Squeezed between stacks of files and computer equipment in a two-room apartment in Tokyo's Takadanobaba area, Chizuko Ikegami and several volunteers are manning the phones. Round the clock, day in, day out, PLACE Tokyo receives calls from people desperately seeking advice after being diagnosed with HIV or AIDS, or people afraid of taking a test in case it turns out positive.
PLACE Tokyo (Positive Living and Community Empowerment Tokyo) is one of a rapidly growing number of so-called civil-society organizations (NGOs and NPOs) addressing social, environmental and other issues in modern Japan.
Among all the thousands of CSOs, providing valuable support for causes from garbage recycling to animal welfare and foreigners' rights, few are as vital as the growing number dedicated to addressing HIV/AIDS. That's because, according to health ministry data, in 2003 the highest ever number of new cases of HIV infection and AIDS were recorded, at 640 and 336, respectively. Added to existing known cases, that took the HIV/AIDS national total to more than 8,600 -- with ministry estimates predicting a rise to more than 27,000 by the end of 2006.
Despite the seriousness of the situation, however, until recently HIV/AIDS was a taboo subject most preferred not to talk about or be involved with.
"One of the main reasons for that was because AIDS is often linked to sex, and people used to automatically think of prostitution," said Ikegami, the founder of PLACE Tokyo. "But AIDS is no different from any other disease. Like cancer, Alzheimer's or SARS, it is an illness that you deal with, with the help of doctors."
Since it was set up in 1994, PLACE Tokyo -- which is primarily funded by donations -- has become one of the best-known organizations in its field. For the past 10 years, its activities have gradually expanded to include helplines, Web sites, pamphleting on safe sex, marketing its Popteen condoms, lecturing on AIDS prevention at schools and universities, and more besides.
"It is our job to help these patients to have a good living environment," said Ikegami. "Whether medically or socially, at home or at school, we need to create a situation in which they can live as they wish, supporting each other."
Over the past decade, a lot has changed, said Ikegami -- mostly triggered by the introduction of Highly Active Antiretroviral Therapy (HAART) for HIV in 1996 in the United States. Though not a cure, these drugs made it possible to control to some extent the progress of HIV and forestall the onset of full-blown AIDS.
"People's image of AIDS used to be a death sentence," said Ikegami. "And in those days, that is exactly what it was. But now, many HIV-positive people can live a lot longer."
As the hopelessness of an HIV-positive diagnosis was eased by the new drugs, and as more people came to understand this wasn't just a lowlife condition, Ikegami said she has seen a distinct change in people's attitudes. When PLACE Tokyo first started, she said, there were very few volunteers, and most hid the fact that they were involved with an AIDS/HIV support group. "Back then, the volunteers were often afraid that people would think they had AIDS," she said.
Now, PLACE Tokyo has 232 volunteers on its books, including doctors, government employees and regular company workers. And according to Ikegami, offers of help show no sign of drying up.
However, it's not only CSOs like PLACE Tokyo that are taking off to fill voids in Japan's civil society. Individuals, too, are increasingly doing their bit to bring about social change. Among them is obstetrician and gynecologist Tsuneo Akaeda.
Twice a month, Akaeda goes on a midnight prowl to clubs in Roppongi and Yokohama. Once a month he goes to a trendy accessory shop in Harajuku during the day. He doesn't like clubbing, nor is he a fashion slave. But there, at young people's hangouts, Akaeda offers free AIDS tests.
"That was the only way I could get these young people to take AIDS tests," said Akaeda. "So many of them have sex without using condoms that, instead of waiting for them to come to me, I decided to dive into the crowd."
Sealed envelope
In a small corner of these venues, Akaeda sets up his medical equipment behind screens to give each person privacy. After he takes a blood sample, all it takes is about 15 minutes before Akaeda hands back the result in a sealed envelope -- making the young people promise to wait until they get home to open it. That way, if they turn out to be positive, they will be in a familiar environment if they go into shock or create a scene.
"If the test proves to be positive, I write down my cell-phone number and ask them to call me," said Akaeda. "Treatment for HIV is very expensive -- about 300,000 yen a month -- though if you have insurance it will usually cover most of that. But most of these young people cannot tell their parents, so they are at a loss and need someone to talk to."
Akaeda regards his initiative as a success, since the number taking his free AIDS tests is gradually increasing, with him now administering around 80 a month. "There are even times," he said, "when so many people appear in one night that I run out of test kits."
So far, though, he said, "Luckily, very few people have tested positive."
But of course, testing for HIV is just the beginning. What is even more important is preventing infection. So, like PLACE Tokyo, Akaeda has also created his own brand of condoms, called Girlsguard. However, his are no ordinary condoms, as Akaeda has put a guarantee on each and every one. If the condom rips during sexual intercourse and the woman gets pregnant, Akaeda will either pay for the abortion or give up to 30,000 yen as a gift to the new baby and its parents.
"Everybody said I was crazy," said Akaeda. "They said that there were bound to be people trying to cheat me and I would go broke. But I was willing to do anything to get people to use condoms."
For Akaeda, though, providing free AIDS tests and selling condoms after he's finished working at his Akaeda Roppongi Clinic is only part of what he does. He's also set up a fund called STAR (Self Trust and Respect) to combat the spread of sexually transmitted diseases and promote sex education among young people. Then there's the Akaeda Medical Research Foundation that he has set up to research women's health issues. Nothing will stop this man from trying to make a difference for the better in a field in which he so strongly believes.
"I may have started all of this on my own," said Akaeda, "but I am not alone anymore. Everywhere I go, people come and ask to help out. Before I knew it, we had all become like one big family. I am definitely not alone anymore in the Japan of today."
