Japan could become one of the first countries in the world to end the HIV epidemic, says the president of Gilead Sciences Japan, Kennet Brysting. The idea for now could seem a little too ambitious, but it is not entirely unrealistic, given that the availability of medicines that can prevent transmission of HIV. Drugs are not the cure, but control over the spread of virus to the point where the disease is no longer a major public health threat.

What Is The Role Of Preventative HIV Medicines?

Gilead's have two key drugs, Truvada and lenacapavir. These two are playing a crucial role in prevention. Truvada is taken as a daily pill, while lenacapavir requires two injections per year. It can make the virus undetectable in infected individuals and prevent transmission to those who are not infected yet. In trials, lenacapavir showed 100% efficacy in preventing HIV infections. This is why it is describe as "almost a vaccine".

In 2024, Japan also approved Truvada for HIV prevention, but the country has yet to approve lenacapavir for the same. Until now, people in Japan had been importing generic versions of Truvada or purchasing it from clinics that source it from overseas.

HIV In Japan

Up until now, Japan reported around 25,000 HIV infections, whereas 669 new cases were reported in 2023. For seven consecutive years, the number of new infections remained under 1,000. The downward trend thus shows that the virus has been controlled, however, getting to zero new infections remains the ultimate goal.

Brysting too acknowledged that simply having effective drug is not enough. What is important is to have a proper implementation, access and healthcare support to make sure that these treatments are widely available and effective.

What Are The Challenges In Implementation?

The biggest challenges is testing rates. There is a need to increase testing rates. At this very moment, around 86% people infective with Japan have been tested, but the goal is to increase it up to 95%, with an ideal goal of 100%. Without widespread testing, many infected people may not even know that they are infected and it could transmit the virus.

Another measure issue is the cost of preventative medication. While Japan's health insurance covers treatments for diseases, it does not cover preventative drugs. Those who purchase Truvada for prevention, pay around $470 per month. Some clinics in Tokyo offer generic alternatives too, which is cheaper, but they are not ideal.

Better Healthcare Support

Brysting expressed concern that individuals importing medications might not be consulting doctors regularly, which is essential for monitoring HIV status and overall health. Truvada users need to be tested for HIV initially and every three months, along with screenings for other infections and kidney function checks. Without proper medical supervision, there is a risk of misuse and inadequate protection.

Gilead is in discussions with Japanese authorities to improve access and insurance coverage for Truvada, and progress is being made. Japan has shown efficiency in approving critical medicines, as seen during the COVID-19 pandemic when Gilead’s remdesivir was approved in just three days.

What Is The Way Ahead?

Gilead at this moment is not only focused on HIV and hepatitis C, but also expanding into oncology with innovative treatments like CAR-T cell therapy, which strengthens a patient's immune system to fight cancer.

However, Japan’s strict approval processes can slow down drug availability. Phase 3 clinical trials often need to be conducted within the country, and Japan tends to approve medicines much later than other regions. For instance, Truvada was approved for prevention in Japan 12 years after the U.S. and nearly 20 years after its approval for treatment. inancial factors also play a role. The Japanese government adjusts drug prices annually, often reducing them, which can make long-term investment challenging for pharmaceutical companies.

A 40-year-old woman developed a rare and potentially life-threatening “flesh-eating” infection of the genital and perineal region about a week after shaving her bikini line and an application of herbal preparation.

The woman, a mother of four with a BMI of 39 kg/m², was diagnosed with Fournier gangrene, a severe form of necrotizing fasciitis that can rapidly destroy soft tissue around the genitals and perineum.

She spent 77 days in hospital undergoing treatment, wound care and reconstruction. Complete wound healing was documented by Day 121, reported doctors from King Saud University in Riyadh, Saudi Arabia, in the American Journal of Case Reports.

Severe Pain and Swelling

The woman presented with worsening pain and swelling of the left labia that had spread toward the area above the pubic bone. She also experienced vomiting and lower abdominal pain.

About a week before admission, she had undergone perineal shaving and had a herbal preparation applied to her vulva by an alternative practitioner. She had not used antibiotics or other topical treatments before seeking medical care.

