In Kobe, Japan, at the recent 7th International Congress on AIDS in Asia and the Pacific, officials said that discrimination against men who have sex with men (MSM) in the region is increasing their vulnerability to HIV.
Steve Wignall of Family Health International said that while there is a dearth of accurate statistics on the issue, some surveys have found that the rate of HIV infections among MSM was nearly 20 percent in Thailand, 14 percent in Cambodia, and 8 percent in Vietnam. Reaching this population is difficult due to social stigma and also because it includes men who sell sex to other men but do self-identify as gay or bisexual.
Most Asian HIV-prevention programs focus on heterosexuals, such as female sex workers. It is time for governments to begin education and treatment programs targeting MSM, Wignall said, and to distribute condoms in the MSM community.
Yet many challenges confront such an effort. The government of Vietnam does not formally recognize that MSM communities exist and depicts homosexuality as a "social evil," said Le Cao Dung of the Ho Chi Minh City provincial AIDS committee. Similar problems exist in China, while civil strife in Nepal puts public health workers at risk.
In Japan, MSM account for the majority of the nation's 12,000 HIV cases, but MSM and lesbians are largely ignored and find speaking out difficult, said Hiromi Hatogai of the Japanese outreach group OCCUR.

The number of women infected with HIV in Asia has risen 20 percent since 2003 to 2.3 million, compared with a 17 percent increase for the region's total population, UNAIDS said at the recent 7th International Congress on AIDS in Asia and the Pacific. In India, 2 million of the country's 5.1 million HIV/AIDS cases are female, said Periasamy Kousalya, head of the Positive Women Network, an activist group of about 5,000 HIV-infected Indian women.
Experts at the conference, held in Kobe, Japan, said the status of women in Asia's male-dominated culture makes them especially vulnerable to HIV. "Economically, culturally, socially, women are disadvantaged," said Kousalya. "They lack access to support systems for HIV."
Frika Chia Iskandar, an Indonesian representative of the Seven Sisters nonprofit for people living with HIV/AIDS, reported that she has occasionally been denied medical care because of her HIV-positive status. Iskandar said she feared further stigmatization at home because of her outspokenness about the disease abroad. "I am the new face of HIV in Asia," she said.
In Japan, HIV discrimination is more subtle, said an HIV-positive women who would only identify herself as "Nancy." "Social welfare is available for Japanese patients with HIV. But I live deep in the countryside, and if I apply for benefits, everybody in the community will know about my infection."
"Japan has good treatments available, good welfare systems," said Nancy. "But those systems are made by someone at the government, without inputs from people with HIV. We want to make our voices heard so that our thoughts and requests will be reflected in decisions of policymakers."

Though TB cases are declining in Japan, a surge in the number of HIV infections could lead to a rapid rise in dual TB-AIDS cases among vulnerable groups, doctors warned Monday at the 7th International Congress on AIDS in Asia and the Pacific in Kobe, Japan.
About 30,000 new TB cases annually are reported in Japan, but many more could go undetected among at-risk groups - the poor, the homeless, low-income immigrants, and youths - who are unable or unwilling to seek medical help, said Dr. Nobukatsu Ishikawa of the Research Institute of Tuberculosis in Kiyose, Japan.
No data are available for the number of people TB-HIV co-infected in Japan. However, HIV-positive people are 50 times more likely to develop TB. Worldwide, one-third of those with HIV, or 14 million, are co-infected with TB. Dr. Takashi Sawada, chairperson of the congress, said as many as 40 percent of the foreign HIV patients he treats are co-infected with TB. "Within an overall decrease, pockets of crises are emerging," said Ishikawa.
"When an ordinary person becomes infected with TB, they can usually be cured," said Ishikawa. "But if inappropriate treatment is administered [to someone also infected with HIV], it can result in multiple drug resistance, which in the worst case can be more frightening than AIDS," he said.
The TB threat in Japan has gone unnoticed, said Sawada and Ishikawa. TB funding is decreasing, and new health care changes could remove coverage for TB treatment from those likeliest to have the disease, said Sawada.

