JMIR FORMATIVE RESEARCH

Kanamori et al

Original Paper

Web-Based Search Volume for HIV Tests and HIV-Testing
Preferences During the COVID-19 Pandemic in Japan:
Infodemiology Study
Rie Kanamori1, MMedSc; Futaba Umemura2, MMedSc; Kosuke Uemura1, MD; Taiju Miyagami1, MD, PhD; Simon
Valenti1, MD; Nobuyuki Fukui3, BA; Mayumi Yuda3, BE; Mizue Saita1, MD, PhD; Hirotake Mori1, MD, PhD; Toshio
Naito1, MD, PhD
1

Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan2

Department of Sports Medicine and Sportology, Graduate School of Medicine, Juntendo University, Tokyo, Japan

3

Center for Promotion of Data Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan

Corresponding Author:
Toshio Naito, MD, PhD
Department of General Medicine
Faculty of Medicine
Juntendo University
3-1-3 Hongo Bunkyo-ku
Tokyo, 113-8421
Japan
Phone: 81 3 5802 1190
Email: naito@juntendo.ac.jp

Abstract
Background: Research has found a COVID-19 pandemic–related impact on HIV medical services, including clinic visits,
testing, and antiviral therapy initiation in countries including Japan. However, the change in trend for HIV/AIDS testing during
the COVID-19 pandemic has not been explored extensively in the Japanese population.
Objective: This infodemiology study examines the web-based search interest for two types of HIV tests, self-test kits andfacility-based tests, before and during the COVID-19 pandemic in Japan.
Methods: The monthly search volume of queried search terms was obtained from Yahoo! JAPAN. Search volumes for thefollowing terms were collected from November 2017 to October 2018: “HIV test,” “HIV test kit,” and “HIV test health center.”
The search term “Corona PCR” and the number of new COVID-19 cases by month were used as a control for the search trends.
The number of new HIV cases in the corresponding study period was obtained from the AIDS Trend Committee Quarterly Reportfrom the AIDS Prevention Foundation.
Results: Compared to the search volume of “corona-PCR,” which roughly fluctuated corresponding to the number of new
COVID-19 cases in Japan, the search volume of “HIV test” was relatively stable from 2019 to 2022. When we further stratified
by the type of HIV test, the respective web-based search interest in HIV self-testing and facility-based testing showed distinct
patterns from 2018 to 2022. While the search volume of “HIV test kit” remained stable, that of “HIV test health center” displayeda decreasing trend starting in 2018 and has remained low since the beginning of the COVID-19 pandemic. Around 66%-71% of
the search volume of “HIV test kits” was attributable to searches made by male internet users from 2018 to 2022, and the top
three contributing age groups were those aged 30-39 (27%-32%), 20-29 (19%-32%), and 40-49 (19%-25%) years. On the other
hand, the search volume of “HIV test health centers” by male users decreased from more than 500 from 2018 to 2019 to fewer
than 300 from 2020 to 2022.
Conclusions: Our study found a notable decrease in the search volume of “HIV test health center” during the pandemic, while
the search volume for HIV self-testing kits remained stable before and during the COVID-19 crisis in Japan. This suggests thatthe previously reported COVID-19–related decrease in the number of HIV tests mostly likely referred to facility-based testing.
This sheds light on the change in HIV-testing preferences in Japan, calling for a more comprehensive application and regulatory
acceptance of HIV self-instructed tests.

https://formative.jmir.org/2024/1/e52306

XSL• FO
RenderX

JMIR Form Res 2024 | vol. 8 | e52306 | p. 1
(page number not for citation purposes)

JMIR FORMATIVE RESEARCH

Kanamori et al(JMIR Form Res 2024;8:e52306) doi: 10.2196/52306
KEYWORDS
HIV test; infodemiology; self-test; COVID-19; search engine; Japan

Introduction
HIV prevalence in Japan is <0.1% among adults aged 15-49
years, and the cumulative total of people diagnosed and livingwith HIV at the end of 2018 was approximately 30,000 [1]. A
recent study using a national database found that 81.5% of
people living with HIV who were on antiretroviral therapy(ART) had at least one chronic comorbidity [2]. According torecent national statistics, the proportion of people diagnosed
and living with HIV on ART was 86% and 80% as of 2018 [3],lower than the first two 90-90-90 Joint United Nations
Programme on HIV and AIDS (UNAIDS) goals, while theproportion of people living with HIV on ART who are virally
suppressed was as high as 99% as of 2020 [4], reaching the
UNAIDS goal. Evidence has suggested that earlier HIV
diagnosis and linkage to treatment should be the core strategy
in controlling the HIV epidemic [5]; however, the sudden andongoing COVID-19 pandemic has overwhelmed the health caresystem globally and caused severe disruptions in medical service
provision, ranging from elective procedures to routine
surveillance for manageable diseases such as HIV infections[6-11]. Additionally, social distancing measures implemented
early in the pandemic affected people’s access or willingness
to visit health care facilities.
There are concerns that disruptions caused by the COVID-19
pandemic may lead to increased HIV incidence and mortality
and pose challenges to the international community’s goal toeliminate the HIV or AIDS epidemic by 2030 [1]. Reports fromAfrica, Asia, Europe, Japan, and the United States have founda pandemic-related impact on HIV medical services, including
clinic visits, testing, and antiviral therapy initiation [1-6]. In
particular, the number of HIV tests conducted in health centers
in Japan reduced from 142,000 in 2019 to 69,000 in 2020, withthe difference amounting to a 50% decline in the first year of
the COVID-19 pandemic [3]. The number of HIV consultations
performed in public health centers also significantly declinedin the second quarter of 2020 (32,565 tests) compared to thesame period the year before (11,689 tests) [2].
In Japan, voluntary HIV testing is free of charge andanonymous, and offered as a package service bundled with preand posttest counseling at appointed public health facilities bylaw. Although the number of health center–conducted HIV tests
increased steadily and peaked in 2008, a 30% decline wasobserved before the COVID-19 pandemic [8,12]. This ispossibly due to the commercial availability of HIV self-tests inJapan, with the number of dry blood spot HIV self-tests
increasing from 26,000 tests in 2005 to 91,000 tests in 2016
[7,12]. However, the HIV self-testing technique is not yet
approved by the health authorities in Japan.
The internet is a common source of disease- and health-related
information, and internet use influences care initiation and thetreatment decisions of people living with HIV [13]. During thehttps://formative.jmir.org/2024/1/e52306

