The UNAIDS Global AIDS Strategy 2021-2026 has addressed inequalities in the HIV response, and set new targets of 95-95-95 and less than 370,000 new infections by 2025. Global AIDS Monitoring is the annual worldwide survey that assesses the level of achievement of these goals. According to Global AIDS Monitoring 2022, the number of people living with HIV at the end of 2021 was estimated to be 38.4 million, and 1.5 million persons were newly infected with HIV in 2021. The evidence proved that the pace of the declining trend in HIV incidence had been slowed by the COVID-19 pandemic. The HIV epidemic in Japan has been concentrated among men who have sex with other men, with the number of new HIV infections peaking in 2013, and standing at 1,057 in 2021. However, late diagnoses were reported in 30% or more of infected individuals after developing AIDS, and serious concerns exist regarding a significant decline in the number of HIV tests at public health centers, as this can lead to a larger number of late diagnoses.

The achievement of the 95-95-95 targets and HIV incidence are estimated in most countries by the software, Spectrum®, which was developed by UNAIDS, and the level of achievement of the triple 95 was 85-88-92 in 2021, globally. While Japan might be achieving the 95-95-95 targets according to the estimates provided by Spectrum®, there are challenges in collecting epidemiological data for the parameters in Spectrum®, such as incidence rates among immigrants.

The national AIDS prevention guidelines have been updated every 6 years, and the next update is expected to be undertaken in 2024. In order to enhance Japan’s response, the adoption of science-based intervention, such as promoting combination prevention, utilizing digital health, increasing the availability of multiple modes of HIV testing, integrating multiple municipal programs, and facilitating community- and patient-led services should be considered, with the aim of ending AIDS by 2030.

The prognosis for persons living with HIV has improved significantly. Antiretroviral therapy (ART) has previously been used successfully in Japan, with excellent treatment success rates and retention rates. Several factors have contributed to these improved prognoses, including improved management of opportunistic infections, establishment of health systems for HIV care, publication of the ART guidelines, provision of training, and dissemination of HIV care information. Furthermore, the emergence of new, effective, and safe anti-HIV drugs has not only improved treatment success rates, but has also resulted in the introduction of novel concepts and treatment options. It has been proven that patients on effective ART who have undetectable blood levels of HIV-1-RNA do not transmit HIV to their partners through sexual intercourse. This is known as Undetectable = Untransmittable (U=U), a concept that challenges commonly held beliefs about HIV infection. There has also been an emergence of innovative therapies, such as two-drug therapy and long-acting injectable regimens. However, not all steps from HIV infection diagnosis to primary care after ART introduction have been successful. This review summarizes the current status and challenges of HIV therapy in Japan, taking into account the latest findings on ART.

The AIDS Core Hospitals mainly provide medical services to persons living with HIV/AIDS (PLWHA) in Japan. As of the end of 2021, roughly three hundred and eighty hospitals have been developed by prefectural governments, with the participation of medical harm victims of hemophilia. Antiretroviral therapy (ART) is provided to PLWHA mainly at the AIDS Core Hospitals, by physicians who have been screened and designated by local governments, and is supported by excellent national healthcare insurance systems.

According to a nationwide questionnaire survey, in 2021, approximately twenty-eight thousand PLWHA received care at the AIDS Core Hospitals, and the continuation rates of ART and the treatment success rates at those hospitals were more than 95% and 99%, respectively. The results of the survey also revealed that the high treatment retention and treatment success rates were independent of both hospital location and treatment experience. Japan is expected to meet the second and third 95 of the 95-95-95 targets that have been set by UNAIDS. Thus, the AIDS Core Hospitals have contributed to the improvement of the life expectancy and quality of life of all PLWHA in Japan.

In recent years, due to progress in ART, the main purpose of medical care for PLWHA has become the prevention and treatment of complications and comorbidities such as diabetes mellitus, dyslipidemia, and non-AIDS-defining cancers. Most AIDS Core Hospitals also have the role of providing emergency and advanced medical care in the regions where they are located. However, doctors at AIDS Core Hospitals are expected to be responsible not only for ART, but also for management of the other chronic diseases of PLWHA. The amount of effort required for these physicians is too substantial for the quality of medical care to be maintained. It is undesirable, given its intrinsic hospital role, for the AIDS Core Hospitals to address all of the medical issues of PLWHA.

