Japan Alarmed by Surging Rates of AIDS and HIV

A rapid spread of AIDS over the past decade has reached a level that has confounded and alarmed the health establishment in Japan, a country that has long felt protected by a first-rate health system and widespread condom use.

Infections that had stayed at infinitesimal levels are surging at rates similar to developing countries, and some experts say the real number of Japanese with HIV or AIDS is two to four times the official toll.

Many also fear that a silent AIDS epidemic is brewing among the nation’s sexually active middle and high schoolers. Other sexually transmitted diseases -- chlamydia, genital herpes, gonorrhea and the human papillomavirus, or HPV -- are also on the rise.

“Japan is on the brink of going under,” said Dr. Tsuneo Akaeda, a gynecologist who raises AIDS awareness by offering free 15-minute blood tests in Tokyo’s nightclubs and streets. “They’re ignoring that they have diseases; they’re ignoring that they are sick.”

The official toll of 10,070 HIV/AIDS sufferers in a nation of 127 million people pales next to some countries. Even if the actual figure is closer to 40,000, that would mean that roughly 1 in 3,000 are infected, compared to about 1 in 100 in Thailand or 1 in 1,500 in China, according to estimates by UNAIDS, the United Nations agency waging the global war on AIDS.

But many in Japan are alarmed at the dangerous mixture of chronic underreporting of cases, a sexually freewheeling youth culture that’s less inclined to use condoms or other protection, and the powerful social stigma of a sexually transmitted disease.

Satoshi Kimura, head of the AIDS Clinical Center at Tokyo’s International Medical Center, estimates that between 20,000 and 30,000 people in Japan don’t know they have the virus.

In 2004, a record 1,165 people were reported newly infected, up 14% from the previous year -- the same percentage growth rate as in AIDS-hit areas such as Sub-Saharan Africa, according to UNAIDS figures.

The total number of cases is thought to be doubling every four years and could reach at least 50,000 by 2010, the Japan Center for International Exchange said in a 2004 report.

The virus appears to be spreading the fastest among males under 35. Transmission between gay men accounts for the majority of cases, but the health ministry’s 2004 annual AIDS report notes that infections among heterosexual and homosexual men are increasing at about the same rate.

Among women, Sato is one of the careful ones. The 23-year-old Tokyoite has unprotected sex with multiple partners, but at least she occasionally gets herself tested for HIV.

“I know about the risks of disease, but usually the guys I’m with refuse to use a condom -- so we just end up having sex without one,” said Sato, who would give only her last name as she waited for her blood to be drawn at a health center.

The risky behavior also extends far beyond youth: Older men often consort with part-time prostitutes of high-school age; businessmen go abroad on “sex tours” thinly disguised as company trips, and the country’s enormous sex industry offers services condom-free for higher prices.

After Japan’s official toll of HIV/AIDS cases broke the 10,000 mark in April, Health Minister Hidehisa Otsuji said, “This is worrisome, and I realize the gravity of the situation.

“Some kind of measures must be taken, as we cannot leave things as they are, and I would like to think of something quickly,” he said, underlining concerns that the fight lacks leadership at the national level.

The history of AIDS in Japan has played a role in worsening the problem.

Japanese became seriously aware of the AIDS threat in the 1990s over a tainted-blood scandal, in which about 2,000 patients, mostly hemophiliacs, contracted HIV.

The tragedy brought a basic understanding of AIDS and established world-class medical treatment. But many say it also sowed complacency and misconceptions -- chiefly that ordinary Japanese don’t get AIDS through sex.

“The average person just doesn’t seem to be able to grasp the immediacy of the threat,” said Tokyo city health official Shizuko Tominaga. “AIDS is perceived as someone else’s problem” -- hemophiliacs, gays, foreigners.

Inadequate AIDS education leaves many Japanese unaware of multidrug cocktails effective against the disease -- meaning that those who fear they are infected choose to suffer in silence rather than seek help.

In Tokyo, even as new infections are being reported at a rate of more than one per day, the AIDS budget has fallen by two-thirds, to 213 million yen ($2 million) in fiscal 2005. The capital also suffers from problems common nationwide: a shortage of testing centers and sex education in schools that critics say tiptoes around the specifics.

“The nature of the problem has changed, and sexual transmission is an urgent issue,” said Tokyo city health official Mami Iida. “Our policies need to be changed to address that.”