On Monday, the Japan Anti-Tuberculosis Association warned that about 70 Japanese per year acquire extensively drug-resistant TB (XDR-TB). Unlike multidrug-resistant TB (MDR-TB), which is resistant to two first-line drugs, XDR-TB is additionally resistant to at least three of the six main classes of second-line TB drugs. A recent global surveillance report put XDR-TB at 2 percent of all TB cases. Little was previously known about the prevalence in Japan.

Only half of Tokyo residents targeted by a government campaign to promote hepatitis C virus (HCV) screening have actually received the test, a recent city government survey showed. Since the beginning of fiscal 2007, the metropolitan government has tried to make screening easier by offering subsidized treatment and more frequent testing opportunities.
In 2002, the Health, Labor and Welfare Ministry initiated a system whereby cities could offer residents subsidized checkups, including HCV screening. The plan targets those who do not receive routine workplace medical examinations, including self-employed people and housewives in their 40s to 70s. The campaign hoped to reach the populations within five years. But just 830,000 of 2 million residents who potentially need HCV screening have been tested, the city reported.
In fiscal 2005, just 25.1 percent of employees at small- to mid-sized firms underwent the voluntary medical exams provided by the public insurance system, which covers HCV screening.
Previously, the tests have been accessible only through health centers and only on weekdays. Now, to help revitalize the campaign, Tokyo will offer hospital-based screening and make testing available at night and on holidays. Tokyo also hopes to have local government officials spread awareness about the HCV campaign to residents over age 40.
The average cost of HCV treatment is about ¥3 million ($26,000 US) annually, even with insurance coverage. The metropolitan government plans to subsidize half the cost. The budget for the campaign is about ¥1 billion ($8.5 million), say municipal officials.

"Kids must be told repeatedly about how to protect themselves from HIV/AIDS," said Chizuko Ikegami, executive director of PLACE Tokyo, a community-based organization supporting HIV/AIDS patients. "But currently there isn't sufficient education or backup from the government."
According to Japan's Health, Labor and Welfare Ministry, 1,199 new cases of HIV/AIDS were reported in 2005. The number of people testing positive for HIV between March 27 and July 2, 2006, was 248. Both figures constitute a record high for Japan, the only industrialized country where HIV infections are growing steadily.
In Tokyo, 309 of last year's 417 reported cases were contracted through sexual contact. Seventy-two percent of the people testing positive for HIV in Tokyo were in their 20s and 30s. Six percent were under 20, according to the city's Bureau of Social Welfare and Public Health.
Ikegami said 10 to 20 new clients contact her office each month to access information on living with HIV/AIDS. Most are in their 20s to 50s, and 90 percent are males.
Ikegami blamed government HIV/AIDS spending cuts as a major reason for the crisis, along with the lack of proper sex education in schools.
Condom makers fear the Japanese have begun to prefer unprotected sex. Toshiaki Ishii, director of the condom manufacturers' association Nihon Condom Kogyokai, said the number of condoms produced in Japan peaked in 1997 at 1.23 billion packs. In 2004, output had dropped to 677 million, a nearly 50 percent decrease.
Yorimasa Nagai of the Japanese Foundation for AIDS Prevention said education is essential to preventing the spread of HIV. Although about 12,000 people in Japan have HIV/AIDS, Nagai said, most people consider it a minor problem because they have not had contact with patients.
"There's no way that HIV/AIDS prevention can be taught without proper sex education and promoting prevention," Nagai said. "Enlightenment through campaigning is important, but adequate education in schools, communities, and workplaces is vital as well."

Japan's Health Ministry recently announced an increase in new HIV infections that may indicate the infection rate is accelerating. In the three-month period from April to June of this year, 248 cases were diagnosed. This was the largest number since July-September in 2004, when 209 infections were reported, according to ministry official Yasuaki Hashimoto.
A ministry statement did not specify a cause for the increase but said the wider availability of HIV testing might account for the marked increase in infections among middle-aged Japanese.
Japan has 17,000 HIV/AIDS patients, a low number compared to many other countries. According to UNAIDS, Japan's infection rate is 1 in 7,529, far lower than the 1 in 110 rate in Thailand. However, the rate at which HIV has spread in Japan in the past 10 years mirrors that of developing countries. Japanese tend to have low HIV awareness and to view it as a foreign problem. "We are greatly concerned about the trend," said Hashimoto.
According to the ministry's AIDS Surveillance Committee, two-thirds of newly infected patients are in their 20s and 30s, but infections among older people are also increasing. The ratio of those newly infected in their 40s and 50s rose to 31 percent in April-June, up from 22 percent in the previous quarter, said the committee's statement. Hashimoto said the increase could be due to June's weeklong awareness campaigns that featured extended clinic hours so that older people, often in managerial positions, could be tested.
Reported cases of HIV, which have been rising since 2002, hit a record high of 832 cases in 2005. The number of reported AIDS cases decreased in 2005 after a two-year increase. Experts argue that cases in Japan are severely underreported, estimating the number to be two to four times the official toll.