In order to ensure sustainability of the maintenance of the current high success rate of ART, the high dependence of care for PLWHA on AIDS Core Hospitals should be resolved. In the future, the medical care provision system for PLWHA in Japan should be innovated. In particular, it is necessary to shift to a medical service system in which all medical institutions, irrespective of whether they are AIDS Core Hospitals, are engaged in the treatment of PLWHA in cooperation with the AIDS Core Hospitals. In addition, the establishment and maintenance of a nationwide surveillance system to evaluate ART treatment outcomes is also important.

Since the COVID-19 has spread across the country, commercial establishments were temporarily closed or closed in succession and club events were cancelled in the gay community. The mood of self-restraint in behavior, such as avoiding the three Cs (closed, crowded, contact) increased, and there were periods when the city was deserted. The period during which testing opportunities were suspended due to the tight workload at public health centers was relatively short, and the situation has now nearly returned to that before the pandemic, although some centers have shifted to an appointment system for testing. However, the current slow growth in the number of tests is partly due to a sense of self-restraint and a decrease in activities for promoting testing.

For those in the gay community who wanted to be tested but were unable to do so, the six community centers that have been established nationwide and the 10 NGOs that continue to conduct preventive awareness-raising activities targeting MSM have provided testing opportunities through face-to-face and internet publicity, utilizing commercially available postal testing kits. In one province and four prefectures, they have continued to provide testing opportunities in collaboration with private medical institutions. The actual number of users of the provided testing opportunities has been small compared to the total number of MSM, they are reaching the population with high testing needs. Although the postal testing service was the first initiative of its kind in the country, the postal testing company and the NGOs that were involved in each region worked together to provide better follow-up after the test results.

Even amidst the COVID-19 epidemic, PrEP use has increased according to the results of the MSM and gay community survey, and the potential needs for a safe environment and regular testing are growing. In addition, condom-use behaviour has declined since before the COVID-19, and there is a concern that the attitudes of norm bearers regarding safer sex are changing. Therefore, it is necessary to develop preventive awareness-raising in a complex way. To make this a sustainable activity, a system to train and support party health workers working in community centers and communities is needed.

The Ministry of Health, Labour and Welfare reports that approximately 60% of HIV/AIDS cases in Japan are among men who have sex with men (MSM).

Many MSM are unable to tell their peers at school or work, or even their families that they are homosexual or bisexual, and they live their lives hiding who they are and pretending to be “heterosexual” This situation causes stress and has a significant impact on mental health, and previous studies have pointed out that it is associated with risky behavior for HIV infection.

School education has thus far offered limited positive representation of MSM and other sexual minorities. The risk of the same-sex transmission of HIV has not received much coverage in school AIDS prevention education. As a result, sexual minority youths enter young adulthood without the appropriate and prerequisite information that is necessary to protect themselves and others from HIV infection.

Since 2007, the authors have run a non-profit organization to serve MSM and other sexual minorities, with a special focus on their mental and physical health, and on providing a safe space where they can be themselves. The results of a questionnaire survey taken by the organization’s walk-in clients indicate that COVID-19 made visitors more vulnerable mentally, especially among those who live with their parents and have not come out, and among those who have not met others of the same sexuality due to pandemic restrictions.

The number of opportunities for LGBT issues to be addressed in textbooks and teacher training is gradually increasing. However, knowledge and information are still insufficient.

It is hoped that more venues will be created that sexual minority youth can access with peace of mind, and that awareness-raising activities and support systems will be expanded in the future.

The COVID epidemic has had a major impact on the AIDS control measures that were implemented in normal times at domestic health center. In recent years, the development of antiviral drugs and a reduction of the medication burden have made it possible for people with HIV to receive long-term treatment while leading a normal life. However, in Japan, the number of cases reported after the onset of AIDS still accounts for about 30% of all new reports. In addition to raising awareness of prevention, it is necessary to disseminate and strengthen a highly convenient testing system, including for sexually transmitted diseases. At the same time, it is necessary to deepen understanding of the reality of sexual minorities in a diverse society, and to take measures and provide support in collaboration with the community from the perspective of the people concerned. The training of public health and community health workers, who play a key role in countermeasures, will continue to be important. It is expected that sustainable measures will be developed to realise zero new HIV infections so that AIDS countermeasures will not be delayed by emergencies such as emerging infectious diseases and disasters.

