Back to Stories
“SARS set me in motion”: Prof Johnson Wang’s southbound scholarly pursuit in public health

Prof Johnson Wang is based not at the CUHK main campus, but the likewise tranquil Prince of Wales Hospital. His office in the Jockey Club School of Public Health and Primary Care was neat and tidy; stacks of documents and stationery lined his desk. Next to his computer sat a picture of a new-born. “She’s over one, “speaking of his bundle of joy, Johnson was all smiles.

His schedule is built around his daughter’s sleep, “Once she gets up, I have to. She’s a clingy one.” The pride on Johnson’s face testified that he is no workaholic. He even “sacrificed” his hobbies. “Don’t get as much time making models (of aircrafts and ships) now, all for her.” The twinkle in his eyes remained as we switched topic to his project on HIV self-testing, which has been enabled by CUHK’s Knowledge Transfer Project Fund (KPF).

Prof Johnson Wang called the SARS outbreak in 2003 the decisive event that kicked off his career in public health research and promotion. (Photo: ORKTS)

Saint Seiya and SARS

Currently a research assistant professor of CUHK’s Jockey Club School of Public Health and Primary Care, Johnson finished both his undergraduate and master’s degree in Peking University (PKU)’s School of Public Health, before coming to Hong Kong in 2010 for his PhD. He stayed at CUHK to further his research, and tied the knot with his PKU/CUHK school mate. This is his ninth year in town. “How come your Cantonese is this fluent?” Not out of courtesy at all. Johnson’s Cantonese is fairly standard, almost accent-free.

“Cos I was born and raised in Shenzhen,” he described growing up with animations on the “Hong Kong channel” – Saint Seiya, Doraemon, Sailor Moon, you name it. “I watched and learned,” while stressing that his grasp of the spoken language is no match for locals. “Aha! You learned Cantonese from Sailor Moon!” the reporter joked, a catchy subtitle flashing across her mind. “Don’t jot that down, will you?” Johnson playfully insisted.

As Japanese anime tied Johnson in with Cantonese, so did the 2003 SARS epidemic lead him down the path of public health research. “On the news, you hear updates to the death toll on a daily basis.” He remembered how the epidemic sparked numerous mainland students’ interest in studying medicine, “it was the first time most of them developed a concept towards public health.” A self-declared industrious student, Johnson believed that being a public health specialist makes greater impact than a physician. He had since set his sights on the A-list institution of the country – Peking University’s School of Public Health – and made it in, spending seven consecutive winters till his master’s graduation.

“Then I thought, with that much learned, how would I directly apply my knowledge onto the community?” But before taking this step, the “research enthusiast” decided to go for a PhD. Looking up to Prof Joseph Lau’s work on health enhancement and promotion, Johnson headed south again, this time to CUHK, researching into AIDS prevention under the tutelage of Prof Lau. “It’s a privilege,” the star student was being modest.

Having spent most of his days within the academic circle, Johnson admitted that it is “competitive and pretty exacting”. Model building is one of his pastimes and ways to de-stress. (Photo: ORKTS)

A service based on evidence and loaded with empathy

Johnson specialises in AIDS prevention, “A lot of breakthroughs were made during that period, while potential beneficiaries were left in the dark.” One of the studies discovered that circumcision lowers risks by half. Using his hometown Shenzhen as a testing site, he partnered with local hospitals to promote this practice to male patients with sexually transmitted diseases (STDs).

“First we got in touch with our service users, understood their views towards circumcision, then designed a promotion plan from their perspective, including a 10-minute video and a counselling session of similar duration.” The programme was well-received, “after these services, 20% of the outreached patients underwent the operation at market price.”

Other than circumcision, AIDS screening is an effective means in curbing infection rates. But because of stigmatisation, screening remains unpopular, even for the high-risk “men who have sex with men” (MSM). Although self-test tools that work like pregnancy tests are readily available in stores, Johnson pointed out “variations in how they are supposedly used”, not to mention they fail to cater for users’ psychological needs. Seeing these shortfalls, Johnson and his team applied for KPF, designing a self-screening service that satisfies users both rationally and emotionally, and testing the waters with an AIDS concern group.

