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Sex education expert Atsuko Yoshida is alarmed by the increasingly decadent lifestyle of youth that has made them more susceptible than ever to sexually transmitted infections.

Yoshida, a 41-year-old midwife and adviser for adolescents at the Japan Family Planning Association, said, however, that she has given up on confronting the youth from a moral standpoint.

“Arguments that they are too young to have sex or should not sell themselves are ignored. So instead, I raise the issue from the scientific side and tell them straightforwardly how to avoid such infections,” she said.

A survey conducted at 7,127 clinics in eight prefectures showed the rate of eight major STIs increased by 14 percent in women and 21 percent in men between 1998 and 2000. The term STI is now more common among the medical community than STD, or sexually transmitted disease, due to the increase of cases without immediate symptoms, such as chlamydial infections and HIV infections.

Youth figures are especially alarming. Data from 90 gynecologists showed that 27.3 percent of females aged between 16 and 19 with an unwanted pregnancy had genital chlamydia.

According to Masako Kihara, another expert on the sexual behavior of youth and an assistant professor with the department of public health at Hiroshima University School of Medicine, such figures are no surprise.

Three separate surveys she conducted — one in 1999 on 13,645 national university students, one in 2000 on 301 teenage couples interviewed in Tokyo’s Shibuya and Ikebukuro districts, and one in 2001 on 11,781 high school students in rural areas — all pointed toward a trend of increasingly careless, “networked” and active sexual conduct among the youth.

The careless nature was highlighted by a common result in all three surveys — the more sex partners one has, the less likely condoms are used.

In the case of the university students, while 74 percent of those who had one sex partner during the past year used condoms, only 43 percent of those who had five or more partners did so. About 58 percent of the male students said it was up to them to decide whether to use one.

“It is surprising that though more young women are becoming sexually active, the traditional view that women should remain passive and not argue with men (including about whether to use a condom) lingers,” Kihara said, lamenting that even among those who used condoms, 90 percent did it just to avoid pregnancy.

“Only 20 percent had in mind that it was also a precaution against STIs,” she said, adding that due to ignorance that many STIs can be transmitted orally, the use of condoms during oral sex was extremely low, at 6 percent to 7 percent.

Gonococcal infection, genital herpes, genital chlamydial infection and syphilis are among the STIs that can be transmitted orally.

“Networking” of sex is increasing among youth, with an active “core” person creating a group around him or her, she said.

“More people with fewer partners are increasingly contracting STIs because a partner happened to be a core person with an STI,” Kihara said. “The often-mentioned rule of safe sex — avoiding numerous partners — is no longer reliable.”

Active sexual conduct is evidenced by a large number of partners, sexual opportunism, and beginning sexual experiences at an earlier age.

Even among the rural students, 20 percent of those in their second year of high school with sexual experience had more than four partners. About 31 percent of men and 24 percent of women between age 18 and 24 took part in “one-night stands” in the past year, and the couples’ research in Shibuya and Ikebukuro indicated 33.3 percent of the boys and 34.6 percent of the girls between age 12 and 14 have had sex.

Dangerous liaisons

Kihara said prostitution is an important focus when discussing STIs in Japan.

“The scale of prostitution in Japan is the largest among developed nations. Some 14 percent of Japanese men aged between 18 and 48 had an encounter with a prostitute during the previous year, while the figures in the U.S. and Europe were only between 1 percent and 2 percent,” she said.

And though she expected most customers in Japan to be middle-aged men, research shows the rate was highest with younger men — 19 percent of men between age 25 and 34 and 16 percent for men between 18 and 24.

“Enko,” the abbreviation of “enjokosai,” or teenage girls’ “compensated dating,” is another example of risky behavior recently seen more frequently among girls. It is usually a guise for prostitution.

A 1999 survey by an association of Tokyo teachers and researchers in sex education conducted on 3,168 high school students showed that 5 percent of high school girls in their second and third years engaged in enko, while a Tokyo Metropolitan Government survey indicated the figure to be 4 percent in both high schools and junior high schools. Some research shows even higher figures.

One survey revealed that many of the girls did not even see their behavior as prostitution, saying, “Prostitution is bad but compensated dating is OK.”

Sense of crisis lacking

Yoshiaki Kumamoto, the 72-year-old president of the Japanese Association for Sexual Health Medicine, despairs at the lack of a sense of crisis among youth.

“They must learn how to protect themselves. With what we know about infectious diseases, it will be a miracle if Japan avoids becoming a major AIDS nation in the near future,” he said.

Although the number of detected cases of HIV infection and AIDS is relatively low, Japan is the only developed nation in which cases of AIDS and HIV infection are still on the rise, according to the doctor.

