The Japanese Perception of AIDS

Back to Contents of Issue: January 2002

Can i-mode play an educational role?

by William Hall

HEART-RENDING PICTURES OF emaciated children suffering from AIDS continue to appear in the media, but recently we are also beginning to see more substantive articles on the social, cultural, political, and economic impact of AIDS. At the Genoa summit meeting of the Group of Eight countries last July, an agreement was reached to establish a multibillion dollar fund to finance global efforts to combat infectious diseases such as HIV/AIDS. To complement this fund, an action plan called for IT networks to link medical facilities in industrialized and developing nations.

This increased attention to HIV/AIDS at the senior policy level indicates that concern about AIDS has moved to a new plane, with AIDS now being considered a major security threat that knows no borders. While 70 percent of persons worldwide infected with AIDS live in Africa, according to United Nations data, India had the highest number of deaths from AIDS in 1999. In the Bahamas, Cambodia, Haiti, and Myanmar, AIDS deaths are expected to cause a staggering three year reduction in life expectancy within the next four years. In the US, statistics from the US Center for Disease Control show some 40,000 new infections occurring every year.

In Japan there are reportedly fewer than 10,000 cases of HIV/AIDS among Japanese nationals. What are the perceptions of the average Japanese about HIV/AIDS, its impact on their lives, and Japan's international role in the fight against AIDS?

In March 2001, the Cabinet Office released the results of a study entitled "Opinion Poll in regard to AIDS" ("Eizu ni Kansuru Yoron Chosa"). The study involved a nationwide sample of 5,000 randomly selected Japanese nationals age 15 and older. A 70 percent completion rate was achieved, yielding 3,483 completed personal interviews (1,577 males and 1,906 females). Earlier studies on the same topic had been conducted in 1987, 1991, and 1996, thereby allowing for comparison of changes in attitudes over time.

Earlier studies involved interviews with adults age 20 and older, but teenagers were included for the first time in the latest study. Accordingly, where comparisons with results from earlier studies are made, data from the latest wave have been recalculated to include only those respondents age 20 and older.

Initially, respondents were asked whether they had ever heard of or seen anything written about AIDS or the HIV virus. 96 percent of respondents replied in the affirmative, a figure unchanged from earlier studies.

Respondents were then asked whether they thought the number of AIDS cases in Japan would increase in coming years. As can be seen in Table 1, a very high 82 percent of respondents thought the number of AIDS patients would increase in Japan. This is a 5 percent increase from the score in 1996, and a 10 percent increase from the figures in 1987 and 1991.

Perception of a future increase in the number of AIDS cases was highest among the young. For example, almost one-third of the 20-29 age group believe that the number of AIDS cases "will increase very much" in Japan. Note also that the low percentages among the elderly for "will not increase/will not increase much" are similar to those of the young, with the "don't know" scores being the differentiating factor. In short, across the entire spectrum of the population there is a perception that the number of AIDS cases will increase, and this concern has increased over the years.

The main reasons given for thinking that AIDS patients will increase in the future were: "sexual behavior of the Japanese has become more liberated" (65 percent); "intermingling with foreign countries has increased" (42 percent); "there is no vaccine or drug cure" (39 percent); "knowledge regarding the prevention of the spread of AIDS is limited" (36 percent); and "it is increasing throughout the world" (31 percent). When asked whether they had a sense of unease in regard to the possibility that they might contract HIV in the future, 75 percent stated that they had no such concern, and only 2 percent had a great concern. Among reasons for not being concerned, 60 percent stated that there is no one in their immediate family or circle of friends who is an AIDS patient or infected with HIV, 30 percent stated that it is a disease of a specific category of people (tokutei no hitobito), and 22 percent claimed to have knowledge of prophylactic methods to protect against infection.