AIDS stigma in Japan threatens the ability of patients to access treatment, activists said Wednesday. "In Asia, many people cannot gain access to AIDS treatment due to poverty, but in Japan, many people cannot access treatment because of the strong stigma," AIDS activist Hiroshi Hasegawa told a news conference.
In 2004, Japan reported 1,165 new HIV/AIDS cases, the highest annual figure yet and more than a tenth of all reported cases since 1985. Experts warn that cumulative numbers could reach 50,000 by 2010 due to less condom use and increased sexual activity among teens. Health Ministry data show that nearly half of all 17 year-old girls have had sex, up from about 17 percent in 1990. For boys, the figure is 40 percent, almost twice as high as the 1990 figure.
Hasegawa, who went public with his HIV-positive status in 1996, is among few people in Japan who admit to having the disease for fear of being forced out of their jobs or losing friends. Such fears prevent many from being tested.
The activist said official indifference to the disease is part of the problem. "In Japan, AIDS policy is handled by one bureau in the Health Ministry," said Hasegawa. "But in many other places, it becomes a national campaign, taken up by the nation's top leaders."
Hasegawa noted that HIV/AIDS stigma is partly due to an aversion to frankly discussing sex in either homes or schools. "When we teach children about the danger of car accidents," he said, "we don't do it without actually showing them cars. With AIDS, we also have to think of policies that are quite concrete."

In an era of increasing rates of teen sex and STDs, Japan's Health Ministry is treading a fine line between proponents of comprehensive sex education and abstinence-only education. Almost half of all Japanese girls age 17 have had sex, up from 17 percent in 1990, according to ministry data. For boys, 40 percent have had sex, nearly double 1990 rate.
Though erotic comics and pornography are prevalent in Japan, concrete sex education is not. In most primary schools, sex education is part of the basic health curricula, while middle and high school students receive sketchy contraception information. Annual abortions among women under age 20 have increased to 40,000, compared to 19,000 in 1980. And chlamydia diagnoses have increased from 3,639 in 1999 to 6,163 in 2003, Health Ministry figures show.
"Many schools teach the names of sexually transmitted diseases, but kids think the only people who get these are middle-aged men," said Masako Kihara, an associate professor at Kyoto University. "Or they think it only happens in cities."
Many Japanese teens have a high partner turnover but consider themselves safe because the relations are not concurrent. "We need to teach that there's a real risk to them," said Kihara. "If you make it specific enough, they'll finally understand. Things like saying that you are basically having sex with everyone your partner's had sex with for the last few years."
Girls should learn that they "can become mothers and their bodies are sacred, their bodies aren't theirs alone," said Eriko Yamatani, a ruling party lawmaker who says explicit sex education is partly behind the rise in teen sex. "So, as a result, it's desirable to have abstinence until marriage. This message has to be thoroughly taught."

With a first-rate health system and widespread condom use, Japanese had long felt protected from AIDS, a disease many still associate with gays, foreigners, and hemophiliacs. If Japan had, as some experts say, nearly four times the official 10,070 HIV infections, that would equal roughly 1 infection in every 3,000 people. That compares to about 1 infection for every 100 Thais, or 1 in every 1,500 Chinese, according to UNAIDS estimates.
Nonetheless, in 2004 there were a record 1,165 new infections in Japan, a 14 percent jump comparable to increases in sub-Saharan Africa, by UNAIDS estimates. Japan's cumulative number of HIV infections is believed to double every four years and could reach 50,000 by 2010, said a 2004 report by the Japan Center for International Exchange.
While HIV is spreading quickest among males under 35, and homosexual transmissions comprise the majority, the Health Ministry's 2004 annual report noted that infections are occurring at roughly the same rate among heterosexuals and homosexuals.
The ministry is hoping to develop countermeasures soon, said Health Minister Hidehisa Otsuji. Satoshi Kimuri, head of the AIDS Clinical Center at Tokyo's International Medical Center, estimates that 20,000-30,000 Japanese do not know they have HIV.
"The average person just doesn't seem to be able to grasp the immediacy of the threat," said Shizuko Tominaga, a health official for Tokyo, where, despite reporting one new infection a day, the AIDS budget has been cut by two-thirds, to $2 million this year.
"The nature of the problem has changed, and sexual transmission is an urgent issue," said Tokyo city health official Mami Iida.