On admission, her heart rate was elevated at 140 beats per minute, although she had no fever and her blood pressure remained normal. Examination showed marked tenderness and swelling, while laboratory tests indicated a significant inflammatory response.

Samples taken from the infected wound grew several different types of bacteria (E. coli, Klebsiella pneumoniae, and Enterobacter cloacae). However, no bacteria were detected in her bloodstream.

Multiple Surgeries

After doctors diagnosed her with Fournier gangrene, they performed urgent surgical debridement to remove the affected tissue.

She subsequently underwent multiple surgical re-explorations and negative-pressure wound therapy.

She was initially given broad-spectrum antibiotics, and later amoxicillin-clavulanate.

What Is Fournier Gangrene?

Fournier gangrene is a rare, rapidly progressive form of necrotizing fasciitis affecting the perineum and external genitalia. It is often described as a “flesh-eating” infection because bacteria can cause rapid destruction of skin and underlying soft tissue.

The condition is much more common in men, but women can also develop it. Reported male-to-female ratios range from 10:1 to 40:1.

Risk factors include diabetes, obesity, immunosuppression, malnutrition, peripheral vascular disease, kidney disease, malignancy and other serious underlying conditions. However, Fournier gangrene can also occur in people without the classic risk factors.

Local trauma, disruption of the skin barrier and invasive or cosmetic procedures can potentially provide an entry point for infection.

Why Fournier Gangrene Can Be Missed in Women

The researchers noted that Fournier gangrene may be underrecognized in women, partly because its symptoms can initially resemble a gynecological condition.

Early symptoms may include severe pain, swelling, redness and tenderness around the genital or perineal area. As the infection progresses, tissue destruction, skin discoloration, blisters or systemic signs of severe infection may develop.

"While men are more frequently affected, women should not be assumed to be at low risk. Severe or rapidly worsening pain and swelling around the genital or perineal region, particularly when accompanied by systemic symptoms, warrants urgent medical evaluation," the team said.

Treatment generally requires emergency surgical removal of dead and infected tissue along with broad-spectrum antibiotics and intensive supportive care. Survivors may require multiple operations, prolonged hospitalisation and complex wound management.

How Serious Is Fournier Gangrene?

Fournier gangrene is a medical emergency. Although rare, it can progress rapidly and become fatal if treatment is delayed.

The condition has historically been associated with high mortality, with risk increasing when diagnosis and surgical treatment are delayed.

A 62-year-old man in Australia died after his urgent heart surgery was cancelled twice. A state coroner later found that failures in an overworked health system contributed to his death.

Petar Josipovic had been diagnosed with moderate-to-severe aortic regurgitation and coronary artery disease. He was placed on the cardiothoracic surgery waiting list at Royal Adelaide Hospital as a Category 1 patient, meaning his surgery was expected to take place within 30 days.

However, his operation, initially scheduled for August 14, 2023, was cancelled twice to make room for higher-priority emergency patients. It was eventually rescheduled for August 25.

The day before his surgery, Josipovic was rushed to the emergency department after his condition deteriorated and suffered a cardiac arrest.

Doctors performed an emergency aortic valve replacement and coronary artery bypass surgery, but he developed severe complications and died about three weeks later in the ICU.

Coroner Says His Death Was Linked To Failures In Healthcare System

South Australian State Coroner David Whittle found that Josipovic's death was potentially preventable and called for a sweeping independent review of how cardiac surgery patients are assessed, listed and managed while waiting for operations.

The coroner, however, did not attribute the repeated cancellations to individual negligence. “I do not make any finding that the decisions that led to the cancellations were the result of ill-will or lack of due care,” Whittle said.

Instead, he said a health system under immense pressure was bound to have systemic failures. He also said that staff were unable to recognise the extent of the patient's deterioration before it was too late.

Also read: Stopping Statins After 75 May Not Raise Death Risk In Low-Risk Adults: The Lancet Study

Why Was An Urgent Cardio Surgery Repeatedly Delayed?

The inquest heard that reduced intensive care capacity had put additional pressure on the cardiothoracic service. ICU capacity reportedly fell from 24 beds to 16 following the move to the new hospital site, meaning urgent procedures could be postponed when beds were unavailable.

