1163
Asia, in which India and Thailand carry by far the heaviest load of HIV infection, there will be 3-0 million people infected by 1995 and several thousand cases of AIDS. HIV-2 infection also exists in India. The long incubation period of 10-12 years implies that HIV infection is still in its early stages in India. There is thus
exceptional opportunity to avert a disaster. India is receiving US$84 million from the World Bank over the next 5 years, plus special funding from WHO, for its national plan for the control of AIDS. What is needed, everyone an
agrees, is to move from paper to action. V.
Ramalingaswami
Japan: Sale of tobacco to minors Japan and 14% of the women were smokers. The prevalence of smoking among men is higher in Japan than in any other developed country. Are there measures being taken to reduce the prevalence? Since 1900 Japan has had an Act for Prohibition of Minors from Smoking. This Act contains four articles: (1) persons aged under 20 years of age (minors) are prohibited from smoking; (2) if these people are caught smoking, tobacco and paraphernalia for smoking shall be confiscated from them; (3) a parent who tacitly permits smoking by his/her child shall be fmed up to ’1000; and (4) anybody who sells tobacco to minors despite the knowledge that the tobacco is for the purchaser’s own use shall be fined Y4000-8000. Is any notice being taken of this law? If so, tobacco retailers should be ascertaining the age of customers who seem to be In
1991, 61 % of men
in
minors and whether the tobacco is for his/her own use. Our experiment, in which a 17-year-old schoolgirl in Omiya and a 14-year-old schoolboy in Tokyo each spent 3 h approaching tobacco retailers for a packet of Mild Seven, indicates that retailers are ignoring the law. Both students were dressed in their summer school uniforms and instructed that, when asked, they were to give their age and to say that the purchase was for their own use. 18 shops were entered in Omiya. In only 1 shop was the student refused tobacco (by a retailer estimated to be in her forties) because of being a minor. In another the student was told, without being asked any questions, to buy tobacco from the shop’s vending machine. In Tokyo, the student was able to buy tobacco freely from 19 out of 20 shops; at the remaining shop he was instructed to buy it from the shop’s vending machine. The age of the retailers ranged widely, with a few being in their teens or twenties. In both areas, more than 80% of the shops had vending machines. Many investigations of this kind have been conducted in the United States. Purchase success rates of 63% have been reported from Massachusetts (DiFranza JR, et al. IAA4A 1987; 257: 3387-89) and of 88 % from Multnomah County, Washington (Thompson B, et al. J Fam Pract 1990; 31:
206-08).
In
King County, Washington, purchase
success
66% before and 58% after tobacco sale to prohibition minors; furthermore, when health authorities made efforts to enforce the regulation, the rate declined to 38% (Lippman ML, et al. Proceedings of the Seventh Conference on Tobacco and Health, Health Department of rates were
Western Australia, 1990: 745-46). Similarly purchase fell from 74% to 39% in Santa Clara County, California, after an aggressive enforcement campaign (Altman DG, et al.JAMA 1989; 261: 80-83). We obtained a higher purchase success rate than those reported from the USA. One reason for this difference is success rate
non-enforcement of the Act, which in turn is due to the existence of the Tobacco Business Law, which "aims to promote the sound development of the Japanese tobacco industry and therefore to ensure stable revenue and to contribute to sound national economic development". In 1990 only 17 cases of violation of the Act were sent to the prosecutor’s office; none of them was prosecuted. The number of cases referred to the prosecutor’s office has varied widely, with peaks of 293 in 1950 and 433 in 1967, but with troughs of under 30 in the 5 years from 1957 to 1962, and a steady decline from 247 in 1972 to today’s numbers. Such swings cannot represent the real trend of the number of violations. The number of prosecutions has remained steady at under 20 per year. The overall picture might in part be due to a lack of effort by the police to expose violations of this law. The prohibition of sale of tobacco is an important measure; the health sector should press for its strict enforcement. Masumi Minowa Hiroshi Satomi
