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By JESSE McKINLEY | Published: May 2, 2010
SAN FRANCISCO — It is an image both shocking and strangely serene: 10 beauty queens, each with a broad smile, sparkling earrings and a beautiful gown. And written across the bottom of the photograph is a simple, stark question.
"Which one," it reads, "deserves to die?"
The image is part of a provocative advertising campaign by San Francisco Hep B Free, which aims to eradicate the disease with citywide vaccinations against hepatitis B. The campaign debuts here in print and on television this week and is aimed at jarring the city's large Asian population into confronting the stubborn public health hazard of hepatitis B.
The new advertising campaign, which is debuting this week.
San Francisco health officials estimate that as many as 1 in 10 residents of Asian descent are infected with the virus here, a percentage that contributes to the nation's highest rate of liver cancer, an unhappy distinction for a city that prides itself on its innovative universal health plan as well as its response to past epidemics like AIDS. In the general population, about 1 in 1,000 people are infected with hepatitis B, which attacks the liver.
A large part of the problem, according to leaders in the Chinese-American community, which is the largest Asian ethnicity here, is the stigma attached to the disease, which is endemic in much of Asia. The advertisements encourage people to get a "simple blood test" because "hepatitis B can be treated, even prevented."
"We are not a confrontational group," said Fiona Ma, a state assemblywoman from San Francisco, who is Chinese-American. "No one wants to talk about it. But we know that people care about their families and their friends. And maybe if they know it can affect them, then maybe they'll talk about it."
Ms. Ma knows of what she speaks; several years ago, she learned she had hepatitis B, which she apparently contracted from her mother. The virus that causes the disease can be spread through blood or other bodily fluids, said Dr. Edward A. Chow, vice president of the San Francisco Health Commission, who said that the disease often displays few symptoms in its carriers.
"It doesn't manifest itself until it's really too late," said Dr. Chow, who said about 25 percent of patients, if untreated, develop serious ailments like liver failure.
A free hepatitis B clinic offered screenings and vaccinations. Rong Chen, 85, had blood drawn for a screening.
The campaign's confrontational approach has ruffled some feathers. Vicky M. Wong, the president and chief executive of DAE, the San Francisco firm that developed the ads, said that several of the beauty queen models walked out of the photo sessions because they were worried about its approach.
"There were so many debates as to whether ‘Are we going too far, is this right or not?' " said Ms. Wong, whose company specializes in campaigns geared to Asian audiences. "We got a lot of pushback. But there's a lot of people who loved it."
Ted Fang, a committee member for Hep B Free, said the high rate of infection among Asians here has been especially frustrating considering that a vaccine for the disease has existed for nearly 30 years.
"We have the medical tools, so long as doctors will test their patients and monitor them," Mr. Fang said. "We can knock out this disease."
Mr. Fang and others liken the city's efforts to the battle against AIDS, which ravaged San Francisco and its gay community in the 1980s and 1990s and also inspired in-your-face tactics. The Hep B Free program began several years ago with a more gentle campaign - the tagline was "B A Hero" - but organizers said it had gone only so far.
"Saying ‘Life is beautiful; get tested,' doesn't work," Ms. Wong said.
For the "Which one deserves to die?" campaign Ms. Wong enlisted volunteers from the Asian community to pose for photographs, depicting families, a basketball team, a group of doctors and office workers.
While the campaign is being published in several languages - including Chinese, Korean and Vietnamese - a target group is English-speaking doctors, outside the Asian community, who might not be aware of the prevalence of the disease.
"Within our ethnic groups, we are all aware of this, because we all have friends and families who have it," Dr. Chow said. "But if you are a very busy practitioner who has a lot of different types of patients, you may not know to check at first."
For Ms. Ma, the assemblywoman, who said she discovered she was positive for hepatitis B when she tried to donate blood, her goal was to bring the disease "above ground," she said. And it is personal: while she is in good health, her mother, who is in her 70s, had part of her liver removed as a result of the disease.
She recovered, Ms. Ma said, but others she knew have not.
"It's a silent killer," she said.