has hepatitis B, and I’ve watched him deteriorate,” Asercion explains. “It’s very sad. Now that I know this disease is preventable, I have to do what I can to let people in the community know.”

The organization helped sponsor free screenings at the recent Pistahan Parade and Festival, an annual celebration of Filipino American culture held in San Francisco that draws up to 40,000 people each year. West Bay also works with San Francisco Hep B Free partners to organize free screenings at its South-of-Market headquarters.

In the meantime, Asercion and his staff are working to inform clients about the disease and refer them to doctors, public clinics or San Francisco Hep B Free testing sites for screening and vaccination.

“Filipinos only go to the doctor when they are sick,” Asercion says. “Prevention is something new for many of them. We’re trying to change that attitude. And it’s a slow process, but I think it’s working.”

“There are boundaries to what any agency can do on its own, and those boundaries are often resources and finance based,” says Kevin Shi, a testing clinic program specialist at the Asian and Pacific Islander Wellness Center. “So whenever we have a chance to combine forces and resources with other agencies, we welcome that opportunity.”

Shi is all too familiar with hepatitis B, having watched the disease take its toll on family members. So he is thrilled to see hepatitis B prevention included in the community outreach efforts of so many agencies.

“Hepatitis B is a big part of our message now,” Shi says. “And people are really receptive. A lot of clients come in and ask to get tested before I even have a chance to offer it to them. That’s really inspiring.”

“Organizing something like this, with so many people and organizations involved, isn’t an easy thing to do, but it’s the smart thing to do,” says San Francisco Assessor-Recorder Phil Ting, one of several elected officials who has actively supported the campaign since its launch in April 2007. “So many great ideas like this never get off the ground because there’s no organized outreach effort.”

Ting appreciates that his name and title can be used to help San Francisco Hep B Free get a foothold in the community, particularly among API residents. But he says that when he appears at San Francisco Hep B Free events, “elected official” is just one of the hats he is wearing.

“I’m there as Assessor-Recorder, as a concerned member of the API community and as a citizen of San Francisco,” Ting explains.

Investing in everyone’s future
“[Fighting] hepatitis B is my latest passion,” says Sunny Clark, associate dean of student health services at City College of San Francisco (CCSF) and director of the Student Health Center.

An estimated one out of every ten APIs is infected with chronic hepatitis B. Nearly half of the student body at CCSF is Asian.

“We’re talking about thousands of students who may be chronically infected,” Clark says. “I don’t feel like I can do enough.”

In addition to offering screening and vaccination at CCSF campuses, Clark and a nurse practitioner also make in-class presentations, organize lectures and meet with various student body organizations to promote hepatitis B prevention. These presentations are given in English, Mandarin and Cantonese to maximize their effectiveness.

Turnout has varied greatly, but Clark says that has not discouraged her.

“I’d call it a lesson in cultural patience,” she jokes. “But this is very important work, so we have to continue trying.”

For the San Francisco Hepatitis B Collaborative at the University of California, San Francisco, partnering with San Francisco Hep B Free has presented an opportunity for its members to put their money where their mouths are, so to speak.

Since 2004, members of the student-run collaborative, which includes doctors-, nurses- and pharmacists-in-training, have attended health fairs and other community events to promote hepatitis B prevention. Screening and vaccination were not offered on a regular basis, however, until the collaborative joined forces with San Francisco Hep B Free.

The collaborative now organizes monthly drop-in clinics at Mt. Zion UCSF Medical Center and the Chinatown Public Health Center, where members of the public can take advantage of free screening and low-cost vaccination.

The goal of the collaborative since its founding, according to Dr. Josh Adler, medical director of ambulatory care at UCSF and a faculty advisor to the students, has been to supplement standard curriculum with real-life lessons in community-based health care. Its relationship with San Francisco Hep B Free, Adler says, allows the collaborative to better achieve that goal.