Introduction: Poverty is a well-established determinant of health. Equity in health care access for the impoverished is an important public health issue. People in poverty refrain from necessary health care visits due to financial reasons despite their need for medical care. In Japan, several welfare systems support health care access for people in poverty. The Free/Low-Cost Medical Care program (FLCMC) is one of the major systems which had a total of 2.70 million users in fiscal year 2020, which can exempt patients in poverty from out-of-pocket medical expenses. Although FLCMC may remove the financial barrier to health care access for patients in poverty, the backgrounds of users and the potential issues of the FLCMC have not been well-described.

Method: An online FLCMC Research Forum was held to share the descriptive data of patients on the FLCMC using data from the FLCMC Registry Study that have been collected from medical facilities providing FLCMC across Japan. Furthermore, medical social workers reported cases of FLCMC and its potential challenges. The opportunities and challenges of FLCMC were discussed quantitatively and qualitatively.

Results: A total of 249 people attended the FLCMC Research Forum. Data including 138 patients on the FLCMC Registry Study indicated that approximately 40% of the FLCMC users had refrained from health care visits due to financial reasons in the past year. This proportion was not alleviated by the users’ knowledge of FLCMC. Approximately half the users had never consulted anyone about their difficulties, suggesting that there were cases whose social needs were identified and whose social support began in health care facilities. Medical social workers presented several strategies to provide FLCMC services more effectively. They also shared several difficulties and limitations of FLCMC, including the fact that FLCMC cannot cover livelihood expenses, home nursing care, and long-term care services. Furthermore, they shared difficulties in applying FLCMC, especially for uninsured people from foreign countries, from the perspective of medical facilities’ financial management.

Discussion: Three points regarding the opportunities and challenges of FLCMC were identified. First, the FLCMC Registry Study should continue to describe more detailed backgrounds of FLCMC users to support accesses to FLCMC among the impoverished. Second, the financial balance of medical facilities related to FLCMC was required. Third, the role of the FLCMC in the contemporary social security system should be further discussed.

Objective: This study clarifies the interview technique and process using the Expanded Sense of Mission Scale as a useful means for workers’ mental health and positive perceptions towards their jobs.

Methods: The study used an exploratory interview method with full-time workers, 24 of whom were inductively analyzed using a qualitative methodology. In the interview, the results of the Expanded Sense of Mission Scale were presented, and self-interpretation and meaning of work were confirmed. The analysis involved 1) extracting descriptions representing interview techniques from a word-for-word syllabus, sorting them according to their similarities, and making them into categories. 2) The categories of interview techniques were arranged in chronological order, and the interview techniques used for each phase were classified and shown as part of the interview process.

Results: 1) Six interview techniques were identified: building collaborative relationships, structuring and orienting the interview, interpreting the Expanded Sense of Mission Scale and confirming self-perception, optimizing meaning-making at work, focusing on strengths and positive feedback; and life storytelling and reframing of experience. 2) A four-step interview process and the interview techniques used were obtained: creating a psychologically safe relationship; connecting the interview structure with meaning-making at work; presenting and interpreting the Expanded Sense of Mission Scale; and life storytelling and reframing of experience.

Conclusion: The paper discusses these interview techniques and processes using the Expanded Sense of Mission Scale. This interview is based on the collaborative relationship between interviewers and participants, uses an objective index called an Expanded Sense of Mission Scale, and promotes participants’ construction of a new self-image and perceptions of their jobs.

In Japan, cost-effectiveness evaluation was officially introduced to the pricing system in April 2019. The results of cost-effectiveness are used to adjust the official prices of drugs, medical devices, and regenerative medical products. The official guideline for cost-effectiveness evaluation was published, which describes the methodological issues. The guideline must be referred to when manufacturers submit cost-effectiveness data and researchers review them. The guideline consists of 14 chapters, which, especially, Chapters 3 (target population) and 4 (comparator(s)), attract users’ attention because they directly relate to “frameworks of analysis” and their influence on the results of cost-effectiveness. In this paper, we focus on both chapters and explain the background of the description. In our view, the idea that a comparator should be selected from the most replaceable ones is not appropriate if we consider the current Japanese cost-effective evaluation system. In addition, when the results of subgroup analysis are interpreted, we always consider the limitation of the analysis, for example, the inflation of α error and β error, and not discussed based on the P value only. The results, including the clinical views, are deliberately appraised by the committee.

Much of the information found online lacks evidence. Inaccurate medical health information amplifies the anxiety of information recipients and can even cause health crises. In this study, we compared and evaluated the crawled websites of authoritative academic societies and medical institutions and the search results extracted by Google. We used HONcode (Health On the Net Foundation code) for this purpose. Although the information displayed in the search results was highly reliable, the HONcode evaluation score result was low. This indicates that academic societies and national centers must construct websites that can withstand formal evaluation while disseminating accurate medical information.

