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Dec. 1 marked the 20th anniversary of World AIDS Day. While there may be more to celebrate now than two decades ago, 25 million people have died of AIDS since then. UNAIDS/WHO estimates 33 million people are living with HIV/AIDS worldwide, while Africa alone has 11 million AIDS orphans. During 2007, an estimated 2.5 million adults and children became infected with HIV, most of them under 25, while 2 million died of complications related to AIDS.

In Japan, the percentage of people infected with HIV is one of the world’s lowest, estimated at around 0.02 percent by the United Nations. However, Japan is not yet a country that has slowed the annual rise in infections. The numbers are steadily increasing, though reliable figures are hard to come by. Japan may be one of the most technologically advanced countries in the world, yet is falling far behind in testing, information and consistent government response.

In 2006, 952 new HIV cases and 406 new AIDS cases were reported in Japan, according to the health and welfare ministry, the highest number ever. Current estimates show 10,000 to 12,000 PHA (people with HIV/AIDS) in Japan. This may seem manageable, but experts warn that the number of PHA could jump to 50,000 in the next two years alone. The nature of AIDS transmission and infection means that numbers can increase exponentially very quickly.

Estimating all this is difficult, though, since Japan has failed to collect sufficient data. Japanese research into attitudes, condom use and sex workers’ practices, among other basic issues, lags far behind what is known, and acted upon, in less well-off countries. Throughout Africa, the last few countries stuck in denial, including South Africa, have finally started to frankly address sex-related issues and take action. The conservative administration of U.S. President George W. Bush can count AIDS funding as one of its few successes. Around the world, the “out of sight, out of mind” approach has largely been discarded.

In Japan, though, misinformation and denial remain the norm. Surveys by nongovernment organizations (NGOs) and the health ministry have found that most Japanese connect condom use to pregnancy prevention and believe HIV/AIDS happens only to certain types of people. Many of the first HIV infections were the result of blood transfusions, but today, more than three-quarters of new cases in Japan occur through sexual contact.

The issue of HIV/AIDS extends into extremely private areas of individual life, as well as into what have long been public taboos. However, embarrassment, social mores and fictitious beliefs should not interfere with public health concerns. In Japan, many groups are starting to distribute information, gather accurate data and correct misunderstandings. NGOs such as the Life AIDS Project and the Japan Foundation for AIDS Prevention need to better coordinate with the U.N.-initiated and ministry-approved Stop AIDS Operations. Strides have been made, but not enough.

Information and coordination are the basis for fighting AIDS. This is especially important for young people, who have been initiating sexual activity at ever-younger ages with the same old recipe of incorrect and missing information. Education on these issues at Japanese high schools and junior high schools is virtually absent. Every young person needs to know that condom usage is the best prevention against AIDS, and against the increasing numbers of other sexually transmitted diseases, such as chlamydia and gonorrhea, associated with HIV infection.

The stigma of being tested should also be dispelled. People need to get tested if they have any slight possibility of contact. At any hospital, a blood check is a simple procedure. More testing facilities with anonymous testing also need to be established and advertised. In past years, the number of people being tested jumps following the publicity of World AIDS Day, only to drop back down later. In other countries, sports and movie personalities consider it a duty to lend their fame to the cause, but in Japan, media stars only rarely risk their careers to help stop AIDS.

Japan has much to learn from how other countries have already managed the crisis, but at the same time, Japan’s so-far contained crisis offers a rare opportunity to confront a global problem at a manageable local level. What Japan succeeds at doing could eventually serve as a model for other countries where underfunded half-measures and crisis management are the only options. Medical and organizational advances in Japan are better than money. If better and more fully instituted, they can offer other countries helpful approaches and constructive cooperation.

As the world globalizes, so do diseases. The lack of study and action indicates that most Japanese believe their country is a separate island with an especially safe sexual disease status. This view is unrealistic and dangerous. Mostly, Japan so far has simply had good luck. An explosion of infections can happen unexpectedly and very, very quickly. With increased awareness, better policies and concrete practical steps, Japan can confront the worst of the crisis before it happens.

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