Recreational Drug Use and Related Social Factors among HIV-Positive Men in Japan

This study aims to determine the relationship between recreational drug use in HIV-positive males in the past year and socio-economic factors and/or social support networks in Japan. 

A national online survey in a cross-sectional study was conducted by HIV Futures Japan project from July 2013 to February 2014. Of the 1095 HIV-positive individuals who responded, 913 responses were determined to be valid; responses from the 875 males were analysed. A total of 282 participants used addictive drugs (32.2%) in past year. 

New psychoactive substances were used by 121 participants (13.8%), methamphetamine or amphetamine by 47 (5.4%), air dusters/sprays/gas by 31 (3.5%), 5-methoxy-N,N-diisopropyltryptamine (5MeO-DIPT) by 16 (1.8%) and cannabis (1.0%) by 9. 

Multiple logistic regression analysis was performed with the use of alkyl nitrites, addictive drugs, air dusters and thinners, which are low illegality, as dependent variables. We found that the odds ratio (95% confidence interval) for use among participants with full-time and temp/contracted/part-time employees compared to management/administration professions were 2.59 (0.99-6.77) and 2.61 (0.91-7.51). 

Also, a correlation was observed between alkyl nitrites and new psychoactive substances and usage rates in people engaged in few HIV-positive networks. It is necessary to develop targeted policies for drug use prevention and user support among HIV-positive men and to support and provide care for drug users who are isolated or have a narrow HIV/AIDS support network.

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By:  Togari T1, Inoue Y1, Takaku Y2, Abe S3, Hosokawa R4, Itagaki T5, Yoshizawa S6, Oki S7, Katakura N8, Yamauchi A9, Wakabayashi C10, Yajima T3,11.

• 1 Faculty of Liberal Arts , the Open University of Japan , Chiba , Japan.
• 2 Japan Network of People Living with HIV/AIDS , Tokyo , Japan.
• 3 Division of Health Management , TIS Inc ., Tokyo , Japan.
• 4 School of Nursing , Nagoya City University , Nagoya , Japan.
• 5 Accelight Inc ., Tokyo , Japan.
• 6 ANGEL LIFE NAGOYA , Nagoya , Japan.
• 7 Faculty of Nursing , Kyorin University , Mitaka , Japan.
• 8 Kobe City College of Nursing , Kobe , Japan.
• 9 School of Nursing , Tokyo Medical University , Tokyo , Japan.
• 10 Department of Health Sciences , Saitama Prefectural University , Koshigaya , Japan.
• 11 PLACE TOKYO , Tokyo , Japan.
• AIDS Care. 2016 Feb 17:1-9. 

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Reluctance to Care for Patients with HIV or Hepatitis B/C in Japan

BACKGROUND:

Healthcare workers are faced with various professional dilemmas in the workplace, including at times, a reluctance to care for particular patients. This study investigated personal attitudes and factors influencing Japanese nurses' reluctance to care for patients infected with HIV, Hepatitis B Virus (HBV), or Hepatitis C Virus (HCV).

METHODS:

Participants completed an anonymous online survey focusing on potential attitudes towards hypothetical patients, awareness of infection risk and their confidence in using precautions to prevent infection. Statistical associations were analyzed using Poisson regression models.

RESULTS:

Regarding personal attitudes, 41 % and 18 % of nurses agreed or somewhat agreed that they would be reluctant to care for a hypothetical patient infected with HIV or HBV / HCV, respectively. Reluctance to care for patients with HIV or HBV / HCV was positively associated with prejudicial attitudes and negatively associated with confidence in personal safety precautions. Hypothetical reluctance to care for patients with HBV / HCV was negatively associated with actual previous experience caring for HBV / HCV patients. Older age among nurses (≥50 years) was positively associated with an increased reluctance to care for hypothetical patients with HIV.