Johnson with his team – Prof Phoenix Mo (left), research assistant Mary and Prof Joseph Lau (not in the photo). (Photo: ORKTS)

“They hate seeing doctors do the talk”

“We chatted with them (MSM), getting to know their thoughts. Some made it clear that they despised seeing doctors in the video, preferring their own ‘kin’ to tell the story.” And so the team invited MSM to explain on camera the advantages and procedures of screening. When some voiced worries that family members may unwrap their mail, the team delivered the tools to convenience stores for users to pick up instead.

And they offered more than a toolkit – users were supported with real-time online counselling. “Our very first counsellor was an experienced nurse who had long been keeping tabs on this circle. A lady she might be, many MSM loved talking to her.” Users tend to self-test around midnight, while counsellors keep them company via instant messaging tools, offering psychological support.

“The first positive case was unforgettable. Confirmed at midnight. The counsellor conversed with him for over an hour; the next day we referred him to a relevant organisation, then arranged for him a formal check-up at a clinic.”

To Johnson’s delight, their partnering organisation took up the service, tuned it, and adopted it as their own. Despite a charge of about HK$200, many were willing to pay. “So much prior effort we devoted (to addressing the medical issue), just so when we retreat behind the scenes, someone would be able to pick it up. This, you see, is how impact could be sustained.” He spoke of a mainland AIDS concern group Lingnan Partners and their mature self-testing services, which have already served thousands.

Prince of Wales Hospital is where Johnson buries himself in his daily research. He wishes to effectively put the latest medical research outputs into practice, so as to benefit the community. (Photo: ORKTS)

HPV is not a female “prerogative”

Besides their project on HIV prevention, Johnson designed a similar service to promote HPV vaccination amongst the high-risk MSM. “The virus infects both women AND men!” He mentioned other STDs and cancer types caused by HPV, such as genital warts and anal cancer. “The commercial world conventionally calls it the HPV vaccine – of course the gentlemen pay no attention!” Debunking common myths is also one of the project’s targets.

To sell their narrative, Johnson again recruited MSM to shoot a promotional video, “Some made it clear that waiting in line together with women is a big ‘no’, so we worked with clinics to reserve men-only periods, saving them from the embarrassment.” With the humanistic design, around 15% of the 200 service users took up the 3 shots of vaccine. Hmm…not up to par? Turned out to be an issue with vaccine supply. “The response should have been better; unfortunately, the sole supplier Merck Sharp & Dohme ran out of the vaccine and stopped supplying for nine months. The price tag soared from around HK$3,000 to over HK$10,000 – tough to lay your hands on the shots even if you wished to.”

Having come up with this many services on disease prevention, Johnson, who has long been fixated on academic research, thought of integrating them into a non-clinical package for those in need. “I’m far from being business-savvy though,” he laughed. On top of AIDS and MSM, the scholar revealed research plans on mental health and lifestyle habits of migrant workers.

Liangshan at a glimpse

Johnson’s research took him beyond Guangdong province to the mountainous Liangshan Prefecture in Sichuan. The Prefecture has a population of over five million, dominated by the ethnic Yi people. Nestled within a rugged landscape, Liangshan is in close proximity to the notorious drug haven Golden Triangle, thus plagued by a dire AIDS situation. Where “poverty coexists with the virus”, “one in every 10 persons suffers from AIDS”. In her book Passage to Manhood, Taiwanese medical anthropologist Liu Shao-hua recounted her decade-long research and 20-month field study in Liangshan, likening heroin and AIDS to the local male’s “passage to manhood”.

MSM I Scholarly keyword

Johnson’s HIV and HPV projects both target “men who have sex with men” (MSM) – not a very familiar term. “Why not just say ‘gays’?” Johnson explained that “gay” defines a group by its sexual orientation, involving emotional factors; whereas MSM are defined by their behaviour, i.e. males who had sex with the same sex within a certain period of time. “MSM include gays, also bisexuals, or even heterosexuals – men who claim to like women but have had sex with other men – not entirely impossible.”

By Kary Wong@ORKTS
English translation by Cathy Wong@ORKTS