Introduction: Though approximately 210, 000 Brazilian immigrants are living in Japan and an increasing number of Latin Americans have been reported to the National HIV/AIDS Surveillance Committee, few studies have been done nor has any HIV/AIDS prevention or care program targeting this population been developed to date. This paper describes the results of a baseline survey of a quasi-experimental intervention trial toward developing effective HIV/AIDS prevention programs among Brazilian immigrants in Japan.
Materials and Methods: Using a self-administered questionnaire, HIV/AIDS-related knowledge, attitudes toward people with HIV/AIDS, HIV testing, and sexual behavior was surveyed among the immigrants in 1996. They were recruited consecutively at the Brazil Bank or Brazilian shops located in 4 separate areas where Brazilian immigrants are concentrated.HIV/AIDS-related knowledge was surveyed also among Japanese subjects randomly sampled for comparison. Response rates were 92.8% (n=451) and 66.6% (n=1, 391), respectively.
Results: Only 21% of the Brazilian respondents were aware of free and anonymous HIV testing at public health centers as opposed to >60% of the Japanese, suggesting that Brazilian immigrants were marginalized in terms of HIV-related information and services from mainstream Japanese society. Furthermore, less than half of them were aware of appropriate timing for HIV tests, HIV-STD synergism, and sexual transmission of chlamydia. Regarding HIV tests, 6.8% have been tested in Japan, and 36.8% of those who have not had an HIV test felt that they should be tested. Importantly, a great majority of the Brazilian immigrants fear that they would be fired or even deported if they were found to be HIV-positive, discouraging them from taking an HIV test. Behavioral risk was noted to be relatively high as 60% of the respondents indicated they have had casual sex and more than 30% of them reported that they never or rarely used a condom during casual sex.
Conclusion: Brazilian immigrants are potentially at high risk toward HIV infection due to a lack of access to HIV-related information and services in Japan and on account of sexual behavior.

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Objective: This study was designed to measure the knowledge level and sexual behavior patterns related to HIV among the male homosexual population, which is facing an increase in infections.
Materials and Methods: A questionnaire was distributed to 301 participants in HIV prevention workshops and gay club members. A total of 255 individuals (84.7%) responded.
Results: Among those who used sex venues, 40.5% had engaged in anal intercourse, while a significantly smaller portion (19.2%) of those without experience at venues reported having had anal intercourse (p<0.05). There was, however, no difference in the rate of condom usage. A significantly high proportion (22.6%) (p<0.05) of users of sex venues indicated that they always carry condoms, but this group included a significantly lower percentage of persons who thought they would always be capable of communicating the need to use a condom to their partners (p<0.05). A comparison of those with an active interest in AIDS (193), those with a passive interest (21), and those with no interest (25) showed experience of anal intercourse at 32.1, 9.5, and 12.0%, respectively . Although this did indicate greater experience among those with active interest, there was no difference in the rate of condom usage. The 60 persons who had interactions with HIV-positive persons exhibited more accurate knowledge about HIV than the 185 who had no contact. Those who knew HIV-positive persons also showed significantly higher levels of intercourse experience (45.0%) and condom usage (77.8%), (p < 0.05).
Conclusion: The study demonstrated the importance of prevention education which emphasizes communication skills as well as the importance of creating a social environment which does not isolate HIV-positive persons.

