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.

In a significant breakthrough for faster diagnosis of tuberculosis -- the world’s most infectious disease --, the World Health Organization (WHO) has recommended tongue swab tests.

The new recommendations come as many people with TB do not produce sputum, but are contributing to transmission. The swab tests may not only expand access to testing but also enable early and timely treatment that can help break chains of TB transmission.

The updated guidance also includes recommendations for the use of near point-of-care molecular tests - the nucleic acid amplification tests (NPOC-NAATs) for drug-resistant TB and pooling of sputa as a diagnostic strategy for the initial detection of TB and drug resistance.

“The WHO has just issued recommendations on new near-point-of-care (NPOC) tests for the diagnosis of #TB; easy-to-collect tongue swab samples to expand access to testing; & a cost-saving sputum pooling strategy to increase testing efficiency for TB & RR-TB,” Tereza Kasaeva, Director - WHO department on HIV, Tuberculosis, Hepatitis, in a post on social media platform X.

“These new recommendations mark a major step toward making #TB testing faster and more accessible,” she said, while calling on countries to roll out the guidelines to close diagnostic gaps.

What Are Tongue Swabs

Tongue swabs are new, readily available, and easy-to-collect specimens for use with NPOC-NAATs and low-complexity automated NAATs (LC-aNAATs) for the initial detection of TB, with and without drug resistance.

The global health body recommends using the low-complexity automated NAATs as initial diagnostic tests in adults and adolescents with signs and symptoms of lung TB.

However, in cases where respiratory samples such as sputum (expectorated or induced), tracheal aspirate, and bronchoalveolar lavage (BAL) cannot be obtained, tongue swabs may be used as initial diagnostic tests for TB.

Tongue swabs may be collected by trained personnel or self-collected with guidance from trained personnel.

Dr Rakesh PS, from the International Union Against Tuberculosis and Lung Disease (The Union), in a LinkedIn post mentioned individuals having no or minimal symptoms, and often cannot present respiratory specimens.

"Tongue swabs offer a practical way to include this otherwise “missed” group in the diagnostic pathway. By enabling testing of individuals who would otherwise be excluded, tongue swab–based testing can enhance the efficiency of active systematic screening," Dr. Rakesh said.

"Tongue swabs are a strategic alternative when obtaining a respiratory specimen is difficult or not possible -- and, when used appropriately, they can strengthen our fight against TB," he added.

What Are NPOC-NAATs

NPOC-NAATs are swab-based molecular tests for TB detection that can produce results from a primary sputum or tongue swab sample in less than one hour. These tests use instruments that can be battery-operated and do not require specialized infrastructure for use or storage.

The tests can be done in basic peripheral laboratories, such as those that perform smear microscopy, and health clinics, mobile units, or community sites that do not have laboratories.

They can be performed by health care workers with basic technical skills because they do not require laboratory methods like precision pipetting.

What Is Sputa Pooling

In sputum pooling, samples from several individuals are mixed and tested together. It is a proven strategy to improve testing efficiency and reduce costs in resource-constrained environments.

Global TB burden

While being preventable and curable, TB remains a top infectious killer, with an estimated 10.7 to 10.8 million new cases and 1.23–1.25 million deaths in 2024, as per WHO.

The infectious disease disproportionately affects low- and middle-income countries.

While TB incidence rates have shown a slight, uneven decline since 2015, the overall burden remains high, with 30 countries accounting for 87 percent of global cases, led by India, Indonesia, China, the Philippines, and Pakistan.

An increasing number of the National Health Service or the NHS UK doctors are now choosing to practise privately. This has happened at the backdrop of mounting pressures and burnout that reshaped the landscape of general practice in England. According to a recent BBC report on Care Quality Commission (CQC), data found a sharp rise in doctors registering to work outside the NHS.

In the five years to the end of 2025, the CQC received 1,238 new registrations for "independent consulting doctors" in England. This is a 212 per cent increase as compared to 396 doctors registering to work independently over the five years. Between 2024 and 2025, registrations rose by 58 per cent.

Independent consulting doctors provide care privately, either in person or online, across a range of specialties including general practice, skin conditions, women’s health and aesthetics.

"You Don't Have Time To Go To The Toilet"

Dr Yvonne Girgis-Hanna is among those dividing her time between NHS and private practice. Speaking to the BBC, she said full-time NHS work had become unsustainable.

“I could not work as a full-time NHS GP,” she said. “The days I do in the NHS, the next day I'm totally wiped out… You might have 30 face-to-face contacts, then extra telephone calls and paperwork. You just don't have time to even go to the toilet.”

