Japan only now confronting rising HIV rate

The women -- employed by massage parlors called fasshon herusu, or "fashion health" -- are discussing ways to avoid AIDS and other sexually transmitted diseases and still keep their jobs if a client insists on not using a condom.

The meetings, which take place once a month at a popular Tokyo restaurant, are led by former prostitutes and health activists who now work for a nongovernmental organization called Sex Work and Sexual Health (SWASH). Female sex workers are one of Japan's highest-risk groups for AIDS.

"The girls take me very seriously because in Japan there is little access to correct information on sexual health," said SWASH activist Yukiko Kaname.

Since the adult rate of infection was only 0.02 percent at the end of 2001 - - the United Nations HIV/ AIDS agency (UNAIDS) says just 12,000 adults in the 15-to-49 age bracket, out of a population of 127 million, have HIV -- the disease has not been taken as seriously here as elsewhere in Asia. In fact, many Japanese believe it is a problem only for poor Third World countries.

"Since the disease is not widespread in Japan, I am not worried about being infected," said a massage parlor employee named Mia, who is a regular at the monthly sessions. "I am here to learn how to protect myself."

But during 2002, Japan set new highs with 301 new cases of AIDS and 595 cases of HIV infection. Health experts predict the number of infected adults nationwide will jump to as many as 50,000 by 2010 because of a booming sex trade, declining condom use, increased sexual activity among young people, the lack of an effective government AIDS awareness program and the low status of women in Japanese society.

Japan's sex trade -- estimated at $13 billion a year -- is one of the nation's fastest-growing industries. In a time of economic recession, record unemployment has forced many women to work at brothels euphemistically known as fashion health, soapland, pink salons or telephone clubs.

The Health and Welfare Ministry blames declining condom use for the spread of the disease. UNAIDS says only 6 percent to 25 percent of sex workers and the public use condoms.

The HIV prevalance rate is highest among female sex workers and especially among foreign women -- 2.7 percent in 1999, according to UNAIDS. Among Japanese who are infected, about 34 percent of heterosexuals and 17 percent of homosexuals contracted the virus during unprotected sex, 19 percent from tainted blood, 0.5 percent from unclean needles and 27 percent from unknown causes.

In fact, until the early 1990s, most people with AIDS were hemophiliacs. The health ministry did not ban unheated blood products, which can spread the virus, until 1985. An ensuing scandal erupted after nearly 2,000 people were exposed to tainted blood, killing about 500 to date.

But most recently, there has been a dramatic increase in AIDS cases caused by unprotected sex. By 2000, 78 percent of new infections were acquired through sexual contact, prompting the government to turn its attention to sex workers, homosexuals and young people. More than 60 percent of the newly infected are either teenagers or in their 20s, according to Masako Kihara, a well-known AIDS expert and adviser to the health ministry.

Kihara says the major problem in fighting the spread of AIDS is the lack of AIDS education for young people, whose ignorance about the subject she describes as "frightening."

Numerous surveys have shown that most men and women in their 20s don't use condoms, often justifying their behavior by saying they are in a monogamous relationship.

"The fact is, Japanese youths have extremely short relationships, mostly a few weeks to three months," said Kihara. "The sad thing is, they do not acknowledge that this is multipartner behavior that exposes them to HIV."

AIDS activists say attempts to educate teens have been stymied by teachers and parents, who argue that such programs encourage sexual activity.

They also complain that AIDS education in primary and middle schools, which began only last year, focuses on eliminating discrimination against those with HIV instead of teaching about safe sex. Although sex education begins in the sixth grade, condoms are not mentioned until students reach their sophomore year in high school.

"We are aware of complaints by (AIDS) activists," said Teruo Otake, the education ministry's director of school sex education. "The school curriculum takes into consideration the opinions of parents and teachers who point out that explicit details are not necessary for children who are not ready for it."

Even more frustrating, AIDS activists and some academics say, is a culture that discourages female assertiveness.

"While modern Japanese women have certainly made strides toward social equality, tradition plays a big part in restricting their rights when it comes to sexual matters," said Yasuko Muramatsu, professor of women's studies at Tokyo's Gakugei University.

"A woman initiating the issue of HIV with their partners and asking them to use condoms would appear rude and challenging, an image she would want to avoid."

Nozomi Mizushima, SWASH program manager, says the low status of women has complicated her group's AIDS prevention work.

A recent SWASH survey showed that nearly 53 percent of massage parlor workers never ask customers to use condoms even though they are aware of the risks. Some brothel owners have banned condom use to please male customers and even pressure female employees not to report violence committed against them. Consequently, SWASH is lobbying for legislation to protect sex workers by requiring brothel owners to encourage condom use.

"Girls working in the sex industry are particularly vulnerable to discrimination and abuse," said the 23-year-old Kaname, as she made her rounds through Tokyo's neon-bathed Kabukicho red light district. "The risk is compounded with the huge profits of the business."

Makoto Iwakura, an official for the health and welfare ministry, says it would be difficult for the government to force a 100 percent condom-use law like the one instituted in 1998 in Cambodia, where prostitution is legal. The reason, he says, is "Japanese laws prohibit the sale of sex," a reference to the 1958 Anti-Prostitution Law. Soapland operators, for example, skirt the law by billing themselves as "assisted bathhouses."

Meanwhile, Kihara says the lack of an effective government program could turn the AIDS virus into a time bomb.

[маловероятное соотношение случаев ВИЧ/СПИД; поскольку СПИД вполне нормально диагностируется (его не спрячешь), указанное соотношение говорит о том, что на самом деле эпидемия в Японии, гораздо шире, чем .02; другими словами система слежения за эпидемией отсутствует ;(]