Development of a partnership between academia, community, and government in response to the 2022 mpox outbreak in Japan.

Objectives　In response to the steady rise in the number of cases of mpox in nonendemic countries, starting with an outbreak in the United Kingdom in May 2022, the World Health Organization declared a public health emergency of international concern on July 23, 2022. As of November 13, 2022, seven cases of mpox have been reported in Japan.Methods　A community engagement approach was applied to prevent the spread of mpox in Japan.Results　A tripartite partnership between academia, community, and government (ACG) was established to promote multisectoral communication between vulnerable communities, medical personnel involved in diagnosis and treatment, public health specialists at public health centers, epidemiologists at the National Institute of Infectious Diseases (NIID), and government and public administration. Through information sharing, this ACG partnership can translate accurate information into effective infection control measures.Conclusion　By developing and maintaining the ACG partnership, an environment will be created that allows an immediate response to future public health crises affecting vulnerable communities. This Practice Report describes the process of establishing an ACG partnership.

Workplace factors associated with willingness to undergo human immunodeficiency virus testing during workplace health checkups.

BACKGROUND: To examine workplace factors associated with willingness to undergo human immunodeficiency virus (HIV) testing during workplace health checkups. METHODS: This cross-sectional study used an Internet-based self-administered questionnaire to obtain data from a pool of 24,287 Japanese workers. Binary and multiple logistic regression analyses evaluated the association between workplace factors and HIV testing. Data were adjusted for sex, age, marital status, education, and history of HIV testing. RESULTS: We gathered information from 4,143 (17.1%) respondents, of whom 1,129 (27.3%) were willing to be tested for HIV as part of a workplace health checkup. The participants were 20-59 years old. Approximately half of the participants were male (49.9%), half were married (48.9%), and half had completed higher education (47.6%). Workplace hepatitis testing was offered to 15.6% of the respondents, and most participants underwent health checkups without their colleagues (52.1%) at a medical facility (60.2%). Willingness to undergo HIV testing was positively correlated with having an increased risk of occupational blood exposure (vs. not at risk, adjusted odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.41-2.15) or working in medical and welfare roles (vs. manufacturing, OR: 1.40, 95% CI: 1.07-1.84). The presence of occupational health staff at the workplace (vs. their absence, adjusted OR: 1.35, 95% CI: 1.16-1.59) and hepatitis testing (vs. not testing, adjusted OR: 2.02, 95% CI: 1.66-2.44) increased willingness to undergo HIV testing. CONCLUSIONS: A pilot HIV-testing program involving individuals at an increased risk of occupational blood exposure and undergoing hepatitis tests in workplaces providing occupational health staff support is recommended.

Associations between Drug Use and Sexual Risk Behaviours among Men Who Have Sex with Men in Japan: Results from the Cross-Sectional LASH Study.

This study assessed drug use patterns among men who have sex with men (MSM) in Japan, and evaluated their potential associations with sexual risk behaviours. Between September and October 2016, study subjects were recruited through a cross-sectional survey (LASH: Love Life and Sexual Health) using a geosocial networking application for MSM. Of the participants, 25.4% (1756/6921) reported ever having used drugs, and 11.3% (780/6921) reported having done so in the past six months. Those who used drugs were more likely to have greater knowledge of HIV/sexually transmitted infections (STIs). Drug use in the past six months was independently associated with each of the following sexual risk behaviours in the same period: (i) six or more sexual partners (adjusted odds ratio [aOR] = 2.70, 95% confidence interval [CI]: 2.30-3.17); (ii) condomless anal intercourse (aOR = 2.88, 95% CI: 2.43-3.42); (iii) group sex (aOR = 2.60, 95% CI: 2.22-3.05); and (iv) sex work (aOR = 2.30, 95% CI: 1.67-3.16). These results suggest that MSM in Japan who use drugs are more likely to report sexual risk behaviours, while also having greater knowledge of HIV/STIs. Supporting MSM to minimise the harm from drug use may be helpful in reducing HIV transmission among this priority population.

Characterizing changes in drug use behaviour following supply shortages of 5-MeO-DIPT, alkyl nitrites and new psychoactive substances among men living with HIV in Japan.