In 2000, among those tested at public health centers, the rate of HIV-positive people was 0.26 percent.

Among blood donors in the Tokyo metropolitan area in 2001, 2.65 out of 100,000 blood samples tested positive, an increase of more than threefold from 10 years earlier.

UNAIDS, or the Joint United Nations Program on HIV/AIDS, believes that the HIV infection rate in Japan among those aged 15 to 49 must be at least 10 out of 100,000 men and 4.9 out of 100,000 women.

There has recently been a rapid increase in HIV infection among younger people. According to the health ministry, the rate of HIV-infected teens and those in their 20s always constituted about 30 percent of the total up to 2000.

In 2001, however, this figure suddenly jumped to 40 percent, with a stronger shift for women to the younger age group.

Now, the largest proportion of women with HIV in Japan are those aged between 20 and 24, while the peak for men is between 25 and 29.

People who contract STIs already belong to a behaviorally high-risk group for HIV/AIDS, as they tend to use less protection, Kumamoto said.

However, a recent U.S. document on AIDS prevention strategies says that when someone is already affected by an STI, the chance on contracting HIV becomes even higher for medical reasons.

“In those STIs that produce ulcers, such as syphilis or genital herpes, the probability of being infected with HIV through ulcer lesions rises between 10 to 50 times in men and as much as 50 to 300 times in women. Even STIs that do not create ulcers, like genital chlamydia or gonococcal infection, raises the chance by two- to fivefold in women,” Kumamoto said. “A major outbreak of AIDS especially among youth is thus a realistic threat.”

Invisible threats

Kumamoto said that the rapid spread of STIs owes greatly to the lack of symptoms of many of them. As they are unnoticed, no treatment is received, allowing them to linger and worsen.

There are about 50 types of STIs. The most common are genital chlamydial infection, genital nongonococcal nonchlamydial infections, including mycoplasma genitalium, gonococcal infection, genital herpes, condyloma acuminatum, trichomonasis, syphilis and chancroid.

Out of these eight, genital chlamydial infection is asymptomatic in 80 percent of cases in women and 50 percent in men. Herpes is asymptomatic in 70 percent of women. Many cases of gonococcal infection also manifest no symptoms.

Incidence rates tend to be higher in women as they are more asymptomatic.

A survey Kumamoto conducted in 2000 showed that the rate of chlamydia infection detected at clinics among women 20 to 24 years old was 1,256 per 100,000, or about 1.3 percent.

However, this figure is believed to represent only a small segment of the total, because the women were those who had developed symptoms.

Statistics on 20,000 pregnant women he collected in cooperation with gynecologists showed figures that are closer to reality, Kumamoto said.

The data showed that 6.9 percent, or one in 15 married pregnant women aged between 20 and 24, and 27.3 percent of single pregnant women between 16 and 19, were infected with the bacterium.

The latter result was higher than among sex-industry workers, whose rate of infection was 17 percent in a similar survey in 2000 by the Tokyo Health Service Association, a public corporation providing services in preventive medicine since 1967.

At 12 public health centers in Tokyo, which are usually believed to have accepted higher-risk population groups for anonymous AIDS tests, the rate of teenage girls infected with chlamydia was 49 percent.

1 million may be carriers

The estimated population carrying the bacterium in Japan, including latent cases, is thus close to 1 million, Kumamoto believes.

The situation is serious because, in addition to immediate symptoms, genital chlamydia, as well as gonococcal infection, can cause infertility, while herpes can cause stillbirths, and condyloma acuminatum can cause cervical, penile and mouth cancer through oral sex, the doctor said.

Michiko Hayashi, a 50-year-old teacher in charge of health education at a municipal high school in Koto Ward, Tokyo, believes that the problems with sexual behavior among youths lie partly in their inability to build a relationship based on self-esteem.

“From an early age, the only thing parents want from their children is to get good grades. If a lonely girl meets a nice man who gives her attention, and who doesn’t want to use a condom, she does not refuse,” Hayashi said. “Parents should think more about the relationship they have with their children.”

Kihara from Hiroshima University blames media “incitement” and a lack of awareness by adults of the reality surrounding youth for the current situation.

“All of Japan is exposed to TV and magazines that repeatedly instigate unrestrained sexual conduct by youth, but only about 10 percent of teachers and parents think it is acceptable for high school students to have sex. The gap between the adults and youth is extremely big,” she said.

Schools don’t want to overly dwell on sexual education because they fear this will make more youth sexually active. They “fear the possibility of waking a sleeping child,” Kihara said, pointing out that 70 percent of schools don’t teach a practical approach to safe sex, such as how to use a condom.

“Adults must come to terms with the reality that STIs, including AIDS, are diseases that students can actually contract.”

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