CONCLUSIONS:

Overall, this study suggests that anxiety arising from perceived infection risk and having a prejudicial attitude might affect the acceptance of infected patients, while personal confidence in universal precautions probably mitigates this situation. Improving nurses' confidence in using universal precautions therefore represents a positive measure that can help reduce prejudice and improve the quality of healthcare services in Japan, as elsewhere.

Distribution of responses by HIV or HBV / HCV status

	HIV		HBV/HCV
	n	(%)	n	(%)
Anxiety regarding the potential infection risk from patients with HIV or HBV / HCV
Agree	133	(13)	145	(15)
Somewhat agree	397	(40)	391	(39)
Somewhat disagree	254	(26)	303	(31)
Disagree	186	(19)	139	(14)
Do not know	22	(2)	14	(1)
Confident that I could protect myself from infection when caring for patients infected with HIV or HBV / HCV
Agree	125	(13)	179	(18)
Somewhat agree	359	(36)	403	(41)
Somewhat disagree	253	(26)	231	(23)
Disagree	143	(14)	84	(9)
Do not know	112	(11)	95	(10)
Have you cared for a patient infected with HIV or HBV/HCV during the past one year?
Yes	110	(11)	668	(67)
No	700	(71)	218	(22)
Do not know	182	(19)	106	(11)
Do you believe that a patient infected with HIV or HBV / HCV might be a homosexual, have multiple sexual partners or be a drug user?
Agree	93	(9)	31	(3)
Somewhat agree	294	(30)	99	(10)
Somewhat disagree	261	(26)	330	(33)
Disagree	304	(31)	512	(52)
Do not know	40	(4)	17	(2)
Would you be reluctant to care for a patient infected with HIV or HBV / HCV?
Agree	109	(11)	43	(4)
Somewhat agree	294	(30)	136	(14)
Somewhat disagree	266	(27)	325	(33)
Disagree	271	(27)	466	(47)
Do not know	52	(5)	22	(2)

HBV hepatitis B virus, HCV hepatitis C virus

Full article at:   http://goo.gl/lomDOA

By:  Wada K1, Smith DR2, Ishimaru T3,4.

• 1Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan. kwada-sgy@umin.ac.jp.
• 2School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, Australia. derek.smith@newcastle.edu.au.
• 3Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand. ishimaru@med.uoeh-u.ac.jp.
• 4Occupational Health Training Center, University of Occupational and Environmental Health, Kitakyushu, Japan. ishimaru@med.uoeh-u.ac.jp.
• BMC Pregnancy Childbirth. 2016 Feb 5;16(1):31. 

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Web-Based Cognitive Behavioral Relapse Prevention Program with Tailored Feedback for People with Methamphetamine and Other Drug Use Problems: Development and Usability Study

BACKGROUND:

Although drug abuse has been a serious public health concern, there have been problems with implementation of treatment for drug users in Japan because of poor accessibility to treatment, concerns about stigma and confidentiality, and costs. Therapeutic interventions using the Internet and computer technologies could improve this situation and provide more feasible and acceptable approaches.

OBJECTIVE:

The objective of the study was to show how we developed a pilot version of a new Web-based cognitive behavioral relapse prevention program with tailored feedback to assist people with drug problems and assessed its acceptance and usability.

METHODS:

We developed the pilot program based on existing face-to-face relapse prevention approaches using an open source Web application to build an e-learning website, including relapse prevention sessions with videos, exercises, a diary function, and self-monitoring. When users submitted exercise answers and their diary, researchers provided them with personalized feedback comments using motivational interviewing skills. People diagnosed with drug dependence were recruited in this pilot study from a psychiatric outpatient ward and nonprofit rehabilitation facilities and usability was evaluated using Internet questionnaires. Overall, website usability was assessed by the Web Usability Scale. The adequacy of procedures in the program, ease of use, helpfulness of content, and adverse effects, for example, drug craving, mental distress, were assessed by original structured questionnaires and descriptive form questions.