BACKGROUND: Since 2005, Japan has incrementally banned a range of new psychoactive substances (NPS), including 5-MeO-DIPT (5MO; foxy) and alkyl nitrites (AN; rush, poppers) that have commonly been used among men who have sex with men (MSM). After the largest ban in 2014, these drugs were reported to have disappeared from the domestic market. Given that 5MO/AN/NPS use has been prevalent among men living with HIV in Japan, a population largely comprised of MSM, we sought to characterize changes in their drug use behavior following the supply shortages. METHODS: Using data from two waves of a nationwide survey of people living with HIV in Japan in 2013 and 2019-20 (n = 1042), we employed multivariable modified Poisson regression to identify correlates of self-reported reactions to the 5MO/AN/NPS shortages and changes in drug use behavior in 2019-20 vs. 2013. RESULTS: Among 391 men (96.7% MSM) surveyed in 2019-20, following the supply shortages, 234 (59.8%) stopped using 5MO/AN/NPS, 52 (13.3%) retained access to the supply, and 117 (29.9%) used substitute drugs: most commonly, methamphetamine (60.7%). Individuals who used substitutes were more likely to report unprotected sex (adjusted relative risk [ARR]=1.67; 95% confidence interval [CI]: 1.13-2.47) as well as low (ARR=2.35; 95% CI: 1.46-3.79) and lower middle (vs. upper middle to high) socioeconomic status (ARR=1.55; 95% CI: 1.00-2.41). The prevalence of past-year methamphetamine use (ARR=1.93; 95% CI: 1.11-3.35) and self-reported uncontrollable drug use (ARR=1.62; 95% CI: 1.07-2.53) were significantly higher in 2019-20 compared to 2013. CONCLUSION: Following the supply shortages, approximately one-fifth of our participants used methamphetamine as a substitute for 5MO/AN/NPS. Methamphetamine use and perceived uncontrollable drug use also appeared to have increased at the population level after the supply shortages. These findings suggest a potentially harmful substance displacement effect of the aggressive ban. Harm reduction interventions are needed in this population.

Assessment of HIV prevalence among MSM in Tokyo using self-collected dried blood spots delivered through the postal service.

BACKGROUND: Men who have sex with men (MSM) are at high risk of HIV infection. However, there are only few data on HIV prevalence in MSM in Japan. The objective of this study was to explore the HIV prevalence in MSM at Shinjuku 2-chome, a well known gay quarter in Tokyo. METHODS: MSM directly collected the dried blood spot (DBS) self-collection HIV test kit from a drop-in center in Shinjuku 2-chome between August 2015 and December 2016. The participants collected their own blood by finger-prick and anonymously posted the kit to the laboratory. The participants accessed the study website and checked the results of their tests using unique ID and password. DBS was soaked in phosphate buffered saline overnight and the eluted sample was examined by the fourth generation HIV Ag/Ab test of LUMIPULSE (FUJIREBIO INC.), and followed by HISCL (Sysmex Corp.) when the first assay was positive. The result was defined provisionally positive if both were positive. RESULTS: A total of 1702 HIV test kits were distributed and 1403 DBS were returned (return rate: 82.4%). Since 20.2% of participants collected the test kit more than once, the estimated number of actual test kit users was 1120. Based on the results of the test kit, 34 cases were provisionally diagnosed with HIV. The estimated prevalence was 3.04% (95% confidence interval: 2.03-4.04). Of these 34, 24 (70.6%) were later confirmed to be HIV-positive in the hospital, while the remaining 10 were lost to follow-up. Among the participants, 34.5% received HIV test for the first time. Especially in those aged 20-29, 46.0% were first time HIV testers. CONCLUSIONS: The prevalence of HIV infection in the study population was 3.04%. The high collection suggested a demand for this type of testing in MSM. The test should be expanded further to difficult-to-reach or hidden populations. TRIAL REGISTRATION: This study was registered with the University Hospital Medical Information Network Clinical Trial Registry in August 20th, 2015 (Registry number: UMIN000018699 ).

High prevalence of quasi-legal psychoactive substance use among male patients in HIV care in Japan: a cross-sectional study.

BACKGROUND: Syndemics of illicit drug use and HIV remain as significant public health issues around the world. There has been increasing concern regarding the rapidly growing market of new psychoactive substances, particularly in Asia. In response, the Japanese government has increasingly banned such substances in recent years. We sought to identify the prevalence and correlates of use of quasi-legal psychoactive substances among people living with HIV/AIDS (PLHIV) in Japan. METHODS: Data were derived from a nationwide survey of PLHIV conducted at nine leading HIV/AIDS care hospitals between July and December 2013. The prevalence and correlates of the use of quasi-legal psychoactive substances (e.g., synthetic cannabinoids, cathinone derivatives, etc. that had not been prohibited from using at the time of survey) among male participants were examined using multivariate survey logistic regression. RESULTS: Among 963 study participants, the majority (95.3%) were male. The most commonly used drug among men was quasi-legal psychoactive substances (55.3% ever and 12.8% in the previous year). In multivariate analysis, the lifetime use of tryptamine-type derivatives (i.e., 5-MeO-DIPT or N,N-diisopropyl-5-methoxytryptamine) (adjusted odds ratio [AOR]: 2.42; 95% confidence interval [CI]: 1.36-4.28) and methamphetamine/amphetamine (AOR: 3.59; 95% CI: 2.13-6.04) were independently associated with recent quasi-legal psychoactive substance use. CONCLUSIONS: In our sample of male PLHIV in Japan, quasi-legal psychoactive substances were the most commonly used drugs. Individuals who had ever used tryptamine-type derivatives or methamphetamine/amphetamine were more likely to report recent quasi-legal psychoactive substance use, suggesting a potential shift in drug use patterns from regulated to unregulated substances among this population. These findings indicate a need for further research to examine implications for HIV care.

