How HIV infected haemophiliacs in Japan were informed of their HIV-positive status

Disclosing haemophilia at school: strategies employed by mothers of children with haemophilia in Japan

INTRODUCTION

Most children with haemophilia in Japan study in mainstream schools. However, many mothers have difficulty deciding whether to inform teachers of their child's haemophilia because of the accompanying potential discrimination and prejudice, particularly after the press coverage on the HIV scandal in the 1980s.

AIMS

We therefore aim to explore and describe disclosure strategies of mothers of children with haemophilia.

METHODS

A qualitative study was conducted using the modified grounded theory approach to explore disclosure strategies of mothers of children with haemophilia. Semi-structured interviews were conducted with 19 selected mothers (12 children were HIV positive and 7 were HIV-negative).

RESULTS

In the pre-HIV/AIDS crisis period, the kind of strategy employed - full disclosure, conditional full disclosure and partial disclosure - depended on the extent of mothers' fears about mainstream schools refusing admission because of their child's haemophilia. After the HIV/AIDS crisis in the 1980s in Japan, the three categories of strategies employed by mothers of children with haemophilia were limited disclosure, non-disclosure and full disclosure. These depended on mothers' expectations of discrimination towards their child because of the social stigma around haemophilia and being HIV-positive.

CONCLUSION

For children with haemophilia to feel safe attending school, public schools must establish care management and anti-discrimination systems for children with chronic diseases, thus assuring parents of their children's welfare at school.

Sexual activities and social relationships of people with HIV in Japan

Sixty-one Japanese with sexually transmitted HIV were investigated to clarify the state of, and difficulties in, their sexual activities and social relationships. The study revealed the following difficulties in social relationships due to HIV infection. Thirty-one per cent had experienced discrimination or breach of confidentiality. Self-restriction due to anxiety over discrimination was observed in approximately 90%, and the self-restriction score tended to be higher in those who were not employed, those with economic problems, those who were in a relatively poor state of health, those who had developed AIDS and those who had previously experienced discrimination or breach of confidentiality. The experience of discrimination or breach of confidentiality, and the experience of receiving negative support tended to increase as the respondents had a wider emotional support network. About 60% were dissatisfied with their sex lives, and the degree of satisfaction was significantly lower in those who had fewer sexual contacts and those who had a suppressive attitude toward sexual contacts. A low degree of satisfaction with sex life was found to be an important factor that escalates the level of depression or anxiety.

Should we tell the truth? Why families in Japan chose to tell their loved ones they were victims of iatrogenic HIV infection

Japanese families traditionally avoid disclosing diagnoses of terminal illnesses to patients, seeking to protect the patient from emotional pain and shock. Using awareness theory, in this study we aimed to investigate the attitudes toward disclosure among bereaved families of Japanese hemophiliacs with iatrogenic HIV/AIDS. Semistructured interviews were conducted with 34 bereaved family members. Qualitative content analysis centered around three main issues: (a) family attitudes toward physician nondisclosure of HIV diagnosis; (b) family attitudes regarding the consequences of nondisclosure; and (c) family attitudes regarding the impact of nondisclosure on patient-family relationships. Our findings suggest that families favored disclosure because they felt that knowledge of the iatrogenic HIV infection would benefit the patient.

How families in Japan view the disclosure of terminal illness: a study of iatrogenic HIV infection

Physicians in Japan typically do not disclose diagnoses of terminal illnesses to patients, in deference to the wishes of family members. Nonetheless, some evidence indicates that relatives of patients with iatrogenic HIV infection would prefer patient disclosure. We collected survey data from 314 family members in 225 households of hemophiliac patients who died from illnesses related to iatrogenic HIV infection in order to examine current attitudes toward patient disclosure in Japan. Family members reported that the diagnosis of iatrogenic HIV infection was disclosed to the patient by the primary physician in 32.8% of cases, by the family in 8.3% of cases, and not disclosed in 26.4% of cases. The majority of families indicated that the timing of the physician's disclosure occurred too late. Multivariate analysis indicated that families wished that patients had been informed of the diagnosis, despite the stigma associated with HIV in Japan. Furthermore, many families blamed the physician for the infection and fatality in those cases in which the physician did not convey feelings of regret. These results have important clinical ramifications to the practice of disclosing terminal diagnoses in Japan.

History of Public Health Crises in Japan

In Japan, a number of serious public health crises involving environmental pollution, food-borne diseases, and health hazards due to pharmaceuticals (i.e., "Yakugai") have occurred in the past 50 years. Based on the literature, we summarize the initial investigations and the subsequent measures. Some common points emerge: (1) prolonged cause identification, (2) lack of countermeasures after the cause was identified, and (3) discrimination against victims and they contributed to spreading the damage. We identify lack of corporate ethics and ill-timed disclosure of information as the principal problems in Japan's crisis-management systems. Defects in information gathering were common to all of the cases, thus we suggest necessary corrective measures, such as the establishment of a new reporting system for health hazard-related information.

Psychosocial problems of bereaved families of HIV-infected hemophiliacs in Japan

This study sought to investigate the psychosocial difficulties faced by bereaved families of HIV-infected hemophiliacs in Japan, with the goal of clarifying appropriate ways to offer them support. Interviews were conducted with 46 family members from 36 families, and a written survey was mailed to 392 families. Valid responses from 225 families (307 family members) were analyzed (response rate 57.4%). We found that even at a mean 7-9 years after their family member's death, the bereaved continued to express deep feelings of sorrow and grief, and further, expressed strong feelings of resentment, anger, guilt and regret, anxiety over discrimination, and loneliness. Notably, 95% of the mothers endorsed feeling "sorry for giving birth to a hemophiliac child". Additionally, even after their family member's death, approximately 70% of the respondents continued to restrict their daily activities due to stigmatization or anxiety over discrimination. Finally, 59% of the respondents were found to have posttraumatic stress disorder-like symptoms according to the Impact of Event Scale-Revised, and 46% were found, according to General Health Questionnaire-12 (a measure of mental disorder) criteria, to suffer mental health problems. These results indicate that bereaved families of HIV-infected hemophiliacs in Japan have special characteristics and psychosocial needs, and still suffer significant psychosocial difficulties years after the bereavement.