1. Keio University of School of Medicine
Clinical Psychologist
Yuriko Yanaga Ph.D.
Clinical Issues in HIV Treatment Age Makes a Difference Aging and PWH in Japan

2. Content HIV in Japan: History and Background Ageism and Prevention
Aging in Japan: Background
HIV in Japan: History and Background
Ageism and Prevention
PWH+50: Physical ;Psychosocial Issues
Approach

3. Aging and Japan
Aging Progress: Rapid progress of aging out of four : over 65
Change of Family Style and Value on the Family 　Extended family ⇒ Nuclear family ⇔ Peer Support
Aging is very serious social issues now in Japan

4. National Institute of Population and Social Security Research
rapid aging Progress
40 years later
2055
2015
Male
Female
Male
Female
National Institute of Population and Social Security Research
127,110,000
65+：1/4
89,930,000
65+：1/2.5

5. HIV/AIDS in Japan
(1)Brief history of HIV in Japan 1985：the first Japanese AIDS case Over 90% of PHA: Hemophiliacs infected by HIV contaminated blood products “AIDS Panic” Strong stigma on HIV/AIDS, the patient with HIV ⇒still strong impact on the mind of Japanese (2) People with HIV (PWH) in 2014 (Male:1091; Female: 50)
Transmission
Number ％
Heterosexual Contact
291
20.00
Homosexual Contact
941
65.62
Drug 5
0.30
Mother to Infant 1
0.06
Other 27
1.88
Unknown
169
11.78
Total
1434

6. reported number of PWH the newly diagnosed
18.2％：50～59 + Over 60

7. Ageism and prevention
Youth oriented; Low attention on the people of mid-adult and the elderly
Poor access to HIV information

8. PWH AGE 50+:BACKGROUD Keio University Hospital
N=22 (Male；MSM:63%) Age Average: CD4:491.3/㎕ (75-854) HIV-RNA Load TND:19(86%)
Years after HIV found: 　　　　　　 （3month-14yr) Employed：17 (77％） Clinical Dx & medication: Adjustment disorder: Depressive mood: 1
REF: ACC (AIDS Clinical Center)
N=42 (Male 36;Female 6)
Age 70＋ : : Over 80:2 CD4:437.0 /㎕（ ）
HIV Load TND：27(64%)
Sugino Y, Ikeda K et al The Journal of AIDS Research 　　Vol.16 No
We followed the 200 PWH so far, and now 70 PWH are visiting our HIV treatment center. ACC over 3000 patients

9. Physical/Psychosocial issues
Complications⇒Future risks
　 Hyperlipidemia :18（81％）　　　　 　 Diabetes : 7（31％） Kidney dysfunction : 5 (22 %) Malignancy : 1 ( 0.45%)
Lack of Social Support/ Social isolation None of Key person：13（ 59%） ⇒ Live Single ：11/13（84％）
Disclosing of Sexuality in the public: None
Disclosing of HIV status: Only Family: Only Partner: None:11（50％）
ACC
Diabetes : 8（19％） Malignancy : 4 ( 9.5%) Kidney dysfunction : 2 (4.7%)
None of Key person：13 (30%)
⇒ Live single:11/13 (84%)
ACC amputation of leg　　liver disease (including hepatitis B and hepatitis C　　　Over 90, demintia
Future concern :Physical ＋ Psychological Care Home care; Palliative care

10. Future concern : Home care; palliative care
Study :PHW’S expectation on the future social care
130 PWH; 40＋; Single living (50%)　Fujita Y, Koyama M, et al The Journal of AIDS Research Vol.17 No <Physical condition>
Level 1:Need of support for medication Level 2:Need of partial physical care
　　　　　　 Level 3:Need of total physical care　　
Home Care
Pre-condition: Primary caregiver
Organizational Care Pre-condition: Staffs’ understanding HIV

11. Study :Level of Readiness of Palliative care for PWH
Survey of Readiness of Palliative Care by Medical professional in HIV Treatment center and hospice in Japan Kojima K, Yanaga Y, et al National Research in Ministry and Health
(1)Palliative Care in HIV treatment centers Response Rate: 59.8%( 226/378) ⇒ 55(24.3%) Centers: Experience of palliative care for PWH with cancer (2)Hospice Care Response Rate: 62.8%( 179/285) ⇒ 17(9.5%) Hospice: experience of hospice care for PHW (7.3%) Hospice: experience of hospice care for PHW with cancer

12. (1) Palliative Care in HIV treatment Centers: “Difficult issues”

13. (2) Hospice Care: “Difficult issues”

14. Conclusion
Triple Stigma on PWH＋50 　HIV/AIDS, Ageism, Sexuality Social isolation is significant among PWH ＋50, ⇒Future obstacle to QOL
Approach Prevention (1) Message to the people ＋50 for prevention from HIV infection (2) Physical prevention from exacerbating complications ⇒Strengthen regular check-up
2.　Better Care system in Home care; Palliative care ⇒Filling the Gap between the expectation of PWH 　　　and the quality of care
　　 Training the medical professional; Developing Community-based Care in advance

15. Acknowledgements
Keio University School of Medicine Dr. Satoru Iwata Dr. Naoki Hasegawa Ms. Yuko Tomaki
People with HIV/AIDS
Japan Foundation for AIDS Prevention (JFAP)