[A survey comparing the route of HIV transmission reported by patients to their physicians and the self-reported "actual route"].

OBJECTIVES: To clarify the proportion of HIV patients who inform their physicians of the actual route of transmission and the factors related to non-disclosure in order to improve conditions to support open disclosure in healthcare settings. METHODS: We conducted an anonymous self-completed online questionnaire between September and December 2010 of people with HIV. The data from 237 subjects living in Japan were analyzed. To identify factors causing patients to not be truthful to their physicians, odds ratios and confidence intervals (CIs) were calculated, with "discrepancy between the actual route of HIV transmission and the route reported to the physician' as a dependent variable, and sex, age, residential area, route of transmission, presence or absence of consent to undergo HIV testing, time since being diagnosed as infected with HIV, and favorability of physician responses as independent variables. RESULTS: The proportions of patients who had informed their physicians of actual and false routes of HIV transmission were 75.1% and 17.7%, respectively. Among subjects reporting homosexual contact, 97.5% reported the actual route. On the other hand, among subjects reporting heterosexual contact, only 64.3% reported the actual route while 28.6% actually had homosexual contact. Furthermore, 47.4% of the subjects who reported their routes of HIV transmission as sexual contact, but did not disclose whether the contact had been homosexual or heterosexual, actually had homosexual contact. On comparing subjects who had evaluated responses from their physicians favorably and unfavorably, the proportion of those reporting a false route of transmission was significantly higher in the latter group, with the odds ratio being 2.51 (95% CI: 1.26-5.01). CONCLUSION: AIDS Surveillance Committee reports of HIV and AIDS cases attributed to a homosexual route of infection may be lower than actual numbers. The most common factor related to non-disclosure was the perception of unfavorable responses from physicians; improvements to support open disclosure are thus needed.

[Factors associated with HIV testing behavior and intention among men who have sex with men (MSM) in Japan].

OBJECTIVES: This study aimed to explore the factors associated with HIV testing behavior and intention among men who have sex with men (MSM) in Japan. METHODS: A self-administered survey was distributed to gay bar customers in Tokyo, Kanagawa, Osaka, Aichi, Fukuoka, and Okinawa from 2010 to early 2011. A total of 4,572 completed surveys were received by mail. Participants were divided into 3 groups based on HIV testing experience and intention: Group 1 consisted of those who had tested at least once in their lives; Group 2 consisted of those who had never tested but had an intention to test; and Group 3 was made up of those who had never tested and had no intention to test. Associations between groups were assessed using Chi-square goodness-of-fit test and multiple logistic regression. RESULTS: Among the 2,809 respondents reporting anal sex within the previous six months, 131 HIV-positive cases were excluded. Data were thus analyzed from 2,678 MSM; 61% (n=1,633) of participants reported having taken an HIV test at least once in their lives, 20.2% (n=541) reported never having tested but with an intention to test, and 18.8% (n=504) reported never having tested and had no intention to test in the future. Knowledge about HIV and testing, STI history, sexuality, academic background, knowing someone with HIV, and condom use in the past six months all correlated with HIV testing experience when compared between groups 1 and 2. Conversations on HIV/AIDS with friends, lifetime STI history, knowing someone with HIV, conversations on HIV/AIDS with a sexual partner, and older age were all correlated with intention of taking an HIV test when compared between groups 2 and 3. CONCLUSION: Among gay bar customers, those who know someone living with HIV and those who had conversations with friends about HIV/AIDS in the previous six months were more likely to take an HIV test compared to those who had never tested but had an intention to test. Thus, although knowledge about HIV and testing is important, knowing someone with HIV and having conversations about HIV/AIDS with friends are also important. Such factors should be considered in promoting the uptake of voluntary HIV testing among MSM.