Introduction

Abstract

In 1994, the Japanese Foundation for AIDS Prevention(JFAP) and the University of California at San Francisco's Center for AIDS Prevention Studies(CAPS) initiated a 2-year collaborative research project with funding from the Center for Global Partnership. The emphasis of the project has been on exploring the ways in which Japan and the United States can benefit from each other's experience in AIDS prevention. Three general questions have guided our research: (a) In what areas do the experiences of Japan and the United States overlap sufficiently for them to pursue similar prevention strategies? (b) Can their different experiences, successes, and failures be mutually educational and beneficial? In which specific ways? (c) How can the United States and Japan work together to develop more effective prevention programs for other nations, particularly those in the Asian-Pacific region? Our first task was to bring together experts in AIDS prevention from Japan and the United States to learn more about the past and present trends of the disease in each country and to discuss current prevention policies, programs, and research. At the outset, there was a need to share basic information about AIDS in both countries. Although there has been more scientific and policy research about the disease in the United States than in Japan, there has been little interchange, and experts in neither country were well informed about AIDS prevention in the other country. [For an overview of AIDS policy in Japan, see Feldman EA, Yonemoto S. Japan: AIDS as a non-issue. In: Kirp DL, Bayer R, eds. AIDS in the industrialized democracies. New Brunswick, NJ: Rutgers University Press, 1992:339-60. ] At the first meeting, a multidisciplinary panel of Japanese and American experts in education, epidemiology, social/behavioral research, government/public health, nongovernmental organizations, law, and health policy identified topics of mutual interest. The participants then wrote papers summarizing a specific aspect of AIDS prevention from their national perspective, which were addressed at a second meeting. The papers that developed from these meetings form the basis of this special issue. Together, they summarize what is currently known about AIDS prevention in each country, its successes and failures, and the specific tasks that must be accomplished to build more effective AIDS prevention programs in the future. Bringing together AIDS prevention and policy experts from Japan and the United States has led to several important outcomes. Most American participants, although expert in their own nation's problems, were uninformed about AIDS in Japan, and the same was true for Japanese understanding of AIDS in the United States. This project has served to expand Japanese and United States perspectives, to stimulate new ideas, and to bring about innovative approaches to research. It has facilitated ongoing professional relationships that will engender further collaboration and intellectual exchange as well as program and policy development. More concretely, we have learned that Japan and the United States have many complementary strengths and weaknesses. In Japan, for example, widespread condom use is a tremendous asset in educating the population about safe sexual behavior. Sexually transmitted diseases are generally well controlled, and the centralized government bureaucracy is able to design and implement national programs. In addition, Japan has been forced from the outset to focus prevention efforts on the heterosexual population. Researchers from the United States have shared with their Japanese colleagues the knowledge gained in more than 10 years of the AIDS epidemic about how to efficiently collect data on HIV and AIDS, how to educate the public and caregivers, and how to target AIDS prevention messages. We have also discovered that our mutual strengths are threatened by similar problems: a lack of openness in both nations in discussing important aspects of AIDS prevention such as sex education, fear and prejudice by some in the medical community about treating AIDS patients, and incomplete epidemiologic information. In the collaborative research process, we have each been enriched by expanding beyond the confines of our own national perspective. We hope that our work will lead not only to greater cooperation and understanding between the United States and Japan in AIDS prevention but also to concrete changes in the way prevention is conceptualized and practiced that will result in behavior change and, ultimately, will save lives. Perhaps the greatest lesson learned has been that the prevention of AIDS in Japan and in the United States cannot be truly effective if the problems of other nations are not also addressed. We hope that the forging of institutional links between JFAP and CAPS will benefit those two nations and, as they work more closely together, will become part of the solution to one of the most serious and tragic problems of our time.