Web of Life

For the last five years, gynecologist Tsuneo Akaeda has been venturing into the heart of Tokyo’s clubland to raise the alarm over the spread of AIDS. In Japan, a predicament he warns "is soon going to explode". The 60-year-old director of the Akaeda Roppongi Clinic gives out free advice to young people at a bar in Tokyo’s pulsating nightlife district of Roppongi. Since 1999, he’s seen over 2,000 of them.

"Japanese people think that AIDS isn’t real, they have no awareness and don’t feel directly affected," Akaeda, 60, tells AFP. "Young people think it’s cool to have sex without a condom." Japan is the only developed nation in which AIDS is on the increase, and health campaigners like Akaeda are determined to tackle the problem. The tally in 2003 set a record since the first case was tracked in 1985. The government counted 336 new cases of AIDS, of which 67.6 percent were caused by sexual contact. But only 640 were found to be infected by HIV, the virus that causes the condition, far lower than expected. "The HIV cases should number about 10 times the AIDS cases, but only 640 have been counted. So where are the other infected people?" Akaeda asks.

The answer is clear, according to Masanori Suzuki, chief of the AIDS Health Care Section at the Health Ministry: "There are probably more cases than the number that have been proven and verified."

Wataru Sugiura, head of the Laboratory of Therapeutic Research and Clinical Science at the national AIDS Research Center, estimates that there were "three or four times the number of HIV/AIDS cases than statistics show," adding that the number of total cases has tripled in the last 10 years. Excluding those infected by tainted blood transfusions, there were 2,892 AIDS patients reported in Japan at the end of 2003 while the HIV cases came to 5,780. "Japanese people don’t get themselves tested. For young people, free testing conflicts with their schedules," Dr Akaeda argues.

Home-delivery prostitution, known as "delivery health", has become a major new factor in the spread of the syndrome, along with the existing problem of sex tourism abroad, the doctor says. The many Japanese who do not use condoms have also multiplied the risks of transmission, he adds. Condoms are more often associated with contraception than disease prevention in Japan, agrees the health ministry’s Suzuki, warning that "sales of condoms are on the decline."

Akaeda says there are a lot of young people who are unaware they are HIV positive, since symptoms can remain dormant for a decade. Japanese HIV cases in Japan were concentrated among people aged 20 to 34 years old last year, government data showed. "The young people I see drink and smoke a lot and have very fragile health," he says. "I think that in the next five or six years, there will be a surge in the number of new cases." But he complains the government "had no will at all" to fight a condition it does not consider serious.

"The government has a budget to fight AIDS, but it is happy just to edit brochures," says Akaeda. He continues to wage his own battle. Sitting at a table with flyers in front of him, he is visited both by young people with HIV/AIDS who ask him how to live a normal life, and by others who are not infected but who want to know about to stay safe. Akaeda also has a radio show called ‘Girls Guard’ which has raised his own profile, and he makes occasional ‘drop-ins’ on other bars in Roppongi. He is urging more sex education in schools because young people do not receive information from anywhere else about the condition. Teachers in Japanese schools who discuss sex with pupils risk getting complaints from parents, who fear that talking about it will only get their children more interested. Sugiura adds that discussion of AIDS is no longer taboo but it remains a touchy subject to talk about.

"It’s a problem that people don’t want to hear about," Sugiura says, adding that the government should launch an educational campaign. "I have never seen an advertisement about it on television." "The number of new cases are definitely going to increase in the next four or five years," Sugiura says. The health ministry said that its testing centers are open on weekends and it is has increased the number of free tests it offers, but Akaeda says: "It’s already too late." (AFP)