ZONE:

Good AIDS - bad AIDS was the mantra used by the Japanese media in the 1980s to discriminate between haemophiliacs who had contracted HIV through blood transfusions and those who had contracted the virus through sexual contact. As a result of the tainted blood scandal, acknowledgment of men who have sex with men (MSM) as a group vulnerable to HIV infection only began with urgency in the1990s.

Until 1997 there was no official prevention work within the MSM community in Japan, however at that time bathhouse owners were distributing condoms and promoting AIDS awareness, says Tetsuro Onitsuka a founding member of MASHOsaka (Men and Sexual Health Osaka).

"The bathhouse owners were pioneers in AIDS prevention and a big stimulus for the sexual health community to do something for the AIDS cause. Japanese doctors estimate that 90 percent of people with HIV in Japan are MSM and statistics show that infection rates have been increasing since 1997. Somehow it's understandable because society at large is not conscious of the epidemic and nor is the government, even though most of the MASHOsaka budget is from the Ministry Of Public Health and Labour under the auspices of HIV prevention research."

"MASHOsaka was established in April 1998 and it was slow going in the beginning as we didn't know which kind of program would be the most beneficial. We started with small conferences with bathhouse owners and sexually transmitted infection (STI) workshops with gay contacts. We created posters in 1998 and conducted a baseline survey in 1999 which was a challenge because no one had done it here before. Subsequently, in 2000 we launched SWITCH; a testing service incorporated into a regular event. The co-ordination was extensive - 250 tests were done in the first year and 400 in the second," says Onitsuka.

At that time government-run clinics conducted HIV tests but only during business hours. After the third SWITCH in 2002 MASHOsaka helped the Osaka City and Osaka Prefectural governments establish CHARM (Center for Health and Rights of Migrants) which provides HIV tests and counselling in various languages.

The safe-sex message is one that extends to the sex-work industry in Japan. Osaka brothel manager Shusaku Nohara promotes safe-sex in his advertisements for clientele and staff.

"The prospective staff will want to work here for the same reasons the customers will want to use our services," he says. Traditionally the advertisements were in gay magazines - Barazoku, G-Men and Badi - but clients shifted to the Internet in around 2000.

In the early years of this decade, most MSM weren't overly concerned about HIV as most infections were still associated with haemophiliacs in the media.

"I knew of the protection afforded by condoms against transmission of HIV but was unaware of the necessity to use water-based lubricant," says Nohara. "The industry bosses stressed not to talk about condoms. It implied we didn't trust the customer."

A knowledge of MSM demographics is integral to disseminating a relevant safe-sex message, says Nohara.

"The 50-60 year-old clients don't care so much about anal sex. The clients coming to my shop recently though are younger - almost the same generation as the staff, who are mostly in their 20s. More clients are bottoms and condoms are used all the time but before it was the opposite. And the good thing is that the younger clients know more about HIV because of the Internet and as a result there is more anal sex, but it is safe-sex."

In 2002 promoting safe-sex as a business strategy was a new concept that was lucrative as well as safeguarding sex workers' health. However, as "early as 1998 Yukio Cho (Akira the Hustler) had proved it was possible to earn money from safe-sex," says Nohara.

"At an AKTA (an STI information center in Shinjuku-ni-chome, Tokyo) Safer Sex and Gay Business symposium we realised that without safe-sex there would be no sex, so safe-sex became inevitable. The next stage is oral sex. Clients think: 'Why should I use a condom if the risk is low?' but we managed condom use with anal sex so maybe we can do it with oral sex too. It's still a grey area though," Nohara says.

Apart from a desire to facilitate greater awareness of HIV/AIDS most of the prominent people working in sexual health in Japan were connected through a common friend - Teiji Furuhashi. Furuhashi was diagnosed with HIV in 1985 while living in New York City. In the mid-eighties treatment for HIV was not an option in Japan. A founding member of the avant-garde dance group Dumb Type, Furuhashi's disclosure of his HIV+ status to a circle of close friends in 1992 galvanised the community into action.

"From then on time passed more quickly and we started to rush. We knew time was short and anyone who knew Teiji started to do something," says Izumi Kagita, MASHOsaka Community Space DISTA (Drop in Station) director.

It was just before that time, in 1991, that Tetsuro Onitsuka established the Japan HIV Centre with colleagues and friends. They went on to organise the International AIDS Conference in Yokohama in 1994 - a huge event for the sexual health community in Japan. By 1996 a class action filed by the HIV infected haemophiliacs had reached a resolution and PWA (People With AIDS) were receiving a variety of services from the Japanese Ministry of Public Health and Labour. The lawyer responsible for the class action fought for services for all people with HIV regardless of sexual orientation. He argued that the disease didn't discriminate on the basis of sexual preference. He also knew that if he didn't include all people that the partners of haemophiliacs wouldn't get treatment.

"The last thing we can do is interventions in bathhouses," says Onitsuka, and to that end MASHOsaka is translating into Japanese the ACON (AIDS Council of New South Wales') Sex on Premises Code of Practice.

"We are in the process of scrutinising Japanese law to keep the code in adherence with legislation," says Hiroyuki Tsuji, MASHOsaka program director. Legal aspects of the code will be localised, as will the health guidelines; in particular the drug use guidelines will probably be omitted as HIV transmission through intravenous drug use is minimal in Japan.

Tsuji says there are about 30 sex on premises venues in Osaka, including saunas and video boxes with glory holes.

"When we have finished translating the code we will hold a workshop with bathhouse owners to discuss implementation and feedback. We are also preparing a new poster for distribution next year," says Tsuji.

Tetsuro Onitsuka says: "the big bathhouses are less willing to participate than the small ones but it depends on the owners. We want those bathhouses to provide condoms. In some smaller places there are condoms within arms reach but there isn't a uniform policy."

Not showing barebacking in pornography is a guideline in the ACON Sex on Premises Code of Conduct, however as genitalia are blurred or blacked out in Japanese pornography it is less of an issue here than in some other countries. Many people in the gay community categorise manga as fiction and as such outside the parameters of regulation. However, conjecture on barebacking in pornography underscores the need for a code of practice for the gay pornography industry in Japan, which is essentially self-censored.

It has taken a decade to establish the sexual health network Osaka benefits from today. Without federal, Osaka city, and Osaka prefectural government funding this would have been impossible, which highlights the commitment the government has made to limiting the spread of HIV within the MSM community. In the future, however, the focus for MASHOsaka and sexual health organisations throughout Asia is to generate funding specific to the sexual health needs of MSM rather than being grouped under the auspices of general HIV prevention. This will allow sexual health organisations to educate those most vulnerable to HIV infection with outreach methods particular to the lifestyles of those concerned.