There were 1,114 new HIV infections in Japan in 2004, exceeding 1,000 new annual infections for the first time, according to Japanese Health Ministry figures released earlier this month. There were 640 new infections recorded for 2003. Japan now has a cumulative 6,528 people with HIV, 3,258 of whom have AIDS, though UNAIDS estimates the actual number of people infected could be 12,000-19,000.
Yoshiaki Sakurai, medical advisor at the governmental Japanese Foundation for AIDS Prevention, acknowledged the increasing infection rate among Japanese in their 20s and 30s and AIDS among those in their 40s and 50s. "This is a sign of a serious situation brewing in Japan," he said. "Full-blown AIDS usually appears after an HIV incubation period of ten years. The latest figures clearly show this cycle and prove how people are not aware of the risks of being infected."
Of Japan's HIV infections, 80 percent were through sexual contact, said Sakurai. There is now fear that Japanese youths could be unaware that HIV is spread through sexual intercourse or be unwilling to test for the virus.
Tsuneo Akaeda, a medical doctor who works on HIV/AIDS projects targeting youths, blamed the figures on the lack of government support for prevention programs, and he criticized public health care center HIV testing - available twice monthly, only in the morning - as not user-friendly.
Recent studies have also found earlier sexual debut among many high-school youths. "Despite earnest appeals by activists to the government for the young to have better sex education, we have to tread carefully," said Hideko Fujimori, head of the HIV/AIDS youth education group Act Against AIDS. "Many conservative parents and older teachers argue that displaying condoms and other contraceptives in class could promote early sexual activity."

Today, Japanese officials said the annual number of new HIV/AIDS cases topped 1,000 for the first time in 2004. They voiced concern that lack of awareness may have led to the virus's spread.
A health ministry survey showed that new HIV infections, while still low by global standards, increased by 17 percent to 748 in 2004 - the highest figure Japan has registered. The number of HIV-positive patients who developed AIDS in 2004 also reached a record high of 366, an 8.9 percent increase from 2003.
The new infections bring Japan's number of HIV-positive patients to 6,528, of whom 3,258 have AIDS. However, health ministry official Masanori Suzuki said the government estimates the true figure of HIV-positive to be 14,000. Many people have not been tested.
"We must launch more aggressive and vigorous campaigns to make people aware of AIDS issues," Suzuki said of the 2004 figures, noting that early detection is key. Japan offers free, anonymous HIV testing at public health-care centers.
Men accounted for 90 percent of the 748 new HIV patients. More than 60 percent, according to the survey, were infected through gay sex.
Activists warn that the relatively low rate of HIV in the country has left the Japanese indifferent to condom use and other preventive measures, making the nation vulnerable to a sudden spike in HIV infections. Health ministry data show domestic sales of condoms sunk 43 percent, to 419 million in 2003, from a 1980 high of 737 million.

A Health, Labor, and Welfare Ministry survey released recently said HIV tests outside business hours and tests with same-day results are not available in more than one-third of the 127 metropolitan, prefectural, and municipal governments that provide free HIV tests at public health centers. Following the survey, the ministry told local governments to improve HIV testing services to make them easier to access.
In 1993, with infections surging, public health centers began offering free, anonymous HIV tests. All 23 Tokyo wards, and metropolitan, prefectural, and municipal governments with populations exceeding 300,000, offer the tests. At first, testing was only available during business hours, and results took one to two weeks. Gradually, governments began offering testing after office hours or on weekends and national holidays. When certain local governments began offering rapid testing last year, the number of people seeking HIV tests skyrocketed.
The ministry survey showed that 14 prefectural and municipal governments have introduced the rapid test, with 15 other local governments planning to follow suit next fiscal year. Sixty-three local governments offer testing in the evenings, according to the survey, and 27 offer tests on weekends and national holidays.
However, the survey revealed, 43 prefectural and municipal governments provide neither the rapid test nor extended testing hours, exposing significant differences in HIV testing services among local governments.
"We understand the difficulties each local government has, but growth in the number of people infected with HIV is becoming very serious," said a ministry official. "It's very important for each local government to prepare a service that makes it easier to have an HIV test anywhere in the country, so that as many people as possible get tested."