Containing AIDS in Japan (Part 2)

Local spread: The human connection

By William Wetherall

A version of this article appeard as
"AIDS: the human connection in local spread" in
The Japan Times, 13 April 1987, page 2

Once in Japan, AIDS spreads between those who have it and those who do not. Nationality and gender make no difference to the virus. A carrier is a carrier whether the infected person is a homosexual, hemophiliac, drug mainliner, or none of the above. If you get it you've got it. And if you've got it, you can give it to someone else.

Statistically, however, there are high-risk groups. U.S. military personnel in Japan are not one of them, if true that the armed forces have screened all their members and sent home those with AIDS.

Homosexuals, and drug abusers who share needles, are more likely to infect their own kind. This increases the incidence within the group. And this means that, randomly chosen, an individual from such a group is a higher risk for a sexual partner outside the group.

The same can be said of hemophiliacs, or any other group which has an incidence of infection higher than that of the general population.

In this sense, Americans as a whole constitute a higher risk than Japanese as a whole, simply because the United States, with roughly 32,000 AIDS cases against Japan's only 40 or so, has 400 times as many AIDS cases as Japan, allowing for America's doubly large population.

Thus there is a kind of epidemiological logic in the advice being given by medics like Shiokawa Yuichi, professor emeritus of Juntendo University, and chairman of the Ministry of Health's Special Council on AIDS Countermeasures.

In a quarter-page newspaper notice called "AIDS can be prevented", Shiokawa advised readers to "avoid sexual contact with risky partners, like a person who has sexual relations with unspecific members of the opposite sex, and male homosexuals, and drug abusers." The notice was published by Tokyo Prefecture, conspicuously at the bottom of the editorial pages of major dailies on the vernal equinox, a national holiday, and an appropriate date on which to inform the public about the deadliest sexually transmitted "spring" disease in history.

Notably absent from Shiokawa's list of people to avoid were foreigners, hemophiliacs, and men as a whole. Since no mention was made of nationality, Shiokawa presumably meant that any homosexual, drug abuser, or person with multiple partners, is an AIDS hazard.

But practically all AIDS patients and carriers in the United States and Japan are men. And so women who sleep around are more likely to be exposed to the AIDS virus than men who sleep around.

And in Japan, as the numbers stand now, hemophiliacs constitute the highest-risk group. This, too, means more danger for women, since all hemophiliacs are men. The Merck Manual says: "The hemophilias are inherited as sex-linked recessive traits with bleeding manifestations only in males; female carriers transmit the abnormal genes."

Japan's Health Ministry has now recognized 36 cases of AIDS. 34 have been men, including 22 hemophiliacs who were infected through putatively imported blood products, 11 homosexuals (including three foreigners), and one for whom the source of infection is unknown.

Hemophiliac groups are opposed to AIDS laws which would treat them as a high-risk group, alongside homosexuals, drug abusers, and aliens. They fear that such treatment would invite more social discrimination than they already face from having an inherited disease.

Hemophiliac carriers were innocently infected with AIDS because their compatriots were unwilling to supply domestic demands for blood. Imported blood products are now decontaminated, but the fact remains that infected hemophiliacs are just as capable of spreading AIDS as other carriers, especially if they are young and sexually active.

A Kochi woman who conceived a child after she had tested positive for the AIDS antibody had been infected by a hemophiliac man she had dated before her marriage. Her husband has tested negative.

The woman is 20, and the man who infected her is 27. A second woman the man had sex with tested negative. A third refused to be tested. The whereabouts of a fourth is unknown. The man, now an AIDS patient, had visited a number of massage-parlor bathhouses.

Also in Kochi prefecture, a 28-year-old hemophiliac AIDS carrier infected a 22-year-old nurse. Two other women with whom he had sex tested negative.

These cases show one way in which AIDS is being heterosexually spread in Japan among (presumably) Japanese. They also show that, even when names are kept from the public, not all partners will submit to voluntary testing or otherwise help trace the route of infection.

One alternative is to test suspect Japanese and alien carriers and monitor known carriers. Another choice is public education, time for people to learn the collective lessons of ignorance and poor judgment, and suffering on the part of those who learn too late.

As now proposed, Japan's AIDS law is a blend of both.