Poland: No sympathy for AIDS patients Despite President Lech Walesa’s promise to intervene, protestors from the village of Jozefow near Warsaw managed to block the opening of a home for HIV-infected infants sponsored by MONAR, the Polish anti-drugs charity. The local population objected on "moral" grounds (that infants should be responsible for the alleged sins of their mothers), through ignorance about how the virus is spread, and because the home might reduce the area’s attraction as a holiday resort. When the MONAR team arrived on April 13 to take over the house, the locals staged a sit-in. The police declined to intervene, explaining later that the MONAR team had not called for police protection and had earlier promised not to open the home against the will of the local population. Eventually, the local authorities prohibited the home, claiming that the house was "technically unsuitable", and that the legal ownership was not clear. MONAR activists and the Polish medical profession generally see this ruling as a
pretext. This event is the second major confrontation over HIV-carriers in two years. In March, 1990, when a rehabilitation centre run by MONAR was transferred to the jurisdiction of the Ministry of Health, local peasants blocked the nearby highway, in protest against rumours that the centre would now admit HIV-carriers. The peasants claimed that AIDS and drug addiction were self-inflicted disorders, and that the inmates in the centre lived in luxury compared with their own conditions. Eventually the Catholic Church intervened, by sending Bishop Alojzy Orszulik, the secretary of the Polish Bishops’ Conference. He attempted to pacify them by stressing that a significant proportion of Poland’s HIV-carriers (some 700 at that time) were victims of inadequacies of the health service, who had acquired the virus through infected blood or inadequately sterilised syringes and transfusion kits. In fact, an increasing number of HIV cases are drugrelated. Poland has a huge drug problem. The growing of poppies for their seed, popular in Polish cuisine, produces as a by-product straw from which opium derivatives can be easily extracted. Furthermore, in the past few months the illegal production of amphetamines has sprung up as a new cottage industry. Vera Rich
Asia, in which India and Thailand carry by far the heaviest load of HIV infection, there will be 3-0 million people infected by 1995 and several thousand cases of AIDS. HIV-2 infection also exists in India. The long incubation period of 10-12 years implies that HIV infection is still in its early stages in India. There is thus
exceptional opportunity to avert a disaster. India is receiving US$84 million from the World Bank over the next 5 years, plus special funding from WHO, for its national plan for the control of AIDS. What is needed, everyone an
agrees, is to move from paper to action. V.
Ramalingaswami
Japan: Sale of tobacco to minors Japan and 14% of the women were smokers. The prevalence of smoking among men is higher in Japan than in any other developed country. Are there measures being taken to reduce the prevalence? Since 1900 Japan has had an Act for Prohibition of Minors from Smoking. This Act contains four articles: (1) persons aged under 20 years of age (minors) are prohibited from smoking; (2) if these people are caught smoking, tobacco and paraphernalia for smoking shall be confiscated from them; (3) a parent who tacitly permits smoking by his/her child shall be fmed up to ’1000; and (4) anybody who sells tobacco to minors despite the knowledge that the tobacco is for the purchaser’s own use shall be fined Y4000-8000. Is any notice being taken of this law? If so, tobacco retailers should be ascertaining the age of customers who seem to be In
1991, 61 % of men
in
minors and whether the tobacco is for his/her own use. Our experiment, in which a 17-year-old schoolgirl in Omiya and a 14-year-old schoolboy in Tokyo each spent 3 h approaching tobacco retailers for a packet of Mild Seven, indicates that retailers are ignoring the law. Both students were dressed in their summer school uniforms and instructed that, when asked, they were to give their age and to say that the purchase was for their own use. 18 shops were entered in Omiya. In only 1 shop was the student refused tobacco (by a retailer estimated to be in her forties) because of being a minor. In another the student was told, without being asked any questions, to buy tobacco from the shop’s vending machine. In Tokyo, the student was able to buy tobacco freely from 19 out of 20 shops; at the remaining shop he was instructed to buy it from the shop’s vending machine. The age of the retailers ranged widely, with a few being in their teens or twenties. In both areas, more than 80% of the shops had vending machines. Many investigations of this kind have been conducted in the United States. Purchase success rates of 63% have been reported from Massachusetts (DiFranza JR, et al. IAA4A 1987; 257: 3387-89) and of 88 % from Multnomah County, Washington (Thompson B, et al. J Fam Pract 1990; 31:
206-08).
