The Topic of This Month Vol. 32, No. 10 (No. 380)

HIV/AIDS in Japan, 2010
(IASR 32: 282-283, October 2011)

HIV/AIDS surveillance in Japan started in 1984.   It has been carried out in compliance with the AIDS Prevention Law from 1989 to March 1999 and then in compliance with the Law Concerning the Prevention of Infectious Diseases and Medical Care for Patients of Infections since April 1999, which obliges notification of all the cases diagnosed by doctors (criteria of reporting is found in http://www.mhlw.go.jp/bunya/kenkou/kekkaku-kansenshou11/01.html).   The data presented below are derived from the final version (March 18, 2011) of the 2010 annual report of the National AIDS Surveillance Committee released by the Specific Disease Control Division, the Ministry of Health, Labour and Welfare (MHLW) (http://api-net.jfap.or.jp/status/2010/10nenpo/nenpo_menu.htm).   Here, 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.

1. Trend in HIV/AIDS cases reported during 1985-2010: The number of reported HIV cases in 2010 was 1,075 (1,015 males and 60 females), which was the third highest since the start of the surveillance, and the number for AIDS was 469 (450 males and 19 females), which was the highest since the start of the surveillance (Fig. 1).   Cumulative number (excluding infections through coagulants) of HIV since 1985 to 2010 was 12,648 (10,570 males and 2,078 females) and that of AIDS was 5,799 (5,164 males and 635 females), which were equivalent to 9.877 and 4.528 per 100,000 population, respectively.   Total number of deceased cases voluntarily reported to Specific Disease Control Division, MHLW in 2010 was eleven (ten Japanese males and one non-Japanese male).   In addition, the independently conducted "nationwide survey of blood coagulation anomalies" has identified 1,439 coagulation factor products-related HIV cases, which includes 168 AIDS patients alive and 659 cases deceased (as of May 31, 2010).

Nationality and gender: Among 1,075 HIV and 469 AIDS cases reported in 2010, 956 (89%) and 421 (90%), respectively, were Japanese males.   These figures were higher than the corresponding figures in 2009, which were 894 and 386 (Fig. 2).   The number of HIV among Japanese females, non-Japanese males and non-Japanese females were 41, 59 and 19, respectively.   The corresponding figures for AIDS were 15, 29 and 4, respectively.

Infection route and age distribution: Among HIV and AIDS Japanese males, infection through homosexual (including bisexual) contact was the most frequent (Fig. 3).   In 2010, 75% of Japanese male HIV (713/956) and 53% of Japanese male AIDS (224/421) were infected through this route.   As for age distribution among this group, HIV was dominant among those in their thirties followed by those in twenties (281 and 236, respectively) (Reference figure) and AIDS among those in their thirties and forties (91 and 59, respectively).

Majority of Japanese female HIV and AIDS cases acquired infection through heterosexual contact.   Drug abuse was implicated in total seven cases (HIV and AIDS altogether): four were Japanese and three were non-Japanese.   There were additional twelve cases that may have had equal chance of infection through drug abuse and sexual contact (10 Japanese and 2 non-Japanese).   Though mother-to-child infection was absent in 2007-2009, three cases were reported in 2010.

Place of infection: For Japanese, in 2010, 88% of HIV (89% for male and 71% for female) and 79% of AIDS (80% for male and 73% for female) were presumably infected in Japan.   For non-Japanese males, 33 in 59 cases (56%) were infected in Japan and 7 outside Japan; for remaining 19, place of infection is obscure.

Reports by districts: In 2010, both for HIV and for AIDS, Tokyo, Osaka and Aichi were the top three (Table 1).   While the number of reports from the regions where these prefectures locate dominates, number of reports from other regions in further West part of Japan is increasing.

2. HIV-antibody-positive rates among blood donors: In 2010, there were 86 HIV-positives among 5,318,586 blood donations (83 males and 3 females), which is equivalent to 1.617 positives (2.298 for males and 0.176 for females) per 100,000 blood donations.   The HIV positive rate among blood donors has on decline in the past successive two years (Fig. 4).   The HIV positive rate among persons who experienced the first blood donation is high (5-6 per 100,000 blood donations) (see p. 290 of this issue).

3. HIV antibody tests and consultation provided by the local governments:Total number of HIV tests carried out by the local governments (provided at health centers and other facilities) has been decreasing and in 2010 it was 130,930 (150,252 in 2009) (Fig. 5); in 2010, there were 473 HIV positives or 0.36% of the tested samples (in contrast to 0.29% in 2009).   While the HIV positive rate among samples tested in health centers was 0.27% (277/103,007), the positive rate among samples from facilities other than the health centers was much higher and was 0.70% (196/27,923), indicating that the latter facilities are more accessible to the risk groups.   The number of counseling provided by the local governments decreased from 193,271 in 2009 to 164,264 in 2010.

Conclusion: Both HIV and AIDS are increasing in Japan.   To stop this trend, prevention, early detection of HIV infection and early treatment of AIDS are of the prime importance (see p. 292 of this issue).   The local governments are requested to strengthen the public education on AIDS prevention and to promote HIV testing taking the local specific factors into account.   HIV testing and medical and other consultations that they provide should be accessible to socially active age groups (20fs-40fs) and risk groups (male homosexuals, young adults, sexual workers and their clients, etc.).   They are advised to consider possible collaboration with appropriate partners, such as, educational and/or medical staff, private companies, and suitable NGOs.

In 2010, after an interval of three years, three infants with HIV infection were reported.   The local governments and medical staff should prevent mother-to-child infection by appropriate measures, such as, HIV screening of pregnant women (supported by the public expense since April 2010), the appropriate management of HIV/AIDS cases pregnancy and delivery and prophylactic administration of anti-HIV drug to newborns delivered from HIV-positive mothers.

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