Objective : To reveal the prevalence of co-infection with hepatitis viruses in HIV infected patients in Japan. The second objective was to assess the efficacy of HBV and/or HAV vaccination in HIV infected subjects' who are considered eligible for vaccination.
Methods : We studied 263 sexually transmitted HIV infected patients (254 male and 9 female subjects) who were over 16 years old. HBV seronegative patients received the threedose regimen of recombinant HBV vaccine (Bimmugen(R), Kaketsuken) and HAV seronegative patients received the three-dose regimen of tissue cultured HAV vaccine (Aimmugen(R), Katetsuken). After vaccination, anti-HBs and anti-HA levels were estimated in the serum by enzyme-linked immunosorbent assay (ELISA).
Results : Seventeen patients (6.5%) were positive for HBsAg. HBs and HA seropositive subjects were 154 (59%) and 50 (20%) patients respectively. And 4 patients (1.5%) were seropositive for hepatitis C virus (HCV). After three doses of vaccine in seronegative subjects, the overall HBV and HAV eroconversion rates were 43 % and 97%, respectively. Though the mean CD4 cell count (183/mm3) of HAV vaccination non-responders was statistically lower than that (451/mm3) of responders, there was no statistical difference in the levels of CD4 cell counts between responders and non-responders (mean CD4 cell counts were 567/mm3 and 463/mm3, respectively) of HBV vaccination.
Conclusion : Although the number of subjects was small and the duration of observation was short, no relationship was found between CD4 levels and immune responses after HBV vaccination. Thus HBV/HAV vaccination should be provided to all HIV infected patients at any stage who are considered eligible for vaccination, considering that the medication for co-infected patients is troublesome and the routes of transmission are shared.

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Objective: To assess the perception of HIV infection and the need for rapid HIV testing in the general population of Hokkaido.
Subjects and Methods: The subjects were recruited from persons registered with the Hokkaido Newspaper Information Institute using stratified random sampling to obtain a representative sample of the general population of Hokkaido Prefecture. A web-based questionnaire survey was conducted among the subjects in December 2004.
Results: Of the 1, 700 subjects, 1, 451 replied to the survey (response rate = 85.4%). The results showed that many of the subjects were well familiar with the epidemic of or preventive methods for HIV infection but not with the HIV testing per se. Seventy percent of the subjects preferred the rapid test to the conventional testing method. Men and young women preferred HIV testing in health centers on weekends at daytime or on weekdays at nighttime. Seven percent of the subjects were worried about HIV status, while only 3% thought about seeking HIV testing in the past.
Conclusions: The proportion of persons who actually went to HIV testing was small among those who were anxious about their own HIV status. Thus, HIV testing strategies need to be revised to be more convenient for those with anxiety over HIV infection and many others who want to know their HIV serostatus. The strategy should take into account, among others, the age and occupation of potential users, anonymous and confidential counseling, and convenience in time and place as well as provision of information on HIV testing and counseling.

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Objective: To evaluate the workshop program for nurses working in Chugoku-Shikoku regional core hospitals for AIDS, and to clarify regional goals.
Materials and Methods: We analyzed the questionnaire intended for 41 nurses who had participated in the workshops held from Jan. 2003 to Jul. 2004. The questionnaire was arranged to be administered at three points in time; before, immediately after, and at sixmonths after the workshop.
Results: The responses showed that the workshop itself and the program were appreciated by the participants as we found the contents suited their needs. In respect to changes of anxiety, the rate of the anxiety regarding referring to sexual issues increased right after the workshop. We considered this was because participants received more information and so realized the importance of referring to sexual terms in nursing practice for patients with HIV/AIDS (PWHA). It may be important to further develop the program in respect to the issue of “Sexuality”. Other anxieties held by participant nurses decreased right after the workshop ; however, they increased slightly again six-months later, except for the anxiety concerning “inexperience of nursing PWHA”.
Conclusion: Some hospitals with few experiences of caring for PWHA tend to lack information. We found that our training course could help support nurses working at such hospitals. To keep providing information and sharing experiences with these nurses, it is important to continue this workshop program and to build up the networking system for nurses caring for PWHA in this region.

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Objective: The purpose of this thesis was to provide an effective clinical social work practice model for HIV patients based on social constructionism. An example of how to address life problems of HIV patients by transforming their complaints into concrete solutions is shown.
Materials & Methods: The Coordinated Management of Meanings (CMM) theory was used to assess deviance amplifying feedback loops (DAFL), which were then altered by applying Solution Focused Brief Psychotherapy (SFBP) skills. Data were collected through a session with a subject, and the effectiveness of the approach was determined.
Results: Using the assessment framework and SFBP skills, the problems of the client were minimized, becoming minor challenges in his daily life. The assessment framework was useful in determining the recommended intervention point, while the SFBP skills were effective in focusing on this intervention point to promote alternative constitutive rules (cR) and regulative rules (rR). The client was able to control his problems as a result, thus allowing him to return to work. His social adaptation level also increased.
Conclusion: A clear area for intervention was illustrated in this case study. The approach involved minimal intervention in dealing with the client's life challenges, as well as facilitating the development of new social relationships. Such clinical social work practice can therefore be used to re-create and find solutions to complaints related to multiple problems.

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[in Japanese]

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