Japan is an affluent country with an industrious workforce and is one of the world’s largest consumer markets. However, with a 15.4% poverty rate, poverty does exist in the East Asian country. In addition to poverty, HIV/AIDS in Japan is a major concern. Specifically, a significant portion of HIV cases still goes undetected until they progress to AIDS. Japan is working with the United Nations Programme on HIV/AIDS (UNAIDS) to rectify that and to improve HIV/AIDS treatments.

Background on HIV/AIDS

Human immunodeficiency virus (HIV) attacks and weakens the body’s immune system by destroying CD4 cells, which leads to a higher risk of contracting other infections, viruses and diseases, such as tuberculosis and specific cancers. In 2021, 38.4 million people around the world were living with HIV, but only 75% had access to treatment therapy. Of those who were tested in 2021, 15% were unaware of having HIV or symptoms. A key problem in Japan is that the number of people unaware of their HIV status is at least double that rate.

Symptoms of HIV may not be noticeable within the first few months and could be mistaken for influenza. However, as the symptoms progress to having possibly swollen lymph nodes, weight loss, diarrhea, fever or cough, people should take a test to determine the diagnosis. HIV spreads through unprotected intercourse, the sharing of needles and blood transfusions, all due to the sharing of specific bodily fluids.

By using protection during intercourse and not sharing needles, people can prevent HIV spread. If infected people take antiretroviral treatment (ART), they can keep their viral load low and prevent transmitting HIV to others. If they do not use ART, their viral load will rise and HIV progresses to (Acquired Immunodeficiency Syndrome) AIDS. People with AIDS have extremely low immunity and are vulnerable to life-threatening infections. Mothers can take ART to prevent mother-to-child transmission through pregnancy, delivery and breastfeeding.

The State of HIV/AIDS in Japan

The annual number of new cases of  HIV/AIDS in Japan remained relatively flat or slightly declining from 2006 to 2019 at about 1300 cases. Still, HIV/AIDS in Japan is a concern because from 1985 to 2019, physicians diagnosed 19,216 men and 2,523 women with HIV. During the same period, physicians diagnosed 9,646 people with AIDS, and they reported 720 deaths.  In 2019, 72% of the new 903 cases were men who had sex with other men. The majority of these men were 20 to 40 years old.  In the same year, heterosexual contact contributed to 11% of new male cases and 27 of 29 new female cases.

The number of cases undiagnosed as HIV and diagnosed as AIDS is a key concern for HIV/AIDS in Japan. Annually, about 30% of new cases nationwide are diagnosed through AIDS onset which means that they were not diagnosed as HIV cases before they progressed to AIDS. Further, the discrepancy between the number of rural versus urban cases of HIV that have progressed to AIDS before diagnosis has been a concern. In 2009, the discrepancy in rural areas of the Aichi region was almost double that of the region as a whole.  In Sapporo in the Hokkaido region cases diagnosed as AIDS were 27.3% in urban areas and 87.3% in rural areas where tests are less accessible. These discrepancies led the Ministry of Health, Labour and Welfare to call on local governments to implement more HIV testing programs in rural areas.

Progress to Date

In December 2020, UNAIDS launched new HIV/AIDS prevention goals. The 95-95-95 goals aim to ensure that 95% of people living with HIV know their status, 95% of them are on ART and 95% of those on ART to have viral suppression by 2025. Japan is currently working to meet UNAID’s 95-95-95 target. In fact, UNAIDS and Japan’s National Center for Global Health and Medicine (NCGHM) entered into an agreement in 2020 to promote awareness of HIV symptoms and prevention, including a campaign during the 2022 Summer Olympic and Paralympic Games. There is also health insurance and social support in Japan. Third, Japan is testing treatments to find the most effective one. One such drug is Dovato, which is an oral drug available for both adults and children over 12.

While Japan offers doctors and patients a host of the original ART, many of the newer medicines that are available in Western countries and generic ART are not available in Japan at this time. Also, mouth ulcers are one of the first signs of HIV infection, and patients with mouth ulcers have trouble swallowing pills. Pharmaceutical Technology underlined that due to the need to run clinical trials in Japan versus just accepting the results of trials run elsewhere, the Japanese market does not have enough injectable medicines available for these HIV/AIDS patients.

Looking Ahead

It is clear that there is a need to raise awareness of HIV/AIDS in Japan. Early diagnosis and treatment are key. The government’s work with UNAIDS and its treatment testing campaign should help Japan get on track with the 95-95-95 goal.

– Deanna Barratt
Photo: Flickr

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is working to end HIV/AIDS. Since PEPFAR’s launch in 2003, the U.S. government has made an investment of more than $85 billion to combat the HIV/AIDS epidemic. This investment has saved more than 20 million lives and has brought the HIV/AIDS epidemic under control in more than 50 countries through HIV infection prevention.

The Joint United Nations Programme on HIV/AIDS set 95-95-95 targets to reduce and control HIV infection by 2030. These include making sure that 95% of people with HIV infection are aware of their HIV status, ensuring that 95% of HIV-positive people receive antiretroviral treatment and calling for viral load testing and suppression among 95% of HIV-positive people. The limited availability of resources during COVID-19 challenges the effort to meet these targets. However, both the CDC and PEPFAR have shown their commitment to ending HIV/AIDS despite countries grappling with the COVID-19 pandemic. 