She now sees private patients in Essex, charging from £129 for a 20-minute appointment, with options of up to an hour. Longer consultations, she told the BBC, allow for continuity of care reminiscent of the “cradle to grave” model that once defined family medicine.

Demand, she argues, is the central strain on NHS general practice. With practices receiving roughly £120 per patient annually, frequent attenders can stretch resources thin. “If you imagine £120 for somebody that might be presenting 20 times, it is very little,” she said.

Patients Pay For Time And Familiarity

A 2024 LaingBuisson report noted that 13 per cent of GP consultations were private, which is up by 3 per cent two decades ago. This is because, some patients want faster access and longer appointments. Vanessa Ravazzotti, 51, told BBC that NHS wait worsened her symptoms and heightened anxiety. This is when seeing a private GP felt "mentally better". "She knows me; I know her."

Ian Miller, 85, who has arthritis, told the BBC he found short NHS appointments difficult and disliked seeing different clinicians. Private care offered familiarity and focus: “You immediately get down to the problem.”

Greater Autonomy, But Less Affordability

Dr Karen Benson, who works privately from a pharmacy in Hertfordshire, said the environment is calmer. “I haven't got constant interruptions… it's a much more relaxed atmosphere." She said she is better able to offer longer appointments and address the root cause of the illness. However, some patients switch back to NHS for specialist referrals that they cannot afford privately.

Dr Oliver Denton of the British Medical Association (BMA) told the BBC that while it is difficult to pinpoint a single cause, “with growing pressures within the NHS it is no wonder more may be considering looking to work outside the health service.”

The meningococcal B vaccine (4CMenB) is completely ineffective in preventing gonorrhea -- a sexually transmitted infection (STI) --, especially among high-risk groups like gay and bisexual men, according to the results of the world’s largest randomized control trial (RCT).

Gonorrhea is a common bacterial STI caused by the bacterium Neisseria gonorrheae, and is transmitted through unprotected sex.

Even as antimicrobial resistance in gonorrhea has increased rapidly in recent years, Australian researchers explored the efficacy of 4CMenB against the disease.

The large randomized, placebo-controlled trial involving 587 gay and bisexual men showed that the risk of gonorrhea incidence remains essentially the same even after vaccination.

“Across both arms, the gonorrhea incidence was virtually the same -- at around 48 per cent per year, indicating very clearly that the vaccine had no effect on preventing gonorrhea,” said Professor Kate Seib, from Griffith University, in Australia, who led the trial.

In light of the study, the researchers stressed the need to explore other options to combat gonorrhea, such as condoms and regular testing.

The 4CMenB Vaccine

While meningococcal disease (caused by Neisseria meningitidis) and gonorrhea (caused by Neisseria gonorrhoeae) are distinct infections, both are caused by Neisseria bacteria, which share 80-90 percent genetic material.

The bacterium N. meningitidis primarily causes meningitis and septicemia, and observational studies have shown that meningococcal B (MenB) vaccines such as the 4CMenB offer 33-40 percent cross-protection against gonorrhea.

However, the latest study, presented at the Conference on Retroviruses and Opportunistic Infections in Denver, US, found no protection against gonorrhea.

The study “provides strong evidence that the 4CMenB meningococcal vaccine is not effective at preventing gonorrhea in gay and bisexual men who are at high risk of contracting it,” Seib said.

According to the US National Institute of Health, the 4CMenB vaccine is a highly effective, protein-based vaccine designed to protect against invasive meningococcal disease (IMD) serogroup B.

Approved in over 50 countries, it offers 71-95 percent effectiveness in infants and 100 percent in adolescents.

What Is Gonorrhea

Gonorrhea is a common STI, and sexually active people of any age can get the disease and pass it on to partners, and even to their baby during childbirth.

Gonorrhea is the second most common STI caused by bacteria, just behind chlamydia.

As per data from the World Health Organization (WHO), in 2020, there were an estimated 82.4 million new infections among adults globally.

The NIH noted that nearly 1 million new gonorrhea infections occur in the United States every year. About half of these infections occur in people ages 15 to 24.

The symptoms of Gonorrhea in men include:

• White, yellow, or green discharge from the penis
• Pain or burning (possibly severe) when peeing
• Testicular pain and swollen testicles.

Notably, the condition also occurs in women, but up to 50 percent of them won’t experience symptoms. This increases the risk of spread to other partners.

• Common symptoms in women include:
• Unusual vaginal discharge (white or yellow).
• Pain in your lower abdomen or pelvis.
• Pain during sexual intercourse
• Pain when you pee
• Bleeding between periods