Josipovic's case also highlighted the problem of keeping track of patients whose condition worsens while they remain on surgical waiting lists.

The coroner noted that Josipovic had been advised to attend the emergency department on occasions but did not do so. This meant clinicians did not have the opportunity to physically reassess his condition and fully appreciate how much his risk had increased.

Also read: More Indians Face Twin Burden of Hypertension and Diabetes After 40: Why Preventive Healthcare Is Important

Coroner Recommended Urgent Changes

Whittle recommended an independent external review of cardiothoracic surgical listing practices, covering the patient's entire medical history from referral and assessment to waiting-list management and hospital resources.

He also called for standard guidelines across South Australia's health networks so staff know exactly what advice to provide when patients waiting for surgery report that their condition is worsening.

The case has renewed concerns about what happens when hospitals have to balance urgent operations against limited beds and resources.

The case has also highlighted an important issue. For patients waiting for time-sensitive procedures, a delay is not always simply a longer wait. In some cases, the patient's clinical condition can change while they remain on the list

US President Donald Trump recent move of overhauling childhood vaccine recommendations has sparked debates across the globe. Several US states have opposed to it too, refusing to follow Washington’s lead.

Trump signed the executive order on August 10, calling for federal childhood vaccine recommendations to be narrowed to vaccines routinely recommended for children against 11 diseases, down from 18 at the end of 2024.

It also calls for the measles, mumps and rubella (MMR) vaccine to be given as three separate shots and says childhood vaccines should, where feasible, be administered during separate medical visits.

The order also asks states to review their school vaccination requirements. But there is an important question here: states, not the federal government, generally set vaccine requirements for children attending schools.

Which States Are Refusing To Follow Trump’s Directives?

At least 29 states and Washington, DC, had already rejected at least some federal vaccine guidance, choosing instead to rely on recommendations from medical organisations such as the American Academy of Pediatrics (AAP).

Among the states that have opposed Trump's order and maintained independent, medicine-based vaccine policies are Colorado, Maine and Washington.

Colorado has gone further by passing legislation allowing the state to rely on organisations including the AAP, American Academy of Family Physicians and American College of Obstetricians and Gynecologists when setting its childhood vaccine policy, rather than depending on federal CDC directive.

Maine has also said it will continue following guidance from established medical and public-health organisations instead of Trump's order.

Washington state officials said its school vaccine requirements have not changed for the upcoming academic year and remain based on recommendations from trusted medical and public-health experts.

This means Trump's order does not automatically change every child's vaccination schedule across the United States. The legal and political battle is likely to continue state by state.

Also read: What Trump’s Childhood Vaccine Order Means: When Will It Take Effect?

Trump's MRI Proposal Sparked Controversy

The MMR vaccine has been used as a combined vaccine for several decades. Trump’s order calls for separate measles, mumps and rubella vaccines, once they become available in the US.

Public-health experts have warned that separating vaccines could mean more appointments, higher costs and more chances for children to contract these infections as they may remain unvaccinated between doses.

The World Health Organization has also defended established immunisation schedules, saying they are based on decades of scientific evidence and proven clinical trials

The timing is particularly controversial as the US has already recorded 2,465 confirmed measles cases in 2026 as of August 6, according to the CDC.

Also read: Kennedy Announces Food Policy Reforms Under Trump’s MAHA Agenda: What Has Been Proposed?

Countries React To Trump's Vaccine Recommendation

The UK has taken a stand against Trump's newly proposed vaccine recommendation. On August 12, the UK's Medicines and Healthcare products Regulatory Agency (MHRA) reaffirmed that childhood vaccines are safe and effective and said there is no evidence that vaccines cause autism.

“The benefits of vaccination are endorsed by the NHS and all major UK public health and paediatric bodies,” said Dr Alison Cave, chief safety officer at the MHRA. She urged parents to follow NHS vaccination has an guidance.

The UK's routine schedule continues to use combination vaccines, including the six-in-one vaccine, and since January 2026 has included a universal two-dose chickenpox programme through the combined MMRV vaccine.