RESULTS:

In total, 10 people participated in the study and completed the baseline assessment, 60% completed all relapse prevention sessions within the expected period. The time needed to complete one session was about 60 minutes and most of the participants took 2 days to complete the session. Overall website usability was good, with reasonable scores on subscales of the Web Usability Scale. The participants felt that the relapse prevention sessions were easy to use and helpful, but that the length of the videos was too long. The participant who until recently used drugs was satisfied with the self-monitoring, but others that had already maintained abstinence for more than a year felt this activity was unhelpful and were bored tracking and recording information on daily drug use. Feedback comments from researchers enhanced participants' motivation and further insight into the disease. Serious adverse effects caused by the intervention were not observed. Some possible improvements to the program were suggested.

CONCLUSIONS:

The Web-based relapse prevention program was easy to use and acceptable to drug users in this study. This program will be helpful for drug users who do not receive behavioral therapy. After the pilot program is revised, further large-scale research is needed to assess its efficacy among drug users who have recently used drugs.

Below:  Video page screenshot

Full article at:   http://goo.gl/lGDKYC

By:  Takano A¹, Miyamoto Y, Kawakami N, Matsumoto T.

¹Graduate School of Medicine, Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan. ayumi-takano@umin.ac.jp.

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Japan - PornHub 2015 Use Review

Via:  http://www.pornhub.com/insights/pornhub-2015-year-in-review  MT https://twitter.com/pornhub

Kiken Drugs: Current Status of Abuse Among Youth in the Nightlife Areas of Tokyo

The abuse of "Kiken drugs," including synthetic cannabinoids, is a serious and growing social problem in Japan. Kiken drugs is the general term for novel psychoactive substances that have not been designated as illegal by Japanese law. 

The aim of this article is to describe the current status of the abuse of Kiken drugs by youth in the nightlife areas of Tokyo. An anonymous field-based survey was conducted using laptop computers at four dance parties in Tokyo, Japan. The questionnaires were completed by 307 (44% female, mean age 30.9 years) young adults at the dance parties. 

Among the survey participants, 24.4% reported Kiken drug use (herbs 22.8%, powders 7.2%, and liquids 3.3%) in their lifetime. The primary reasons for Kiken drug use were peer pressure (37.3%), and avoiding penalties for possession of illegal drugs under Japanese laws (28.0%). In addition, 61.3% reported obtaining Kiken drugs from close friends. 

Our results clearly suggest that young adults at dance parties have a higher lifetime prevalence of Kiken drug use than the Japanese general population (0.4% reported in 2013). As the social stigma associated with drug use is extremely high in Japan, avoiding illegal drugs prohibited by law by using easily available Kiken drugs may be more socially acceptable among youth in the nightlife areas.

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By:  Shimane T.

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Effect of Educational Leaflets on Knowledge & Attitude to Tuberculosis among Homeless Persons in Tokyo, Japan

SETTING:

Delay in seeking care is one of the critical issues in tuberculosis (TB) control among homeless persons in Japan. Yet knowledge of and attitude towards TB among homeless persons have remained unclear and limited efforts have been made to disseminate information related to TB among homeless persons.

OBJECTIVE:

To evaluate the effect of TB leaflets, produced and distributed to homeless persons by a group of ex-homeless TB patients, and to understand what homeless persons know about TB.

DESIGN:

Self-administered questionnaire was conducted among homeless persons before and after distribution of the TB leaflets. Changes in the responses to each question were also subjected to principal component analysis to group questions into types according to response patterns and identify constructs of TB-related knowledge.

RESULTS:

Results of 88 participants were analyzed. TB knowledge score related to risks and symptoms significantly improved after the intervention (from 54.3% to 70.6%, p < 0.05), while knowledge on treatment cost did not. Two components were identified, namely, the "improvement in TB impression" and "improvement in TB knowledge".

CONCLUSION:

TB leaflets were effective in improving certain aspects of TB knowledge. However, its effect on knowledge regarding treatment cost, which may be crucial in improving delay, was limited and thus the messages need to be revised.

