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HIV/AIDS in Japan: Addressing Testing and Awareness

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

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Expanding Philippine Internet Access

Philippine Internet Access
On October 28, 2021, the United States Agency for International Development (USAID) officially announced its new project, Better Access and Connectivity (BEACON). USAID is partnering with the Philippine government to expand Philippine internet access to bridge the digital gap in the Philippines.

About the Philippines as a Developing Country

Although the Philippines enjoys a high literacy rate and strong human and natural resources, the country still ranks only slightly higher than 0.7 on the Human Development Index (HDI). The HDI, which weighs factors including life expectancy, education and GDP, considers any country under 0.8 a developing country. The Philippines is 111th of 189 countries ranked in the index. USAID has partnered with the Philippines for decades to improve the Philippines’ status on the HDI. BEACON is its latest initiative in that work even though expanding internet accessibility is difficult in most developing nations.

Internet Accessibility in Developing Nations

The World Bank has declared internet access a fundamental human right in all nations alike, regardless of their development status. With that said, the World Bank also estimates that, currently, only 35% of the population in developing countries has internet access.

Using this statistic, the World Data Lab has created a secondary comparison for individuals living in poverty without internet access. Those living with this criteria live in the framework of “internet poverty.” Living in internet poverty, one cannot afford the minimum reliable internet, which is 1.5 gigabytes of internet download speed per month. This notion of internet poverty equates to the extreme poverty line, where an individual lives off of $1.90 per day.

Internet Accessibility in the Philippines

Besides not being a widespread commodity, the internet in the Philippines is extremely slow. In 2020, the country ranked 119th of 139 countries for mobile speed and 106th of 174 countries for broadband speed.  One of the reasons the internet in the Philippines is limited is because only two companies — Philippine Long Distance Telephone Company (PLDT) and Globe — currently provide internet connectivity and services. This contrasts with the dial-up era when over 300 independent companies provided service in the Philippines. As a result of having just two providers, internet service costs in the Philippines are some of the highest in the world.

Congressional Holdup

There are many Philippine congressional bills to improve the internet in the Philippines, specifically the Better Internet Connection Act. This Act requires the Philippine internet-providing companies to provide a minimum speed of 10 megabytes of internet access per second to all subscribers’ devices. However, unfortunately, this bill has remained in Congressional review. The lack of passage gave USAID further impetus to launch the BEACON Project.

How The BEACON Project will Help the Philippines’ Internet

The BEACON Project will cost $1.65 billion Philippine pesos, equivalent to $33 million. This project will expand internet access, beginning with underserved communities. It will bolster economic growth by providing stronger information and communications technology (ICT). The BEACON Project will also support the government in digitization and automation efforts. By providing the funding for internet improvement, USAID takes the burden off of the Philippine government. Finally, introducing more reliable internet in the Philippines could open jobs and provide support for businesses.

The Philippines has already succeeded in expanding internet access through its entry into Business Process Outsourcing (BPO) sector. By 2016, the Philippines outpaced India as a call center hub. The Philippines’ BPO sector enjoyed a 10% compound annual growth rate during the decade ending in 2016. The BEACON Project will allow the Philippines to escalate modernization for companies. This should also open additional business sectors and expand job opportunities.

Outlook for the Future

The Philippines has struggled with internet connectivity, unreliable speeds and high prices for years. Internet in the Philippines is a necessity, and Philippine internet access is pertinent to eliminating poverty and ridding the Philippines of its label as a ‘developing country’ by the HDI.

– Clara Mulvihill
Photo: Flickr

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Speaking About the Success Against HIV in Africa

HIV in Africa
Big data is buzzing in the healthcare sector. As more and more data becomes available, analysts are looking for ways to improve the healthcare industry. While developed nations, with their multitude of activity trackers and smart devices, are better positioned to leverage big data, developing nations are also taking advantage of the rapidly growing pool of information being recorded.

The International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University was clearly aware of the value of data when it proposed the Population-based HIV Impact Assessment (PHIA) Project. In partnership with the Centers for Disease Control and Prevention (CDC), ICAP has been gathering data to measure the level of success against HIV in Africa. With the help of the ministries of health in the affected countries, they have been conducting surveys and diagnostic tests to measure national HIV incidence, pediatric prevalence and viral suppression. Zimbabwe, Malawi and Zambia were the first countries to release their survey and test results. Over the next several years, 17 other countries will participate in the project and publish their findings.

So far, the results have been encouraging. The data indicates that the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is achieving success against HIV in Africa. PEPFAR is the largest commitment by any nation to combat any single disease internationally. If the results from Zimbabwe, Malawi, and Zambia are early indicators, then the PEPFAR has been well worth the investment.

The initial results of the PHIA Project indicate that these countries are on track to achieve the 90-90-90 targets set by the United States Agency for International Development (USAID). The goal is to have 90% of HIV patients diagnosed, 90 on antiretroviral therapy and 90% with adequate viral suppression by 2020. Models predict that the AIDS epidemic can be ended by 2030 if these goals are reached.

In Zimbabwe and Zambia, the treatment and viral suppression goals are almost a reality; more than 85% of patients are on treatment and virally suppressed. In Malawi, the viral suppression target has already been reached. The percentage of patients on treatment is just shy of 90%. Ninety percent and 86% of women and men, respectively, are on treatment. In all three countries, though, improvements in diagnosis are needed. Three out of every 10 patients are unaware of their status.

However, these early indicators of success against HIV in Africa are not signs that there is no more work to be done. Rather, in the words of Dr. Wafaa El-Sadr, the director of ICAP, “Now more than ever, we have to keep our foot on the pedal and push even harder.”

– Rebecca Yu

Photo: Flickr