1. Trend in HIV/AIDS cases reported during 1985-2008: Cases reported in 2008 were 1,126 for HIV (1,059 males and 67 females) and 431 for AIDS (391 males and 40 females). The respective numbers for 2007 were 1,082 and 418, and the numbers for 2008 were the higher than ever (Fig. 1). In the AIDS surveillance, HIV is defined as the case that is detected by laboratory diagnosis before development of AIDS, and AIDS as the case detected by the manifest AIDS symptoms.
The cumulative number of HIV and that of AIDS (both excluding infections through the contaminated coagulation factor products) from 1985 to 2008 were 10,552 (8,590 males and 1,962 females) and 4,899 (4,307 males and 592 females), respectively. They were equivalent to the incidence of 8.259 and 3.834 per 100,000 population (calculated using population as of October 2007). The "nationwide survey of blood coagulation anomalies" conducted independently identified 1,439 HIV cases due to the contaminated coagulation factor products. That number includes 169 AIDS patients alive and 638 cases deceased (as of May 31, 2008).
Nationality and gender: HIV cases continue to increase among the males of the Japanese nationality. They numbered 999 in 2008 (931 in 2007) occupying 89% of all the HIV cases. The same tendency was observed for AIDS; there were 359 Japanese males in 2008 (343 in 2007) occupying 83% of the total AIDS. For males of non-Japanese nationality, however, the both HIV and AIDS tend to decrease. For females, HIV cases decreased among the both Japanese and non-Japanese nationalities (Fig. 2).
Infection route and age distribution: The most frequent infection route was homosexual (including bisexual) contact of males for these years. In 2008, it recorded the highest figures, 743 HIV (692 in 2007) and 182 AIDS (152 in 2007) (Fig. 3). Among this group, the 30s has been the most prominent in number and in the rate of increase, though it decreased slightly in 2008 (290 in contrast to 304 in 2007). The homosexual infections among 20s and 40s continued to increase. The increase of HIV among homosexuals in 50s was remarkable this year (49 in 2008 in contrast to 26 in 2007) (Fig. 4). As a consequence, the infection through homosexual contacts occupied 78% of all the HIV cases for population of 15-49 years and 52% for population of 50 years or older. The infection through heterosexual contacts was 14% for the former population and 28% for the latter population. For Japanese females, the common infection route is heterosexual contact.
There were additional 10 cases of HIV infection through intravenous drug abuse (6 Japanese and 4 non-Japanese) and 6 cases categorized as gothersh that include those who had chance of infection through drug abuse and sexual contacts. Infection through drug abuse is much less frequent in Japan than in other countries. There was no report of the mother-to-child infection in 2008.
Place of infection: In 2008, 91% of HIV (92% for male and 85% for female) and 76% of AIDS (76% for male and 68% for female) were presumably infected in Japan. For non-Japanese males, since 2001, infection in Japan has been more frequent than infection outside of Japan.
Reports by districts: The prefectures reporting more than 10 HIV cases were, in the decreasing order, Tokyo, Osaka, Kanagawa, Aichi, Fukuoka, Hyogo, Saitama, Chiba, Shizuoka, Kyoto, Okinawa, Hokkaido, Hiroshima, Okayama, Ibaraki, Tochigi, and Gunma. The reports from Tokyo and Osaka respectively occupied 40% and 17% of all the reports. Among the regional blocks of prefectures, the Kanto/Koshin-etsu block that includes Tokyo reported 54%, and the Kinki block that includes Osaka reported 22% of all the reports. The number of reports increased from 2007 to 2008 in all the blocks except Hokkaido/Tohoku and Tokai blocks.
2. HIV-antibody-positive rates among blood donors: In 2008, there were 107 HIV-positives in 5,077,238 blood donations (104 males and 3 females), corresponding to 2.107 positives (3.065 for males and 0.178 for females) per 100,000 donations. This rate was higher than ever (2.065 in 2007) (Fig. 5).
3. HIV antibody tests and consultation provided by the local governments: The local governments are providing HIV antibody tests at health centers and at other facilities. They are increasingly utilized. Total number of HIV tests carried out by the local governments in 2008 was 177,156 (in contrast to 153,816 in 2007) (Fig. 6). The health center covered 146,880 tests, and the other facilities 30,276. The HIV antibody positive rate was 0.28% (501/153,816) as a whole. When looked at it by the facilities, the positive rate tended to be higher for the other facilities (0.64%, 194/ 30,276) than for the health centers (0.21%, 307/146,880). This difference is probably due to easier access to the other facilities. The number of counseling provided by the local governments increased from 214,347 in 2007 to 230,091 in 2008 (Fig. 6).
4. Drug sensitivities and subtypes of HIV: The frequency of the drug-resistant HIV carriers among those going to receive the chemotherapy for the first time is still low in Japan in comparison with Europe and North America. However, the tendency is towards the higher frequencies because it was 4.0% in 2003-2004, 7.8% in 2005, 6.6% in 2006 and 9.7% in 2007 (see p. 232 of this issue). As for prevalent HIV subtypes in Japan, there are three groups, subtype B transmitted among Japanese homosexuals, CRF01_AE transmitted through heterosexual contact among Japanese, and non-B subtype transmitted through heterosexual contact among non-Japanese (see p. 234 of this issue). HIV-2 infection that presumably occurred in Japan has been reported (see p. 235 of this issue).
Conclusion: The numbers of HIV and AIDS reported in 2008 were higher than ever, and the HIV-positives among the blood donors too. HIV transmission mainly through the homosexual contact is increasing continuously among all the age groups of the Japanese males (see p. 231 of this issue).
It is considered that the activities of the local governments during the World AIDS Day in December and the HIV Week for Promotion of HIV Testing in June (started in 2006) have greatly contributed to the increased number of HIV testing and counseling throughout the year. Nevertheless, the local and national governments are further requested to strengthen the public education on AIDS prevention and to promote HIV testing for earliest possible detection necessary for appropriate clinical intervention. They should consider possible collaboration with necessary partners, such as, educational and/or medical staff, companies, and NGOs while taking into account the target populations, such as, younger generations, foreigners, homosexuals, sexual workers and their clients, males whose behaviors are conductive to HIV infection, etc.