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By:   Kawatsu L, Uchimura K, Watabe H, Kaguraoka S, Kubota Y, Sakakibara M, Ishikawa N.

 

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What Triggers a Diagnosis of HIV Infection in the Tokyo Metropolitan Area? Implications for Preventing the Spread of HIV Infection in Japan

Background

Japan has not succeeded in reducing the annual number of new HIV-infected patients, although the prevalence of HIV infection is low (0.02%).

Methods

A single-center observational study was conducted at the largest HIV clinic in Tokyo, which treats 15% of the total patients in Japan, to determine the reasons for having diagnostic tests in newly infected individuals. HIV-infected patients who visited our clinic for the first time between 2011 and 2014 were analyzed.

Results

The 598 study patients comprised one-third of the total reported number of new patients in Tokyo during the study period. 76% were Japanese MSM. The reasons for being tested which led to the diagnosis was voluntary testing in 32%, existing diseases in 53% (AIDS-defining diseases in 22%, sexually transmitted infections (STI) in 8%, diseases other than AIDS or STIs in 23%) and routine pre-surgery or on admission screening in 15%. 52% and 74% of the study patients and patients presented with AIDS, respectively, had never been tested. The median CD4 count in patients with history of previous testing (315/μL) was significantly higher than that of patients who had never been tested (203/μL, p<0.001).

Conclusions

Only 32% of the newly HIV diagnosed patients were diagnosed because of voluntary testing, and 53% were diagnosed due to presence of other diseases. These results remain unchanged from our previous report 10 years earlier (2000–2004) on newly diagnosed patients at the same clinic. HIV testing has not been widely used by newly diagnosed patients in the Tokyo metropolitan area.

Below:  Comparison of reasons for HIV diagnostic testing in newly diagnosed patients between 2000–2005 and 2011–2014 time periods

Full article at:  http://goo.gl/pdYVPf

By:

Takeshi Nishijima, Misao Takano, Shoko Matsumoto, Miki Koyama, Yuko Sugino, Miwa Ogane, Kazuko Ikeda, Yoshimi Kikuchi, Shinichi Oka, Hiroyuki Gatanaga

AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan

Shoko Matsumoto

Graduate School of Public Health, Teikyo University, Tokyo, Japan

Shinichi Oka, Hiroyuki Gatanaga

Center for AIDS Research, Kumamoto University, Kumamoto, Japan

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Homelessness and Cognitive Impairment: An Exploratory Study in Tokyo, Japan

Homelessness has frequently been associated with neuropsychological impairment. This has been observed using general screening tests for dementia as well as tests of more focal abilities, particularly executive function. Most studies have been of homeless individuals from North America with none reported from Japan.

In this exploratory study we interviewed a sample of 16 homeless adults from Tokyo, Japan, and performed tests of cognitive function, assessed head injury, addictive behaviours (drug use, gambling, alcohol abuse), and recorded details of homelessness history. The cognitive examination involved the Japanese Adult Reading Test to estimate premorbid intelligence quotient, the Wisconsin Card Sorting Test to measure frontal lobe-related cognitive function, and the Mini-Mental State Examination to measure global cognitive impairment associated with dementia.

Among the 16 homeless individuals, 7 (44%) displayed global cognitive impairment. In addition, executive function tended to be poor. In contrast, estimated premorbid intelligence quotient was within the normal range. Substance abuse in general was not at a level to cause clinical concern, although a high level of pathological gambling was observed. There were no associations between cognitive function and clinical and addictive behaviour variables, although associations were noted between cognitive scores and time spent homeless.

The results suggest high levels of neuropsychological impairment in this sample of homeless adults in Japan. Furthermore, cognitive impairment is acquired rather than developmental in origin, and is proportional to the length of time spent homeless.

