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San Francisco Mayoral candidates talk hep B and C
  by Liz Highleyman 11/03/2011


HIV/AIDS has long been a key concern as the LGBT community considers candidates for local office, but this year hepatitis B and C are also on the radar. Men who have sex with men are one of the groups at increased risk for hepatitis B, and recent years have seen growing outbreaks of sexually transmitted acute hepatitis C among HIV-positive gay and bisexual men.

San Francisco Hep B Free and the San Francisco Hepatitis C Task Force asked mayoral candidates how they would combat the city's hepatitis B and C epidemics; most of the major candidates provided responses.

Asians hit hard by hep B

Jeff Adachi committed to seek resources locally, statewide, and nationally for hepatitis treatment, prevention, education, testing, and research.

"I understand the tremendous impact hepatitis has on our communities and this awareness requires a commitment to action by City Hall," he said in his response. "As a person of Asian descent, I feel personally responsible to increase awareness."

Asian and Pacific Islander communities are particularly hard hit by hepatitis B, which is endemic in those parts of the world. An estimated one in 10 Asians are living with hepatitis B, which is the leading cause of primary liver cancer worldwide.

In addition, injection drug users have high rates of hepatitis B and C, which are easily transmitted through shared drug injection equipment. Adachi stressed that his work as San Francisco's public defender has demonstrated his belief that substance use must be decriminalized.

Board of Supervisors President David Chiu said that, if elected, hepatitis will be "a top public health priority." Chiu worked with Asian community leaders on the Hep B Free campaign, and he said he agrees with many of the December 2010 recommendations of the Hepatitis C Task Force.

"To provide critical hepatitis services we must maintain funding for Medi-Cal and Healthy San Francisco," Chiu emphasized. "As mayor I will be the city's chief advocate in Sacramento to preserve the programs San Franciscans count on."

Noting that hepatitis B is known as the "silent killer" because many people do not experience symptoms or realize they are infected until late stages of disease, Assessor-Recorder Phil Ting said, "We should expand and encourage more testing for HBV and HCV. ... We need to ensure that individuals receive adequate treatment and understand the risk they pose to society if they are infected."

Ting added that the city must improve its methods for gathering data in order to target prevention and treatment to the neediest neighborhoods. "My campaign to Reset San Francisco focuses on the necessity for data-driven decision-making, so our city government can be more effective and more responsive," he said.

Other candidates also spoke of public health as a major issue.

"As mayor, there will be no higher priority for me than public health, including addressing our ongoing crisis with hepatitis B and C," said City Attorney Dennis Herrera. "For the last decade, I've fought to expand access to quality, affordable health care in San Francisco, helping to draft Healthy San Francisco, and successfully defending it all the way to the U.S. Supreme Court."

Joanna Rees, an adjunct professor at Santa Clara University, vowed to appoint a citywide hepatitis elimination coordinator. She also proposed a prevention campaign to include clean needle distribution and enforcement of safety measures at tattoo parlors and nail salons.

Interim Mayor Ed Lee praised Hep B Free's work to increase awareness and reduce hepatitis B infections, especially in Asian/Pacific Islander communities. "Media and grassroots messaging has raised awareness of hepatitis B and promoted testing of API adults, vaccinating the estimated 40 percent who are not infected or immune, and treating the 10 percent who are infected," he said.

Turning to hepatitis C, Lee supports the task force recommendations and said he would ask DPH to explore "new ways to treat hepatitis C," including the antiviral drug telaprevir (Incivek), which was approved along with a similar drug, boceprevir (Victrelis), in May.

Drawing on HIV leadership

Former District 8 Supervisor Bevan Dufty and former District 2 Supervisor Michela Alioto-Pier both recommended that the city use its widely recognized leadership in HIV/AIDS as a model for addressing hepatitis B and C.

"Since the early days of the HIV/AIDS crisis, San Francisco has been a world leader in prevention and treatment campaigns for communicable diseases," Alioto-Pier said. "Our city's efforts have saved the lives of countless San Franciscans, and our example has helped other communities save lives around the world. We need to apply our experience and our resources to dealing with hepatitis."

Dufty, who represented the Castro, said that San Francisco, as a leader in community response to HIV/AIDS, "must use that experience to mobilize public and community partnerships to end hepatitis B and C."

Dufty committed to ensure that DPH has adequate resources to tackle viral hepatitis. "Everyone in Healthy SF should be offered a hepatitis B vaccination and hepatitis C testing and treatment," he said. "We can do better at building awareness about hepatitis C, including the possibility of sexual transmission."

Harm reduction for drug users

Dufty also stressed that he has been a "strong advocate" for safe syringe access and substance abuse treatment, and said he supports "a community-led approach" to establishing safe injection sites.

State Senator Leland Yee emphasized his two-year effort to pass SB 41, which allows physicians and pharmacists to provide sterile syringes to adults without a prescription. "We passed the single most important hepatitis and HIV prevention policy in the last 20 years," he said, adding that he is also interested in exploring safe injection sites.

District 11 Supervisor John Avalos said San Francisco should implement hepatitis B vaccine requirements, following in the footsteps of states across the country that mandate vaccination for entry into daycare, elementary, and middle schools. He added that the city needs a hepatitis C prevention program "that is well funded and doesn't need to go looking for funding every year."

Avalos, too, supports creation of safe injection sites. "These facilities, while controversial, have been proven to lower infection rates of HIV and hepatitis, provide for proper disposal of needles, eliminate the need for emergency services and enforcement costs to the city, help to temper addiction, and save lives," he said.

SF Hep B Free and the SF Hepatitis C Task Force will hold a press conference Friday, November 4, to discuss the city's response to hepatitis, coinciding with the American Association for the Study of Liver Diseases conference taking place at Moscone Center this weekend.

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