Japanese nervously laughing at AIDS

By William Wetherall

A version of this article appeared as
"Japan curses Gaijin and AIDS still spreads" in
Far Eastern Economic Review, 136(15), 9 April 1987, pages 111-113

AIDS became a minor issue in Japan in 1983, a bigger one in 1985, and officially a real problem only this year, when a Japanese woman died of the disease, caused by a virus which destroys the body's defence system so that other infections can kill. Japan's escalating concern about AIDS has been fueled by the kinds of irrational fears that usually race ahead of rumored epidemics, cause panic, and provoke discrimination against members of high-risk groups.

Japan's Health Ministry has so far recognized 36 cases of AIDS: 11 in 1985, 14 in 1986, and 11 as of mid March this year. 24 patients have already died. Another 4,000 to 11,000 people are thought to be carrying the AIDS virus. A 1986 study projected 950 patients by 1996. A model of annual doubling starting with 50 new cases in 1987 would predict 800 new cases in 1991, and a total of 1,550 cases in the five-year interim, or 20 percent-30 percent of the estimated carriers.

All but two of Japan's 36 AIDS patients have been men, including 22 who were infected through imported blood products, 11 homosexuals (including three foreigners), and one man who died before the path of infection could be learned. Both of the women have died, including a Japanese prostitute who had lived with a bisexual Greek man, and a 26-year-old Swiss woman who is thought to have been infected through intimacy with a foreign man who is no longer in Japan.

No AIDS cases were known in Japan in 1983. Japanese associated the disease entirely with American homosexuals. So up went signs reading "Japanese Men Only" on several straight and gay bathhouses cum massage parlors and saunas.

The stated motive for this discrimination was hygiene over profit. The real motive was to keep the patronage of mainstay Japanese customers, who might stop coming if word got out that the attendants were servicing skinny, feverish, hollow-eyed aliens-"might" because, as one joke puts it, clients turned on by the risk would pay more.

The first AIDS cases in Japan were recognized in 1985. Half were haemophiliacs who had been infected with blood products imported mainly from the United States. So the Ministry of Health told Japan's drug companies to sterilize all possibly contaminated foreign blood coagulants. It also launched a long-term drive to increase the rate of domestic blood donation to the point of self-sufficiency. U.S. forces in Okinawa, while alleging that none of their personnel were infected with AIDS, ordered a ban on donating blood for use in local hospitals, to avoid any blame for cases of infection through transfusions.

A mini AIDS panic ensued in November 1986 when Quezon city reported that a Filipina AIDS carrier had gone to Japan. The woman was working as a prostitute at a Matsumoto city night club. Japanese mass media showed no concern for her privacy. Sandee Mainichi, a major weekly news magazine, wrongly reported that two other Filipinas who had worked in Japan were AIDS carriers. The magazine corrected the story, but it was sued by the Japanese men who had employed the women.

Kobe, a major seaport on the Inland Sea, became the focus of the current, more genuine AIDS scare from 17 January this year, when the Ministry of Health reported Japan's first female AIDS victim. The 29-year-old woman, who died on the 20th, had apparently lived with a bisexual Greek sailor for about one year. She then became an habitual prostitute who reportedly had sex with about 100 men before being struck by the symptoms, which confused one doctor after another until finally they were diagnosed as AIDS.

The busy international port of 1.4 million (including about 40,000 resident aliens) exploded with alarm. By mid February, Kobe city had produced over 200,000 handbills, pamphlets, and posters to allay public fear. An AIDS hot line received over 100,000 calls, and nearly 20,000 people visited health consultation centers. Between 18 January and 28 February, 8,443 people requested AIDS antibody tests. All 7,152 blood samples processed by the end of February were negative.

The Kobe woman's death provoked some critics to call AIDS another kurobune [sic = kurofune] [black ship] , an allusion to the American "invasion" of Commodore Perry in 1853. If Japan is the innocent victim of an alien social disease, then the spread of AIDS in Japan can be blamed on foreigners and Japanese who sexually fraternize with foreigners, and on Japanese infected by foreign blood.

Some sex-related businesses in Kobe posted signs which said in the bluntest English: GAIZIN OFF LIMITS; and in the civilest Japanese: Gaikokujin no o-kyakusama wa go-annai moshiageraremasen [Foreign guests will not be invited in]. The crude English assumes that alien butchers who can find the local meat market have been in Japan long enough to have learned the native slur for themselves. The polite Japanese could only have been intended for Yamato businessmen who would bait or seal their barbarian contracts with oriental flesh.

The media response to AIDS has been both massive and sensational. Yet AIDS information and advice in even the pulpiest tabloids and magazines has generally been reliable.

On the other hand, some of the most responsible efforts to disseminate facts about AIDS have also been effective in spreading infectious xenophobia. A primetime AIDS documentary by NHK, Japan's equivalent of BBC, silently showed men distributing the bilingual off-limits signs in Kobe. Within days, similar signs began to appear in other Japanese cities, complete with the unconventional spelling of gaijin [outsider], which is popularly used to mean "foreigner" as defined by racial appearances, not citizenship.