Limited Resource Availability  

Lockdown restrictions and travel restrictions to battle the COVID-19 pandemic have affected the availability of essential HIV services around the world, making it difficult for PEPFAR to end HIV/AIDS. In the early stages of the COVID-19 pandemic, health professionals dedicated to combatting HIV/AIDS diverted their efforts to the COVID-19 response. Viral load testing platform manufacturers started developing molecular diagnostic capability for COVID-19 using the same equipment that people used for viral load testing for HIV previously. All this decreased the availability of antiretroviral services. It also restricted the ability of healthcare professionals to follow with treatment outcomes associated with viral load testing.  

The Impact of COVID-19 on Viral Load Testing 

PEPFAR conducted a review to examine the global impact of the pandemic on viral load testing for HIV. The review showed that the coverage of viral load testing for all countries supported by PEPFAR was at a stable 78% between September and December 2019, but that coverage dropped to 71% between January and March 2020 due to the limited accessibility to laboratory and medical services amid the pandemic. Between April and June 2020, when routine services restarted, viral load testing coverage jumped by 75%. 

Additionally, 91% of the patients on antiretroviral treatment who did receive the viral load testing between October 2019 and March 2020 remained stable in terms of viral suppression. That continued at 92% between April and June 2020. This stable suppression of viral load indicates that even though fewer patients received antiretroviral treatment and testing during the COVID-19 pandemic, those who did receive the viral load testing had access to and complied with the antiretroviral treatment regimen. Despite poor odds, PEPFAR’s effort to end HIV/AIDS was right on its track during the first year of COVID-19. 

Innovative Initiatives  

To fulfill the HIV/AIDS targets by 2030, PEPFAR must develop newer strategies that countries can implement during the ongoing COVID-19 pandemic. One innovative approach PEPFAR has adopted includes point-of-care technology for those patients who are in need of expedited testing. These include patients failing the antiretroviral treatment, pregnant and breastfeeding women and children with low rates of viral suppression.

To support the impoverished communities in the sub-Saharan Africa region who the COVID-19 pandemic hit especially hard, PEPFAR has begun to dispense antiretrovirals for several months at once. It also has implemented task shifting and healthcare worker sharing. Third, it has encouraged the use of telemedicine while canceling most of the in-person activities to reduce the transmission risk. Fourth, PEPFAR has allowed flexibility in reporting requirements, funding reallocation and staffing. All these strategies combined have helped PEPFAR to keep on track with its agenda to end HIV/AIDS despite COVID-19.  

The COVID-19 pandemic has significantly affected the resource availability required for delivering the services for HIV infection control. However, PEPFAR is continuing to meet targets for 2030 by applying innovative strategies.

– Jared Faircloth
Photo: Flickr

HIV/AIDS Prevention and Treatment in Botswana
The AIDS crisis shook the world in the 1980s, but some countries, including Botswana, are still trying to find their footing in terms of HIV/AIDS prevention and treatment. HIV/AIDS prevention and treatment in Botswana has been a struggle, but the country is taking the right steps forward to fight the virus.

HIV/AIDS Prevention and Treatment in Botswana

Botswana has the fourth-highest rate of HIV in the world, with a rate of 20.3%. In 2000, the peak rate was 26.3% and rates have decreased every year since. The National AIDS Coordinating Agency created a treatment plan to offer universal free antiretroviral treatment (ART), making Botswana the first country in the Southern African region to do so. This effectively reduced the rates of HIV in Botswana.

This first strategy for treatment is simple. The test and treat strategy gives people who test positive for HIV access to immediate treatment. With enough treatment, HIV levels can become so low that they are undetectable on a test. However, this does not mean treatment should be stopped. Continued treatment is necessary in order to maintain an “undetectable viral load,” which means the chance of a person transmitting HIV is zero.

Women and HIV/AIDS

More than half (56%) of people who have HIV in Botswana are women. HIV disproportionately affects women in Botswana for reasons including sex work, forced marriage, domestic violence and more. Botswana’s HIV prevention strategy includes offering protective solutions as 85% of condoms available in the country are free. However, the country’s sex education is vague and does not cater to women or young people.

Many women contract HIV at a young age because of forced youth marriage, domestic violence and more. Botswana’s sex education program holds ideas such as faithfulness and cultural traditions as the basis of its programs. Without comprehensive and adequate sex education, Botswana’s HIV rates remain high even though treatment is easily accessible.

HIV’s disproportionate effect on women in Botswana triggered the creation of a second treatment plan called Option B+. Option B+ functions similarly to the test and treat strategy, but is specific to women. Since women can pass HIV on to children, after a woman tests positive for HIV once, she receives ART for the rest of her life under Option B+, regardless of whether the HIV becomes undetectable on a test. This lowers the chance of a woman passing HIV on to a baby, which reduces HIV rates among the general population.

Looking Ahead

Botswana’s treatment plans for HIV and AIDS using ART transformed the country from struggling with an epidemic to having a strong plan for it. As of 2017, out of 380,000 people who had HIV in Botswana, 320,000 of them had access to treatment. Botswana is on its way to ending AIDS as a public health threat through its treatment plans.

– Sana Mamtaney
Photo: Flickr