Facets of Medicine (6)


By William Wetherall

A Japanese version of this article appeared in
Kokutai, 16(8), September 1995, pages 160-161

AIDS has been a social issue in Japan for over ten years now. When rumors about AIDS first surfaced in mass media in the early 1980s, very few people, including doctors, knew very much about HIV. And the few people who stood out as experts were not very "politically correct" in the way they talked about the virus, its routes of infection, and how infected people should be treated.

My first encounter with the politics of AIDS actually came before the term "PC" had come into vogue. The problem of editorial sensitivity towards "discriminatory words" was, of course, as old as the rocks.

I was writing articles for various newspapers and magazines, and I persuaded the editor of The Japan Times to let me write a four-part series on AIDS. It was to be the paper's first comprehensive look at the AIDS problem in Japan as illuminated by popular weekly magazines in the country.

The first part was called "Japanese have role in spread of AIDS around the world." This article digested a report in the 25 October 1986 issue of Lancet, which suggested that HIV could spread from Ghana to Japan and other countries through Japanese and Korean fisherman and seamen who patronize infected prostitutes in Ghana. The report was based on a survey of Ghanaian prostitutes, some of whom reported having non-Ghanaian sexual partners, including Japanese and Koreans.

The Lancet report, by a research team at the University of Ghana Medical School, clearly attributed the rise of AIDS in Ghana to the return of its own citizens from neighboring countries. And it warns that foreigners who pass through Ghana and have sexual contacts with infected prostitutes there could spread the virus elsewhere, including their own countries when they return.

Some Japanese critics angrily charged that the Ghana report "insults Japan" by making it seem as though "Japanese are spreading AIDS all over the world" (Asahi Shinbun, 4 February 1987, evening edition. These critics, however, were more concerned with Japan's "image" than with the social and medical facts reported in the article.

The Asahi article went on to report that a doctor returning to Japan from Africa had diagnosed many transient Japanese for venereal diseases like gonorrhea, syphilis, herpes and soft chancres. The article also disclosed that a Tokyo blood-donation center had found HIV in blood donated by a man who admitted having sexual relations in Africa about one month before his return to Japan.

The fact is, many infectious diseases have entered Japan because someone coming or returning to the country had been infected abroad. Syphilis is a good example. When Europe was hit by syphilis in the 1490s, the French called it the Spanish disease, and the English knew it as the French pox, among other popular names that reflected a theory of outside origins. (Frederick Cartwright, Disease and History, 1972)

Syphilis reached India in 1498, China by 1505, Japan by 1512, and Korea by 1515, probably via China, where it was called "Canton pox", indicating a southern route. Yamato Japanese people called syphilis both tomo (Chinese pox) and ryukyumo (Okinawa pox), but Okinawans called it nanbankasa (southern barbarian pox) to express their versions of where the new disease had come from. (Tatsukawa Shoji, Nihonjin no byoki, 1976)

Sexually transmitted diseases (STD) are transmitted by sex. The specific mechanisms of transmission vary from disease to disease. But anyone who comes in contact with the agents of an STD, under conditions that favor transmission, can be infected. And they, in turn, can infect others, if they act in such a manner that favors transmission. Doesn't matter who you are: the agents of disease do not discriminate according to nationality, ethnicity, race, religion, or other such traits.

But in 1987, when I was writing my series of articles, some people thought differently. Some people thought that certain HIV carriers should be treated differently than others. A "political" was made between "active" and "passive" victims.

The second part of my series was called "AIDS: the human connection in local spread". In it, I talked about how HIV was then spreading to, and within, Japan.

I quoted a quarter-page newspaper notice called "AIDS can be prevented", which had been published by Tokyo Metropolitan Government, 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. In the notice, Shiokawa Yuichi, then professor emeritus of Juntendo University and chairman of the Ministry of Health and Welfare's Special Council on AIDS Countermeasures, advised readers to "avoid sexual contact with risky partners, like a person who has sexual relations with unspecific members of the opposite sex, male homosexuals and drug abusers."

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.

At the time, however, most identified HIV carriers in Japan were Japanese men who categorically neither homosexuals nor drug abusers, but hemophiliacs. Of course, all three categories could overlap -- but that is another problem. The problem here is that the notice was designed to avoid making specific mention of hemophiliacs, since they were being regarded as "passive" victims who had done nothing "wrong" to become HIV positive.

I went on to note that hemophiliac groups were opposed to AIDS laws that would treat them as a high risk group, alongside homosexuals, drug abusers and foreigners. They feared that such treatment would invite more social discrimination than they already face from having an inherited disease.

Yet I also pointed out that, if a hemophiliac carrier is sexually active, and promiscuous, he would constitute just as high risk as any other category of carrier. I even cited a case widely reported in the weekly magazines about a female nurse who had been infected by a hemophiliac carrier who also had other women friends.

Well, The Japan Times got some phone calls complaining about what I had written, and parts three and four were never published. Part three was about the AIDS "panic" in the mizushobai, and how this was resulting in discrimination against foreigners in Japan. Part four discussed the distribution and transmission mechanisms of ATL in Japan and other parts of the world, as another example of the complex relationship between geography, social conditions, and disease. The Japan Times later published an expanded version of this forth part on its health page. Part three never appeared.

I was not surprised that my series was canceled. Censorship is a fact of life -- not one I like, but one I have to constantly deal with. Ironically, the cancellation had little censorial impact, since the part that apparently had hurt the feelings of some readers had already been published. What surprised me was the "reason" that the apologetic editor gave me for canceling the series, which was being run on the paper's National pages, the section for domestic news: "Some other editors feel it should have been on the Opinion page."

I thought I was just reporting medical and social facts.