In
King County, Washington, purchase
success
66% before and 58% after tobacco sale to prohibition minors; furthermore, when health authorities made efforts to enforce the regulation, the rate declined to 38% (Lippman ML, et al. Proceedings of the Seventh Conference on Tobacco and Health, Health Department of rates were
Western Australia, 1990: 745-46). Similarly purchase fell from 74% to 39% in Santa Clara County, California, after an aggressive enforcement campaign (Altman DG, et al.JAMA 1989; 261: 80-83). We obtained a higher purchase success rate than those reported from the USA. One reason for this difference is success rate
non-enforcement of the Act, which in turn is due to the existence of the Tobacco Business Law, which "aims to promote the sound development of the Japanese tobacco industry and therefore to ensure stable revenue and to contribute to sound national economic development". In 1990 only 17 cases of violation of the Act were sent to the prosecutor’s office; none of them was prosecuted. The number of cases referred to the prosecutor’s office has varied widely, with peaks of 293 in 1950 and 433 in 1967, but with troughs of under 30 in the 5 years from 1957 to 1962, and a steady decline from 247 in 1972 to today’s numbers. Such swings cannot represent the real trend of the number of violations. The number of prosecutions has remained steady at under 20 per year. The overall picture might in part be due to a lack of effort by the police to expose violations of this law. The prohibition of sale of tobacco is an important measure; the health sector should press for its strict enforcement. Masumi Minowa Hiroshi Satomi
Poland: No sympathy for AIDS patients Despite President Lech Walesa’s promise to intervene, protestors from the village of Jozefow near Warsaw managed to block the opening of a home for HIV-infected infants sponsored by MONAR, the Polish anti-drugs charity. The local population objected on "moral" grounds (that infants should be responsible for the alleged sins of their mothers), through ignorance about how the virus is spread, and because the home might reduce the area’s attraction as a holiday resort. When the MONAR team arrived on April 13 to take over the house, the locals staged a sit-in. The police declined to intervene, explaining later that the MONAR team had not called for police protection and had earlier promised not to open the home against the will of the local population. Eventually, the local authorities prohibited the home, claiming that the house was "technically unsuitable", and that the legal ownership was not clear. MONAR activists and the Polish medical profession generally see this ruling as a
pretext. This event is the second major confrontation over HIV-carriers in two years. In March, 1990, when a rehabilitation centre run by MONAR was transferred to the jurisdiction of the Ministry of Health, local peasants blocked the nearby highway, in protest against rumours that the centre would now admit HIV-carriers. The peasants claimed that AIDS and drug addiction were self-inflicted disorders, and that the inmates in the centre lived in luxury compared with their own conditions. Eventually the Catholic Church intervened, by sending Bishop Alojzy Orszulik, the secretary of the Polish Bishops’ Conference. He attempted to pacify them by stressing that a significant proportion of Poland’s HIV-carriers (some 700 at that time) were victims of inadequacies of the health service, who had acquired the virus through infected blood or inadequately sterilised syringes and transfusion kits. In fact, an increasing number of HIV cases are drugrelated. Poland has a huge drug problem. The growing of poppies for their seed, popular in Polish cuisine, produces as a by-product straw from which opium derivatives can be easily extracted. Furthermore, in the past few months the illegal production of amphetamines has sprung up as a new cottage industry. Vera Rich
