This reporting was supported with a grant from the Pulitzer Center and a California Health Equity Fellowship from the USC Annenberg Center for Health Journalism.
This article is adapted from an episode of our podcast, “Civic.” Click the audio player below to hear the full story.
A push by community organizers around the country for universal hepatitis B screening is gaining momentum.
In San Francisco, clinics like North East Medical Services, where many Asian American immigrants receive care, routinely offer universal hepatitis B screening, meaning primary care doctors there are regularly suggesting it to their patients. This kind of preventive action is becoming increasingly common in the Bay Area.
This episode of “Civic” explores the history of health professionals, city leaders and community advocates in San Francisco working together to improve education and outreach around hepatitis B, including how to reduce transmission and treat chronic infection.
The regional root of this effort traces to the early 2000s, when a wave of deaths among young Asian Americans due to hepatitis B shocked the community. In response, local leaders and physicians in 2007 formed San Francisco Hep B Free, a coalition that brought together government officials and representatives from the major hospitals and health providers in the region to discuss the illness. They laid the groundwork for public outreach campaigns, free screenings and better education for doctors — many of whom had little experience diagnosing and treating the disease.
In some ways, the community initiative echoed work by local physicians and patient advocates to create a model of care for the treatment of HIV/AIDS at San Francisco General Hospital’s Ward 85 in 1983.
Stuart Fong, a founding member of the coalition, helped launch a program that offered free hepatitis B screenings at Chinese Hospital, where he worked in the early 2000s. Fong said staff would set up tables at community events to reach more residents. Their goal wasn’t just to vaccinate children — the focus of most prevention efforts — but to reach their parents who might not have known they were living with asymptomatic chronic cases.
Richard So, who now leads the coalition — which recently changed its name to Hep B Free — is reviving those efforts. He is working to reconnect with hospitals and other healthcare systems to educate providers on successful screening and treatment models.
Hep B Free was a key player in advocating for California’s hepatitis screening law, which requires insurance companies to cover the cost of hepatitis B and C testing.
The organization is sharing its experience and knowledge to support other advocacy groups around the country.
So said he believes the Centers for Disease Control and Prevention’s expanded screening recommendations could address gaps in testing. He said adding electronic health record alerts to remind physicians to test more patients also could help.
Fighting stigma is crucial
For some people with chronic hepatitis B, fear of being associated with the disease has contributed to it staying under the radar in some communities.
Francis Yao, medical director of the Liver Transplant Program at the University of California, San Francisco, said that even with some awareness in San Francisco’s Asian immigrant communities — which historically have had higher rates of infection due to transmission during childbirth — getting people screened for hepatitis B remains a challenge due to lingering stigma.
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Tony Lau, who was diagnosed with hepatitis B before he got married, experienced that firsthand. When he received his diagnosis, a doctor bluntly told his wife: “Oh, you know he’s not going to live after his 40s,” leaving them both shocked and fearful, he said.
Now 45, Lau has successfully suppressed his hepatitis B viral load through treatment. But he still faces barriers, such as difficulties obtaining life insurance.
“Even people in the medical field need better information,” he said.
No longer expecting support from Washington
For a while, community organizers advocating for hepatitis B screening felt like they had support from the federal government. In 2023, the CDC updated its guidelines to recommend that all at-risk adults get screened at least once through a simple blood test.
The Trump administration has extinguished their hope that federal funding would support efforts to build a model of care for hepatitis B around the country.
Patient advocate Wendy Lo has lived with chronic hepatitis B since 1991. She said funding to combat the illness has always lagged, but new cuts at the CDC, including $43 million slashed from hepatitis prevention, would make it harder to chart progress.
“They dismantled the viral hepatitis lab,” she said, noting how the site’s researchers had studied viral samples from around the world to track mutations.
Additional reporting by Zhe Wu.
About the ‘Silent Killer’ Series
The San Francisco Public Press examined recent efforts to step up diagnosis, vaccination and treatment for hepatitis B. Chronic hepatitis B affects an estimated 305,000 people in California, with the vast majority of cases affecting people in Asian American and Pacific Islander communities. Deep racial and cultural disparities in illness caused by the hepatitis B virus have persisted for decades. A cure is in trials, but those inequities, along with federal funding cuts, could hamper its rollout.
This reporting was supported with a California Health Equity Fellowship from the USC Annenberg Center for Health Journalism and a grant from the Pulitzer Center.