Shukan Pureibooi, a popular young men's weekly magazine, coated its palatable prophylactic advice with tasteless racist humor: "When in a disco, beware of [naked black] men with bows and arrows, green monkeys, and women who come with [white] foreigners. And don't forget your condoms."

The same article warned its readers: "Casually ask your date if she's ever had sex with whites, blacks, Central Americans, East Africans, merchant marines, American military personnel, people with weak bodies [alluding to haemophiliacs], and homosexuals. Also inquire if she's had sex with [Japanese] men who have been abroad on business. Be wary of women who like reggae, Prince, Michael Jackson, African music, and black contemporary. Special caution is needed with women who like soul and frequent discos where blacks hang out."

Most AIDS articles, though, do not single out foreigners or racial minorities as a main source of AIDS in Japan. Rather they advise caution among even the purest Japanese, because more Japanese are becoming AIDS carriers. And the butt of most AIDS humor in Japan is the hapless horny Japanese man who buys sex overseas or at home.

When a deadly epidemic strikes, and limited resources must race against time, it makes perfect medical sense to screen known high-risk groups first. Though AIDS is far from becoming an epidemic in Japan, fear of its spread has led to an AIDS control law bill that some critics feel unnecessarily infringes on human rights.

As drafted now, the AIDS bill requires prefectural governors to take steps to curb the spread of AIDS in local areas, and it authorizes them to recommend or order tests or treatment under the Infectious Diseases Control Law. The bill also calls for modification of the Immigration Control Law and the Refugee Recognition law, to ban the entry of aliens who have tested positive for AIDS antibody, though apparently Japan will not attempt to screen all entering foreigners.

The AIDS law would oblige doctors to report the age, sex, and the source of infection for all patients they diagnose as being infected with AIDS, and to advise these patients or their guardians on how to prevent the spread of the virus. Doctors would also have to report the name and address of any infected patient they think might not heed their advice or might infect others, and of the person who infected the patient, if known, and if the person might infect others.

Infected persons would have to follow their doctor's advice. And the law would prohibit them from engaging in "acts which carry a high risk of infecting another person with the AIDS antigen" like donating blood, or sex.

Doctors and public officials who fail to keep secrets about infected people would be subject to a maximum prison term of one year, or a fine of less than 300,000 yen (about 2,000 US dollars). People who either refuse a governor's order to submit to a medical examination, or who give false answers to examination questions, would be subject to a fine of not more than 100,000 yen (about 650 US dollars).

Critics charge that provisions for the protection of human rights are inadequate. Some feel that the medical community can contain AIDS without a special law. Others think that AIDS needs to be classified as an infectious disease for purposes of collecting epidemiological data, but that failure to explicitly protect the privacy of infected individuals would drive possible carriers underground, and hence defeat the law's purpose.

Earlier drafts of the bill were more obsessed with exclusion and punishment than the present version, which still fails to protect the social rights of people handicapped by AIDS. Shohei Yonemoto, a specialist on the ethical problems that arise between society and the life sciences, has observed that "The biggest difference in the AIDS debates in Japan and the United States is that, in Japan AIDS patients are discussed as though they were objects of hatred who would spread a fatal disease, whereas in the United States they are seen as weak people [jakusha] who need social protection."

Haemophiliacs dislike the bill because they feel that it would increase the discrimination they already face. They do not want to be put in the same category as homosexuals and foreigners. Yet 22 (61 percent) of Japan's first 36 AIDS patients have been haemophiliacs. And infected haemophiliacs are just as capable of spreading AIDS as other carriers, especially if young and sexually active.

17 February morning papers reported the case of a Kochi prefecture woman who had conceived a child after she had tested positive for AIDS antibodies. The woman had been infected by a haemophiliac man she had dated before her marriage. She refused to abort the pregnancy, and the baby was delivered by Caesarean section on 15 March. It is not yet known if the baby has been infected. Her husband has tested negative.

The Kochi 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. And the man, now hospitalized as an AIDS patient, had visited a number of massage-parlor bathhouses. Also in Kochi prefecture, a 28-year-old haemophiliac AIDS carrier infected a 22-year-old nurse. Two other women with whom he had sex tested negative.

These profiles prove that AIDS is spreading in essentially the same way it does in other countries. Though AIDS is not easily transmitted through heterosexual intercourse, the chances of being infected or infecting someone else quickly increase when one is sexually active and has multiple partners.

The Kochi cases also show that, when a carrier is discovered, not all partners can be identified or located for follow-up purposes. Even when the identities of known partners are scrupulously kept from the public, not all partners will cooperate. Thus investigations based on voluntary testing may fail to uncover an entire infection network.

One alternative is mandatory testing of high-risk individuals and close monitoring of all 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. Japan may be opting for a mixture of these two.