AIDS IN JAPAN
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The Current Situation of HIV/AIDS Epidemic in Japan
-How to approach the gradual increase in people with HIV/AIDS 1. Introduction: The HIV/AIDS surveillance system in Japan The current situation of HIV/AIDS in Japan has been analyzed by Committee on AIDS Trends (CAT), a committee in Japan Ministry of Health, Labour, and Welfare (MHLW). In the present HIV /AIDS surveillance system, both HIV and AIDS cases are reported by medical doctors to a public health center, which collects these HIV/AIDS cases and reports them to a prefecture. The prefecture reports them to a relevant department in the MHLW. CAT analyzes these HIV/AIDS cases based on the data from the MHLW, and presents the data once in the 3 months. In addition, the trends in the number of reported cases of HIV/AIDS in each year are organized as the HIV/AIDS statistics and released once a year. CAT analyzes only reported cases of HIV/AIDS and neither "sentinel surveillance" nor "second generation surveillance", which are to understand the trends of HIV infection at the early stages, are conducted in the current Japanese government system. Although research groups in MHLW conduct these types of surveillances, these surveillances are neither widely available nor well organized. In Japan, social awareness and public perception about HIV/AIDS is low and few people voluntarily attempt to have HIV testing, except for a part of gay communities in large cities. Therefore, it difficult to know actual number of people with HIV, HIV infection rates, and trends of HIV/AIDS at the early stages based only on the reported cases of HIV/AIDS. Even at present, it is considered that there is a big difference between actual number of HIV/AIDS and the trend, and the number of HIV/AIDS and the trend, which CAT presents. 2. The trends in HIV/AIDS in Japan
It was 1985 that MHLW announced the first AIDS case in Japan. However, they knew that many of hemophiliacs were infected with HIV even before 1985. In other developed countries, the HIV infections have rapidly increased during the period between 1980s and the early 1990s. However, Japan did not experience such rapid increase but, instead, continued to increase slowly. In other developed countries, the increasing trends of HIV/AIDS cases have stopped during the mid-1990s and a decline in the number of HIV/AIDS cases has been observed in the late 1990s. In contrast, the number of HIV/AIDS cases in Japan continues to increase slowly. However, the number of new HIV cases in Japan has been increasing year by year and in 2004 the total number of new HIV/AIDS cases was over 1,000 cases and the cumulative reported number of HIV/AIDS cases was more than 10,000. A research group, funded by MHLW, predicts that the number of people with HIV will be approximately 30,000 by the end of 2006 With comparison with other countries, Japan has two particular characteristics in the HIV/AIDS situation: (1) a majority of reported HIV cases is infected through male-to-male sexual conducts, and (2) very few reported HIV cases is infected through intravenous drug use (IDU). Among new HIV reported cases in 2004, 61.8% were infected through male-to-male sexual conducts. Also, among new AIDS reported cases, 36.6% were infected through male-to-male sexual conducts. Although, the proportion of those who were infected through male-to-male sexual conducts has been high since long before, the proportion became even higher after 1999. In the recent years, more than half of new HIV reported cases are infected through male-to-male sexual conducts. The primary reason for this is that HIV infection is actually increasing among gay communities and MSM (men who have sex with men) populations, and thus gay communities in Japan has been exposed to the high risk of HIV infection. The primary reason for few HIV infections through IDU is that the population of injecting drug users is comparatively small and they are isolated. Also, intravenous drug use is not mainstream among all drugs users in Japan. Furthermore, in Japan, social stigma against drug users is very strong and drug controls is also very strict, thus people with HIV may not report it, even if they were infected though drug injection. The proportion of foreign nationals who live in Japan are only 2%, but among all HIV/AIDS reported cases since 1985, the proportion of foreigners with HIV is 28.8% and the proportion of foreigners with AIDS is 24.1%. In 2004, among all HIV/AIDS reported cases, the proportion of foreigners with HIV was 13% and the proportion of foreigners with AIDS was 19.7%. Due to the recent increase of HIV/AIDS cases among Japanese nationals, the proportion of foreign nationals who have HIV/AIDS has been declined, as compared with before. However, the proportion is still high, considering the low proportion of foreigners who live in Japan. Among foreign nationals with HIV/AIDS, the majorities are South-east Asians (79%), Latin Americans are second (19%), and Sub-Saharan Africans are the third (12%). In terms of gender, Japanese men account for 89% of all cumulative HIV cases since 1985, as compared with Japanese women (11%). In contrast, foreign men account for 38% of all cumulative HIV cases, as compared with foreign women (62%). The possible reason for this difference is that the major route of HIV transmission among Japanese HIV/AIDS cases is male-to-male sexual conducts, whereas foreigners are infected with HIV primary through sexual conducts between the opposite sexes. Among reported HIV cases in Japan, the primary age groups are between the early 20s and the late 30s. Among reported AIDS case in Japan, the primary age groups are between the late 20s and the early 50s. From late 80's, there has been no big differences in the proportions of HIV/AIDS in age groups. Although more attentions tend to be paid to young age groups, no rapid increase of HIV infection has been observed among the late teenagers by 2002, according to the CAT report. 3. Conclusion As described above, HIV/AIDS cases in Japan seem to continue increasing slowly but the increase rates are becoming faster. Based on the analyses of present surveillance data, the HIV infections through male-to-male sexual conducts tend to increase in the next few years. Although Japan is now in the low level of HIV/AIDS epidemic, it is considered as shifting to "concentrated epidemic". In Japan, HIV testing system is not strong and totally lacks counseling (it is not VCT: we can call Japanese testing system as "Voluntary Testing Without Counseling") and the motivation for HIV testing is also weak. It is impossible to know the latest trend in the actual number of HIV/AIDS cases, based on the present surveillance system, which depends on only reported HIV/AIDS cases. Using the present surveillance system, it is also impossible to know which population groups and communities are at the risk of increasing HIV infections, so the urgent measures for prevention can't be issued. This is the major limitation to understand the current situation of HIV/AIDS in Japan.
released: 31st, March, 2006
This article is written by Masaki,INABA Program Coordinator on HIV/AIDS and Infectious Diseases, Africa Japan Forum
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