Respondents were shown a number of statements describing different ways in which HIV could be contracted, and were asked their awareness of each of these. Overall, 90 percent or more of the population was aware that HIV/AIDS can be contracted from sexual intercourse with an AIDS sufferer or an HIV-infected person, or from needles used by such persons. 60 percent were aware that HIV/AIDS can be contracted by using the shaving razors and toothbrushes of an AIDS sufferer or an HIV-infected person, and 52 percent were aware that HIV/AIDS can be passed from an infected mother through breastfeeding. Awareness that HIV/AIDS can be contracted from breastfeeding was higher among women than men (55 versus 47 percent). This was also the case for AIDS being contracted at birth: More women (73 percent) were aware than men (63 percent). Respondents were asked how they would react if they discovered that their spouse had contracted HIV/AIDS. 55 percent said they would continue living their life as they had done in the past, 20 percent would continue living under the same roof but compartmentalize their lifestyle, 5 percent would move to a different dwelling, and 3 percent would divorce. 17 percent gave a "don't know" answer. Although the odds of one's spouse contracting HIV involuntarily are slight, the responses show a remarkable degree of tolerance. What's at work here? Love? Favoring the status quo? Or does life as normal mean hardly seeing one's spouse anyway?

Next, respondents were asked how they would feel if a person with AIDS or an HIV-infected person were to work together with them at their place of employment. Responses were divided. 45 percent stated that they would not be agreeable to this, 40 percent would be agreeable, and 15 percent answered "don't know."

From a multiple choice list of responses, reasons for being agreeable were "discrimination is not good" (65 percent); "they have a right to be able to work" (61 percent); and "the chances of catching the virus are low" (37 percent). Among those unfavorably disposed to having an AIDS patient or an HIV-infected person working with them, 66 percent mentioned the "need to have to always be mindful/anxious"; 36 percent said that "it would have a (negative) influence on the workplace environment"; 34 percent mentioned the "possibility of catching the HIV virus."

Given the relatively small number of AIDS/HIV cases in Japan, the probability of employing a person with AIDS/HIV is likely to be very slight. Nevertheless, the above attitudes about AIDS/HIV in the workplace may serve as useful background information for the handling of other cases involving employees with other diseases or handicaps. (By law, companies with over a certain minimum number of employees are required to employ a fixed percentage of handicapped persons.)

In the survey, respondents were next asked whether they used a condom as a preventive measure against contracting AIDS. As might be anticipated, there were significant differences by age group in response to this question, with usage being highest among those in their 20s and 30s, and declining with age. Because the birth control pill has only recently been approved for general use in Japan by the government, condom usage remains the main method of birth control in Japan, and Japan has a high ratio of condom usage compared with other advanced economies. Accordingly, although the question asks specifically about using a condom for prevention against contracting AIDS, given the relatively high percentage figures for condom usage in the older population (see Table 2), we can reasonably presume that many respondents simply answered about condom use in general. Otherwise, the data would indicate that Japan has an interesting group of swinging oldies!

Among those not using a condom, 69 percent stated that they don't use a condom because their partner does not have AIDS or HIV. 7 percent mentioned not wanting to wear a condom, while only 2 percent said condoms were difficult or embarrassing to buy. (Condoms of varying colors and textures are openly sold in stores such as Condomania.)

Finally, respondents were asked what role Japan should play internationally in the fight against AIDS. Interestingly, the perceived No. 1 international role was "assistance to foreigners living in Japan who are AIDS sufferers or infected with HIV" (53 percent). This was followed by "assisting the overseas activities of nongovernment and volunteer organizations" (31 percent); "international cooperation via research targeted at developing drugs and treatment methods for AIDS" (30 percent); and "assistance in the provision of information to AIDS patients/those infected with HIV living in foreign countries" (30 percent).

What conclusions can we draw? First, compared with other advanced countries, Japan at this stage remains relatively little affected by HIV/AIDS, even though some health experts believe that the reported HIV/AIDS figures may be on the low side. Second, HIV/AIDS is perceived by the general public as a problem primarily caused by and affecting foreigners, not Japanese. According to government reports on AIDS/HIV cases in Japan, around 15 percent of male cases and over 50 percent of female cases are foreigners (presumably females working in the sex industry). But it is Japanese males who for the most part are contracting HIV/AIDS within Japan (and also while traveling overseas), and thus HIV/AIDS will increasingly become a Japanese problem.

Third, there is a role for IT in the international fight against HIV/AIDS. There is also likely to be an opportunity in Japan for an i-mode-type advisory service directed at the young. In general, youth have little appetite for receiving admonitions from elderly doctors (the average age of a general practitioner is 59). The ability to anonymously access information and advice on various sexually transmitted diseases and thereby avoid possible loss of face could be of major help in reducing the spread of these diseases and in persuading young persons to visit a doctor for a checkup or treatment if necessary. @

William Hall ( is president of Isis Research Japan Ltd., which provides market research and consulting services in Tokyo.

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