On Friday, CDC published an analysis of the successes and failures in preventing and treating HIV/AIDS in the United States over the past 25 years.
Since it was first described in the Morbidity and Mortality Weekly Report published June 5, 1981, AIDS has "become one of the greatest public challenges both nationally and globally," having claimed the lives of at least 22 million people worldwide and more than 500,000 in the United States, CDC epidemiologists said. And though combination drug therapies that became widely available in the 1990s now allow patients to live longer, "HIV/AIDS remains a potentially deadly chronic disease," said the authors.
Though the first US diagnoses of AIDS occurred in young white gay men, the disease has since spread to take a heavy toll on minorities and women. While comprising just 13 percent of the US population, blacks accounted for more than half of new HIV diagnoses, according to federal data.
In 1987, heterosexual transmission accounted for about 6 percent of AIDS cases. Now, 30 percent of HIV/AIDS diagnoses are among heterosexuals. Women are especially vulnerable to HIV during sexual intercourse; in 2002, HIV infection was the leading cause of death for African-American women ages 25-34, CDC said.
CDC spokesperson Karen Hunter said the agency's "biggest success to date" is the reduction in mother-to-child HIV transmission. In the epidemic's early years, about 30 percent of babies born to HIV-positive women became infected. That figure is now less than 2 percent.
However, efforts to address HIV transmission among men who have sex with men have been less successful. "Men who have sex with other men account for approximately 45 percent of newly reported HIV/AIDS diagnoses, and nearly 54 percent of cumulative AIDS diagnoses," the report said.
The analysis, "Twenty-Five Years of HIV/AIDS - United States, 1981-2006," was published in the Morbidity and Mortality Weekly Report (2006;55(21):585-589).

In Japan, TB experts and social workers are targeting the elderly, especially the homeless, in an effort to fight TB among the most vulnerable.
National data show more than 60 percent of new TB infections reported are among those age 60 or older. And in 2004, some 20 percent of homeless, whose ranks have grown during recent tough economic times, had TB, and they experienced a high mortality rate. Annually, Japan records 30,000 new infections and more than 2,300 deaths from the disease. Last year, there were 72,079 TB patients in the country, the highest number for an industrialized country.
The great majority of these patients caught TB in the 1950s, while Japan's economy and health services were poor. Weakened immune systems due to aging, inadequate nutrition, disease, and stress are responsible for the TB cases.
"The homeless in Japan, mostly elderly people who live alone, are particularly vulnerable to being infected with TB," said Suzuko Yasue, a social worker who takes medicine to Tokyo's homeless, an approach known as directly observed therapy short-course (DOTS). Many homeless people are day laborers and want to avoid long hospital stays, she said, so people like her encourage these patients to adhere to therapy and have their health assessed.
"Community support for high-risk people such as the homeless, who do not go to hospitals on their own, has been effective," said Nobutaka Ishikawa, a director at the Research Institute of Tuberculosis (RIT). "Economic disparity has encouraged the spread of new infections among the disadvantaged such as the homeless community," said Ikushi Onazaki, deputy director at RIT. "As well, with increasing HIV rates among the young, we fear that TB will become a national issue again."

For the second consecutive year, new HIV cases and new AIDS diagnoses in Japan topped 1,000, totaling 1,124 in 2005, according to a preliminary report from the health ministry. New HIV cases hit a record of 778 in 2005, compared with 748 in 2004. New AIDS cases numbered 346, down from 366. The number of people being tested for HIV hit a 10-year high at 100,287. From October through December 2005, 195 new HIV cases and 89 new AIDS cases were recorded, according to the preliminary data.