San Francisco is home to the highest liver cancer rate in the country. The main cause is the high prevalence of chronic hepatitis B infection among the city's large Asian population, despite the fact that both a vaccine and treatment exist. City public health officials are trying to raise awareness of the issue.
At the Asian Heritage Street Fair in front of San Francisco's glittering City Hall recently, television anchor man Alan Wang takes the microphone on the main stage.
"By day I'm an anchor man with ABC 7 news, but when people are in danger ... " he says, seductively unbuttoning his shirt to reveal a Superman logo with the letter "B" — part of the city's campaign urging residents to get tested for hepatitis B. "That's right. I'm a hero, too."
Hepatitis B attacks the liver and can lead to cancer. The virus may have originated in Asia centuries ago, and it's been passed down from infected mothers to their newborn infants ever since. Many of those Asian parents and children immigrated to San Francisco, where one-third of the city's population is of Asian descent.
"I have hepatitis B, my brothers and sisters do," Wang tells people at the fair. "By talking about it, you take away the stigma. I'm not a drug user. I'm not a prostitute. In fact, most of the people who carry hepatitis B are like me, and so we're here to encourage you just to get tested."
The hep B virus can be detected by a blood test. But U.S. physicians typically test only patients who engage in risky behaviors like intravenous drug use or unprotected sex, because the virus is spread through infected blood and bodily fluids. A recent Institute of Medicine report concluded that doctors aren't aware that Asian immigrants, especially those from China, are much more likely to have been infected at birth.
Reluctance To Get Tested
As part of an aggressive campaign to stem hep B infections, San Francisco is offering free testing, vaccination and treatment to all residents, young and old.
Thirty-year-old Albert Ng's Chinese grandfather died of liver cancer caused by the virus.
"In the Asian-American family, usually parents don't want to discuss if they have diseases," he says at a testing booth at the fair, where he got tested for the first time. "They just want to discuss the good stuff, but never discuss the weaknesses."
That reluctance has been a big challenge for public health officials in San Francisco. After launching an upbeat public awareness campaign three years ago, the city recently unveiled a much darker approach. The ads, which feature statuesque Asian beauty queens, ask: "Of all these young women, which one deserves to die?"
The ads go on to say that 1 in 10 Asian Americans is infected with hepatitis B, "the leading cause of liver cancer."
Getting tested is critical, public health officials say, because many people who are chronically infected feel no symptoms. If caught early enough, the virus can be suppressed with medication. But if left untreated, it can lead to liver cancer, which is often fatal.
"This is a disease [for] which, unlike HIV, we have all the solutions," says Samuel So, who directs the Asian Liver Center at Stanford University. He says state and federal health officials need to bring more money and attention to the disease.
"We know how to prevent it. We have a very effective vaccine; we have treatments which can help to suppress the virus," he says, "and yet we are not doing a good job."
The San Francisco effort is an important start, he says. Indeed, a handful of other cities including Los Angeles and Philadelphia plan to replicate the program. But until there is a more aggressive national campaign to control chronic infection, people like anchorman Wang will sell the message of hep B in anyway they can — even if it means a Superman-inspired striptease in front of City Hall.
This report was produced in conjunction with Spencer Michels, Catherine Wise and Jason Lelchuk of the PBS NewsHour.