“It’s a practical way to apply that knowledge,” he explains. “Making a difference in the health of a population requires a population approach. But those skills aren’t generally taught to health care workers. So these students are getting unique experience — experience that we hope will stay with them.”

Forging unlikely alliances
Another corporate/community partner of the S.F. Hep B Free campaign is Bristol Myers Squibb, which has developed a hepatitis B advocacy team to work within high-risk communities to strengthen the existing disease awareness efforts and advocacy networks. This team helps bring together physicians, patients, community groups and media.

Rose Chung, creator of the Miss Asian America Pageant, has been involved in the fight against hepatitis B since 2003. Chung signed on shortly after the launch of the Asian Liver Center’s Jade Ribbon Campaign, an effort to increase awareness of hepatitis B and liver cancer in API communities around the world. That campaign helped set the stage for San Francisco Hep B Free.

While a beauty pageant may seem an unlikely partner for a health campaign, Miss Asian America’s involvement has proven invaluable in helping get the word out. Organizers and contestants promote hepatitis B prevention at pageant-related events, and pageant audiences are encouraged to donate money to the fight against hepatitis B. To date, the Miss Asian America Pageant has raised several thousand dollars to fight the disease.

“We didn’t know what a problem hepatitis B was in the Asian community,” says Shana Daum of the San Francisco Giants. “Once we recovered from the shock of hearing those numbers, management went, ‘Let’s get on this.’”

The Giants declared May 12-17, 2008, Asian Heritage Week, and included hepatitis B prevention information in promotions and game-night programming. Giants left-fielder Dave Roberts signed on to help drive San Francisco Hep B Free’s message home with fans. The Japanese American player made appearances at San Francisco Hep B Free events and taped a public service announcement with the campaign’s honorary chairwoman, State Rep. Fiona Ma, who is chronically infected with hepatitis B. The Giants also donated a portion of ticket sales for one game to the effort.

“I think we can reach a great number of people with this message in a very unique way,” Daum explains. “A ballgame is the last place you think you’ll get information like this. You’re having a good time; your guard is down. I think the message sinks in. And all it takes to make a difference is for one fan to go home or go to work the next day and share what they learned with someone. That’s pretty great.”

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San Francisco: Hep B Free Campaign Milestones

May 20, 2006 – First Hep B screening at Asian Heritage Street Celebration screens 596 patients in five hours. Approximately 10% test positive as chronic Hep B carriers.

November 2006 – San Francisco enacts a resolution calling for universal screening and vaccination of all adult Asian/Pacific Islander residents.

February 2007 – Steering Committee forms with Asian Liver Center at Stanford University, San Francisco Department of Public Health, AsianWeek Foundation and State Rep. Fiona Ma as honorary chairperson.

April 2007 – SF Hep B Free Campaign Kicks off at New Asia Restaurant in Chinatown. 150 community and healthcare groups lend their support. Mayor Gavin Newsom calls on San Francisco to be model for nation in eliminating hepatitis B disease.

May 2007 – First outdoor marketing and ethnic media campaign is launched.

June 2007 – First monthly SF Hep B Free Planning Committee meeting takes place.

August 2007 – Medical protocol defined and published.

September 2007 – UCSF kicks off Viet Hep B Free campaign to target Vietnamese Americans.

October 2007 – 7 stand-alone HBV testing sites set up and open to public.

December 2007 – Campaign begins receiving national recognition.

January 2008 – Campaign expands to institutions such as S.F. State University, City College and various communities.

March 2008 – Santa Clara Hep B Free campaign is launched.

May 2008 – San Francisco Giants host first Asian Heritage week with SF Hep B Free as beneficiary. Media blitz results in multiple coverage in all major mainstream media.

September 2008 – B a Hero outdoor marketing campaign launched.

September 2008 – First-ever fundraising dinner for Hepatitis B disease in California.

November 2008 – Launching of Asia and Pacific Alliance for global elimination of Hep B transmission, sponsored by CDC and Asian Liver Center.