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Objective: In this study, we categorized patients with HIV (PWH) and AIDS (PWA) according to the CD4 cell count, and separately analyzed the costs of outpatient and inpatient care for the hemophiliac and non-hemophiliac patients in each category.
Materials & Methods: HIV infection was classified into 4 stages reflecting severity of disease. The stages were AC-1 (n=28), CD4 cell count ≥500; AC-2 (n=45), CD4 count 200-500; AC-3 (n=34), CD4 count less than 200; and AIDS patients (n=46). The costs of outpatient and inpatient care for PWH and PWA were investigated on the basis of receipts for monthly statements of insurance payments. The costs of medication were calculated item by item for each patient, and the mean cost of medical care per day was calculated for the 4 disease stage groups by dividing the costs by the actual number of days of outpatient or inpatient care. In the patients receiving anti-HIV drugs, we calculated the costs of AZT and ddI, and determined the percentage of the total cost of medical care occupied by anti-HIV drugs.
Results: The monthly cost of medical care for the non-hemophiliac patients receiving anti-HIV drugs was 2.5 times and 3.5 times higher in the AC-2 and AC-3 groups, respectively, than that in the AC-1 group of patients not receiving anti-HIV drugs. The cost of anti-HIV drugs accounted for more than 60% of the total cost. A similar tendency was also observed in the hemophiliac patients, and anti-HIV drugs accounted for 40-60% of the cos of medical care excluding the home-care costs of coagulation factor products . The life-time cost for HIV/AIDS treatment with anti-HIV drugs was estimated to be 13, 440, 000 yen.
Conclusion: The cost of outpatient care increased as the disease progressed; especially, in terms of the use of anti-HIV drugs.

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Objective: The trends in the number of AIDS death cases reported to the HIV/AIDS surveillance were analyzed.
Materials & Methods: HIV/AIDS surveillance data were available from 1989 through 1998. We tried to link reported AIDS cases with reported death cases (key code: date of diagnosis of HIV/AIDS, sex, and nationality).
Results: The cumulative reported number of deaths among Japanese nationality and non-Japanese residents in Japan up to the end of 1998, was 466 and 106, respectively. The number of deaths reported had increased monotonically since 1989, and peaked in 1996, and since then began to decrease. The number of reported deaths in 1998, in particular, was reduced to about 62% compared with that in 1997. About 90% of all reported deaths were able to be linked individually. Upon examination of the year of death for the cases diagnosed as AIDS after 1989, it was suggested that some of the deaths might not be included in the surveillance report.
Conclusion: The trend in the number of reported AIDS deaths was shown. It was suggested that the rate reported to the Surveillance was not complete

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Objective: A future prediction of HIV/AIDS in Japan (except HIV infection through blood coagulation factor products) was done.
Materials & Methods: The numbers for HIV-infected persons and AIDS cases until 2003 were predicted using HIV/AIDS surveillance reports until 1998, the estimated coverage rate of HIV infection, proportion of HIV-infected persons with recent anti-HIV therapies, and the latent distribution from HIV infection to AIDS.
Results: The prevalence of HIV-infected persons was estimated to be 7, 300 in the population of Japanese nationals and 700 in that of non-Japanese nationals by the end of 1998, and was predicted to be 15, 400 in Japanese and 700 in non-Japanese by the end of 2003. The cumulative numbers for AIDS cases were reported to be 925 in the population of Japanese nationals and 361 in that of non-Japanese nationals by the end of 1998, and was predicted to be 3, 300 in Japanese and 900 in non-Japanese by the end of 2003.
Conclusion: The numbers predicted for HIV-infected persons and AIDS cases until 2003 were shown.

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Objective: We have noticed that HIV-infected patients often show hyper-IgE immunoglobulinemia in their clinical course, and examined the correlation between serum IgE and clinical condition of HIV infection.
Materials & Metheds: (1) We compared serum IgE concentration between 24 HIVseropositive hemophiliacs and 13 HIV-seronegative hemophiliacs. (2) We evaluated the correlation between serum IgE levels and clinical condition of HIV infection in 32 HIVinfected patients (mean age: 33.4 years old, male: 29 cases, female: 3 cases).
Results: (1) The number of patients with a high-degree of hyper-IgE immunoglobulinemia over 1, 000 U/ml was greater for HIV-seropositive hemophiliacs than HIV-seronegative hemophiliacs. (2) The number of patients diagnosed as having AIDS was significantly higher for patients with hyper-IgE immunoglobulinemia than normal IgE immunoglobulinemia. The count of blood CD4-positive cells significantly decreased in patients with hyper-IgE immunoglobulinemia.
Conclusion: These results suggest that HIV infection may affect serum IgE levels in patients with HIV infection and that hyper-IgE immunoglobulinemia may indicate the progression of HIV infection.

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