Abstract
Foreign residents represent an increasing proportion of newly diagnosed human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome (AIDS) cases in Japan, though scant research has addressed this. This study aimed to estimate the diagnosed proportion of people living with HIV/AIDS (PLWHA) among foreign residents in Japan, covering 1990–2017 and stratifying by geographic region of the country of origin. A balance equation model was employed to statistically estimate the diagnosed proportion as a single parameter. This used published estimates of HIV incidence and prevalence, population size, visit duration, travel volume, as well as surveillance data on HIV/AIDS in Japan. The proportion varied widely by region: People from Western Europe, East Asia and the Pacific, Australia and New Zealand, and North America were underdiagnosed, while those from sub-Saharan Africa, South and South-East Asia, and Latin America were more frequently diagnosed. Overall, the diagnosed proportion of PLWHA among foreign residents in Japan has increased, but the latest estimate in 2017 was as low as 55.3%; lower than the estimate among Japanese on the order of 80% and far below the quoted goal of 90%. This finding indicates a critical need to investigate the underlying mechanisms, including disparate access to HIV testing.
Highlights
While the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) undoubtedly remains a disease responsible for a substantial number of deaths, great progress has been made in constraining it [1]
The end of the AIDS epidemic is still far away [6], these declines show a positive association with the Joint United Nations Programme on HIV and AIDS (UNAIDS), which launched its “90-90-90” targets in 2014, aimed at ensuring that 90% of people living with HIV know their status, 90% of infected individuals receive antiretroviral therapy (ART), and 90% of infections under ART benefit from viral load suppression [7]
Japan has no individual registry of HIV-infected individuals, and the present study was premised on an analysis of surveillance data based on physicians’ notification of HIV diagnosis or AIDS cases, in accordance with the Infectious Disease Control Law, Japan
Summary
While the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) undoubtedly remains a disease responsible for a substantial number of deaths, great progress has been made in constraining it [1]. Supported largely by widespread testing and antiretroviral therapy (ART), referred to as treatment as prevention (TasP) [2,3,4], the annual number of AIDS-related deaths worldwide decreased from 1.9 million in 2005 to less than one million in 2016. Incidence of HIV infection decreased, from 2.8 million in 2000 to 1.8 million in 2017 [5]. The latest evidence suggests that having an undetectable viral load on ART can ensure the absence of HIV transmission, referred to as Undetectable = Untransmittable (U = U) [8,9,10], and UNAIDS even aims to achieve “95-95-95” by 2030 [11,12]. As the risk profile of HIV infection is highly heterogeneous, a combined approach is deemed essential, including coordination of globally scaled-up prevention programs, pre-exposure prophylaxis (PrEP), and detection and treatment programs [13,14,15]
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