Objectives: The purpose of this study was to conduct trial interviews with regular workers using the Expanded Sense of Mission Scale developed by the author, clarify the interview technique, and verify the effectiveness.

Methods: 1) Investigation of interview technique and interview process: A verbatim transcript was created from the recorded interview data, and a qualitative descriptive analysis was conducted.2) Development of an interview evaluation scale: A 34-item interview evaluation scale was drafted based on previous research, and a questionnaire survey was conducted. A factor analysis was performed using the maximum likelihood method and Promax rotation, and internal consistency and stability were examined by the retest method. In terms of external criteria for criteria-related validity, we used the Expanded Sense of Mission Scale and Utrecht Work Engagement Scale to obtain the correlation coefficient with the interview evaluation scale.3) Verification of the effectiveness of the interview: A questionnaire survey was conducted before and after the interview and one month later, and the amount of change in the interview evaluation scale, Expanded Sense of Mission Scale, and Utrecht Work Engagement Scale was analyzed. Furthermore, we also analyzed the amount of change in each scale score before and one month after the interview between the intervention group and the control group (without interview).

Results: 1) Six interview techniques were extracted, including “Interpretation of the Expanded Sense of Mission Scale and confirmation of self-awareness”, “Optimizing the meaning of work”, and “Life story and reframing of experiences”, and four stages of the interview process and interview techniques used in each phase were organized.2) We developed an interview evaluation scale consisting of 3 subscales and 11 items whose validity and reliability were confirmed.3) The interview evaluation scale scores were significantly higher immediately after the interview and one month later compared to before the interview. At 1 month after the interview, the intervention group had significantly higher scores on the interview scale than the control group.

Conclusion: The results suggest that interviews using the Expanded Sense of Mission Scale facilitated the construction of a new self-image and gave meaning to the work of the participants, and increased positive emotions and perceptions regarding work.

An Internet questionnaire was conducted to determine the effects of the provision of information on public awareness regarding the drinking water supply. We targeted a total of 700 young people in their 20s and 30s, whose awareness of water supply services is particularly low compared to other age groups. The results indicated that information provision enhanced a sense of ownership, awareness of drinking water supply sustainability, and increased interest in 51.4% of the experimental group. A relationship was found between interest and recognition of water supply service, indicating the importance of raising interest, especially among those with no interest. Conversely, we found that information provision led to both agreement and disagreement on strengthening the financial basis of water utilities. We also found that people do not always understand the fact of a decrease in water tariff income due to the declining population as a risk. Furthermore, by analyzing free description of the reason for acceptance of the water tariff increase, we showed the contents of the PR that should be emphasized in the future.

Objectives: The cost-effectiveness of lifestyle intervention for preventing kidney disease in patients with type 2 diabetes was not fully elucidated.

Methods: We developed the Markov model with a Japanese healthcare payer’s perspective to examine the cost-effectiveness of lifestyle interventions for preventing the development of kidney disease among patients with diabetes. Model parameters, including the lifestyle intervention effect, were derived from the results of the published literatures. The incremental cost-effectiveness ratios (ICER) were calculated from the difference in cost and quality-adjusted life years (QALY) between the lifestyle intervention and diabetes support education group.

Results: The ICER for the lifestyle intervention compared with the diabetes support education was JPY 1,510,838 per QALY.

Conclusions: The results of the present study showed that the lifestyle intervention for the prevention of kidney disease in patients with diabetes would be cost-effective from a Japanese healthcare payer’s perspective compared to the diabetes support education.

Pilot-scale experiments of ozone/biological activated carbon (BAC) process were conducted to reduce disinfection by-products and their precursors, especially trihalomethane formation potential (THM-FP). There were no organic indicators (ultraviolet absorbance (E260), fluorescence intensity, and total organic carbon (TOC)) that were related to the behavior of THM-FP in all treatment processes. Two indicators, E260 and fluorescence intensity, of water after coagulation and sedimentation were used to predict THM-FP after ozonation. It was shown that precursors of dichloroacetic acid and trichloroacetic acid could be controlled using chloroform as an indicator. The ozone consumption per TOC to reduce THM-FP sufficiently was about 0.6 to 1.0 mg/mg C. Bromate formation after ozonation was controlled by feedback control of 0.1 mg/L of dissolved ozone at the inlet of biological activated carbon treatment.