Full article at: http://goo.gl/O4Mi3z

By: Pluck G1, Nakakarumai M2, Sato Y2.

• 1Quito Brain and Behavior Laboratory, Universidad San Francisco de Quito, Ecuador; Faculty of Policy Studies, Chuo University, Tokyo, Japan.
• 2Faculty of Policy Studies, Chuo University, Tokyo, Japan.

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Increase in Primary & Secondary Syphilis Notifications in Men in Tokyo, 2007-2013

The number of notified syphilis cases in Tokyo has more than doubled in recent years. The number of reported primary and secondary syphilis cases increased from 108 cases (0.8 per 100,000 population) in 2007 to 245 cases in 2013 (1.9 per 100,000 population). 

During this period, the majority of cases was male (905/1,024), and the recent increase among primary and secondary syphilis cases was attributed to the increase among males (90/108 [83%] cases in 2007 to 218/245 [89%] cases in 2013); men aged 20-49 years contributed most to the increase, with those aged 30-34 years having the highest rate in 2013. Male-to-male transmission was the primary route of infection reported, and men who have sex with men (MSM) accounted for nearly 80% of male cases in 2013. 

Syphilis appears to be reemerging in Tokyo, and reducing the risk of acquiring syphilis among MSM aged 20-49 years should be a public health priority in Tokyo.

Via: http://ht.ly/SAWr6 Read full article at (PDF):  https://goo.gl/uYjRrV

By: Sugishita Y1, Yamagishi T, Arima Y, Hori N, Seki N.

• 1Epidemiological Information Section, Tokyo Metropolitan Institute of Public Health. 
  
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Prevalence of Anal Human Papillomavirus Infection and Risk Factors among HIV-Positive Patients in Tokyo, Japan

Oncogenic human papillomavirus (HPV) infection, particularly multiple HPV types, is recognized as a necessary cause of anal cancer. However, a limited number of studies have reported the prevalence of anal HPV infection in Asia. We determined the prevalence, genotypes, and risk factors for anal HPV infection in Japanese HIV-positive men who have sex with men (MSM), heterosexual men, and women.

Oncogenic HPV rate was 75.9% in MSM, 20.6% in heterosexual men, and 19.2% in women. HPV 16/18 types were detected in 34.9% of MSM, 17.7% of heterosexual men, and 11.5% of women. Multiple oncogenic HPV (≥2 oncogenic types) rate was 54.6% in MSM, 8.8% in heterosexual men, and 0% in women. In univariate analysis, younger age, male sex, MSM, CD4 <100, HIV viral load >50,000, no administration of HAART, and having ≥2 sexually transmitted infections (STIs) were significantly associated with oncogenic HPV infection, whereas higher smoking index and corticosteroid use were marginally associated with oncogenic HPV infection. In multivariate analysis, younger age (OR, 0.98 [0.96-0.99]), MSM (OR, 5.85 [2.33-14.71]), CD4 <100 (OR, 2.24 [1.00-5.01]), and having ≥2 STIs (OR, 2.81 [1.72-4.61]) were independently associated with oncogenic HPV infection. These 4 variables were also significant risk factors for multiple oncogenic HPV infection.

Among Japanese HIV-infected patients, approximately two-thirds of MSM, one-fifth of heterosexual men, and one-fifth of women have anal oncogenic HPV infection. Younger age, MSM, ≥2 STIs, and immunosuppression confer a higher risk of infection with oncogenic HPV and multiple oncogenic types.

Read more at:  http://goo.gl/DSydvH

By: Nagata N1, Watanabe K1, Nishijima T2, Tadokoro K3, Watanabe K2, Shimbo T4, Niikura R1, Sekine K1, Akiyama J1, Teruya K2, Gatanaga H2, Kikuchi Y2,Uemura N5, Oka S2.

• 1Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
• 2AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
• 3BML, Tokyo, Japan.
• 4Ohta Nishinouchi Hospital, Fukushima, Japan.
• 5Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan 
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