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With no advance warning, a team from the Health and Welfare Ministry has announced that a large-scale infection of HIV, the virus that causes AIDS, is a far greater threat in this country than the public has been led to believe. After what seems like a long ministry silence on the issue, the team estimates that more than 15,000 people in Japan will be infected by the end of 2003, more than twice the officially estimated total of 7,320 HIV carriers at the end of 1998. The group also projects the number of patients with full-blown AIDS here will rise to about 3,300 over the same period, about 3.5 times the figure of 930 at the end of last year.

If health ministry bureaucrats themselves consider these latest estimates “alarming,” as reports indicate, how is the public to react, lulled into dangerous complacency by what almost seems a government policy of silence on the continuing HIV-AIDS danger? The project numbers may indeed still be lower than comparable figures in the United States and Europe, but they represent a dramatic upsurge from a similar ministry prediction issued in 1995, which forecast only 5,500 HIV-infection cases in 1998 and 7,000 in 2000.

The registered number of Japanese reported to be HIV-positive last year was 1,598 but the health ministry team believes its estimate of 7,300 is closer to reality since many people who have not been tested are unaware of their infection and others only learn about their condition after considerable delay. While belated attempts to correct previous estimates are to be welcomed, they provide further ammunition for the many observers who believe the government consciously and deliberately underreports the true situation to avert a public panic.

Anyone who assumes that the Health and Welfare Ministry had learned a lesson from its tragic earlier experience causing widespread HIV infection among Japanese hemophiliacs through the release of tainted blood products would appear to be mistaken. How else to explain the reaction that the projected dramatic increases in HIV infection and AIDS may demand a “new approach in the near future” that was expressed by the ministry team? New approaches are plainly needed now.

Critics charge that the timing of this survey is questionable if not downright suspicious, coming as it does just prior to the ministry’s long-delayed release of low-dose oral contraceptive pills for women. Indeed, a detailed analysis of the survey’s findings to detect “changing trends” has already been promised.

What the health ministry has been too slow to recognize is that changes in sexual behavior are already occurring at a rapid pace, even before the official fall release of the pill. The latest projections for HIV infection rates and AIDS cases may not include specific figures for women, but for the first time they included regional breakdowns, with the highest estimates being for Tokyo and the surrounding Kanto-Koshinetsu region. Earlier this summer a survey conducted among students at Tokyo Metropolitan Government-run high schools found that nearly 40 percent of third-year students — 38 percent of the boys and 39 percent of the girls — had engaged in sexual relations. Roughly half of their partners were other high school students, suggesting that the other half must have been adults.

Respondents were allowed to give more than one reason for having sex and as might be expected, the answers ranged from “love” to “fun” and “curiosity.” Of more pressing interest is the fact that even though 95 percent of the students had “learned about” AIDS in school, the numbers of both boys and girls saying they used contraception declined from a previous survey. Too many of them obviously did not learn enough, since they also registered considerable ignorance about other sexually transmitted diseases. While the issue of sex education in the nation’s schools remains highly controversial, the question of young people’s health does not.

So-called “drug cocktail” therapy has registered marked success in industrialized countries in slowing the development of AIDS symptoms and reducing the number of AIDS deaths. Medical researchers here and abroad are also gradually making new breakthroughs in AIDS prevention treatments. Until they achieve unqualified success, however, there is still an urgent need for the “new approach” foreseen by members of the health ministry team that announced the latest estimates. It should include ready availability of clear-cut instructions for the public, including sexually active young people, on prevention, testing and early treatment not only for HIV infection, but for all STDs.

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