A new medication for treatment of the Human Immunodeficiency Virus (HIV) was placed on sale in Japan from April. But the government has been slow to approve other effective methods for dealing with HIV that have achieved favorable results in foreign countries.
To learn more about the current status of HIV/AIDS in Japan, Nikkan Gendai (June 28) met with Dr Shinichi Oka, director-general of AIDS Clinical Center at the International Medical Center of Japan in Tsukuba, Ibaraki Prefecture.
HIV carriers whose conditions go undiagnosed or untreated may eventually develop one or more of 23 afflictions, such as malignant lymphoma and others to which carriers are most vulnerable.
"What's important is to begin a regimen of treatment before AIDS develops," Oka is quoted as saying. "With the right treatment and support, people living with HIV can enjoy normal lives."
Once a drug regimen is initiated, within three to six months the volume of HIV in the blood is reduced to "untraceable" levels. Use of a condom during sex is generally considered sufficient to prevent infecting one's partner. Likewise the statistical likelihood of a pregnant female HIV carrier receiving treatment to transmit the HIV to her fetus is below 1%.
"There's no chance of the virus developing resistance," says Oka. "As in the past, missing one dosage won't result in a problem. Moreover development is progressing with new drugs that will only need to be administered by injection once a month, or every other month."
"In the case of Japan, some 30% of patient infections are diagnosed after the appearance of full-blown AIDS," Oka points out. "There are certain areas where this phenomenon occurs more common than others. Over the past decade, the situation in Japan related to AIDS has not changed, and the number of new cases reported remains the same as before."
The methodology for reducing the number of new cases is clear. The first step calls for early diagnosis of HIV and initiating a full treatment regimen. In Japan for some reason, this appears to be a high hurdle.
A free, anonymous blood test can only be conducted at public health offices, but people make various excuses for not going, such as "I can't make the time." (The offices are closed on weekends.) Or, "If people find out, I'll be in trouble." Or, "There's a chance I'll run into someone I know at the public health office." And so on.
In many foreign countries, a number of test options are available such as diagnosis by mail using a saliva test kit --- something that has yet to receive government approval in Japan.
Also available overseas is Truvada, a PrEP (an acronym for preexposure prophylaxis) prescribed to high-risk individuals. This has been strongly promoted by the World Health Organization and already approved in over 40 countries. But not Japan. If purchased out-of-pocket (without insurance coverage), a daily PrEP dosage costs about 3,800 yen; individuals who want it can purchase generic varieties online from overseas and it can enter the country legally as a "personal import." But physicians are reluctant to recommend drugs that have yet to be approved and the average person cannot easily come by useful information.
"In many African countries with a serious AIDS problem, the number of cases has been reduced by half from the peak," says Oka, who added. "In some parts of the U.S., Australia and Europe, where preventative medication is available, new cases have been drastically reduced."
Japan, meanwhile, continues to cling inflexibly to two strategies: "Get a test at the public health office" and "Use a condom." The data on new cases indicate that reliance on these is ineffective in reducing the contagion.
At the very least, Nikkan Gendai concludes, Japan should approve the simple and inexpensive saliva test and adopt the strategy of making preventative drugs available to high-risk individuals with multiple sex partners.© Japan Today