At a popular Tokyo restaurant, a dozen young sex workers are engrossed in a heated debate over ways to avoid AIDS and other STDs and still keep their jobs should a client insist on not using a condom. The women are attending a monthly meeting led by former prostitutes and health activists working for the nongovernmental organization Sex Work and Sexual Health (SWASH).

UNAIDS reports that just 12,000 adults out of 127 million Japanese have HIV. But during 2002, Japan recorded unprecedented new infection rates with 301 new cases of AIDS and 595 HIV cases. Health experts say this number could increase to 50,000 by 2010 because of a booming sex trade (estimated at $13 billion annually), declining condom use, lack of an effective government awareness program, increased sexual activity among young people and the low status of women in Japanese society.

According to Masako Kihara, an AIDS expert and adviser to the health ministry, more than 60 percent of the newly infected are in their teens or 20s. Numerous surveys demonstrate that most men and women in their 20s do not use condoms.

Kihara points to a lack of AIDS education for young people, whose ignorance about the subject she describes as "frightening." AIDS education in primary and middle school, which began just last year, focuses on eliminating HIV discrimination rather than teaching safe sex, AIDS activists complain.

Activists and some academics also highlight a culture that discourages female assertiveness. "A woman initiating the issue of HIV with their partners and asking them to use condoms would appear rude and challenging, an image she would want to avoid," said Yasuko Muramatsu, professor of women's studies at Gakugei University in Tokyo.

Meanwhile, Kihara says that without an effective government program, "all signs in Japan point to higher HIV rates in the future."

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