XSL• FO
RenderX

COVID-19 pandemic, infodemiology studies found thatweb-based search trends for symptoms associated with
COVID-19 coincided with the disease outbreak [14]. Conversly,
the global web-based interest in information on HIV/AIDS careservices decreased [15]. However, the search engine trend for
HIV/AIDS testing during the COVID-19 pandemic has not been
explored extensively in the Japanese population. This study
aims to characterize and compare the trend for web-based searchinterest in HIV testing before and during the pandemic toinvestigate whether there is a change in HIV/AIDS
health-seeking behavior in Japan.
Data from the search engine provided by the Yahoo Japan
Corporation will be used for this study because Yahoo! JAPANis the most visited website in the country, and compared to mostother countries, Japan uses Google less frequently.

Methods
Data Source
To examine the pattern of web-based search interests in HIV
testing before and during the COVID-19 pandemic, the monthly
search volume of selected search terms was determined basedon the number of searches over a specified period extracted
from Yahoo! JAPAN, which is one of the most used digital
services in Japan, and compared to the rest of the world, Google
is used less. According to the data, 68.9% of the population(aged >2 years) used Yahoo! JAPAN at least once a month
between January and November 2021, while 65.1% used Google
in the same period [16]. Search volume data were retrieved withauthorized access from the Yahoo Japan Corporation server via
the DS.INSIGHT People portal. It has been used in studies
focusing on transition or trends in search behavior over time
among different demographics (eg, gender, age, or prefecture)[17]. The user manual is available on the web [18].
The internet user population is the number of internet users
throughout Japan, calculated based on the “Telecommunications
Usage Trends Survey” published by the Ministry of Internal
Affairs and Communications.
The quarterly number of new COVID-19 cases between January
2019 and December 2022 was obtained from an excerpt fromthe Japan Ministry of Health, Labour and Welfare [19].
The number of newly infected people with HIV between
December 31, 2018, and June 26, 2022, was obtained from the
AIDS Trend Committee Quarterly Report from the AIDS
Prevention Foundation, API-Net AIDS Prevention Information
Net [20].

Search Queries Used in the Analysis
The search term “HIV検査” (ie, “HIV test” in Japanese) wasused to assess the web-based interest in general HIV testingfrom January 2020 to October 2021. The result is presented
together with the search volume of “コロナPCR” (ie,JMIR Form Res 2024 | vol. 8 | e52306 | p. 2
(page number not for citation purposes)

JMIR FORMATIVE RESEARCH“corona-PCR” in Japanese) and the number of new COVID-19
cases by month. The search volumes of “HIV検査キット” (ie,“HIV test kit” in Japanese) and “HIV検査 保健所” (ie, “HIVtest health center” in Japanese) were compared to analyze thedifference in web-based interest in self-instructed/postal andfacility-based HIV testing from November 2018 to October
2022.

Data Standardization
The monthly number of searches per prefecture for each search
query was obtained, adjusted by sex, and converted tostandardized z scores according to the following formula:“Query A” refers to the queried search term.

Statistical Analysis
Internet users were stratified according to age on the day of thesearch, sex, and year. Demographics were summarized as thenumber and percentage of patients for categorical variables.
Descriptive statistics were summarized using Excel (Microsoft
Corporation).

Ethical Considerations
This infodemiology study adhered to chapter 1, section 3, part1, subsection (C), item 3 of the ethical guidelines for Medicaland Health Research Involving Human Subjects of the Ministry

https://formative.jmir.org/2024/1/e52306

XSL• FO
RenderX

Kanamori et alof Health, Labour and Welfare of Japan [21]. In accordancewith this guideline, since this study used previously anonymized
and deidentified data, an ethical review was waived, and patient
informed consent was not required.

Results
Between 2018 and 2022, 50% to 51% of overall adult internet
users were male, and the user population was evenly distributed
across different age groups by decade (11%-18% across different
age groups in 2018, 12%-17% in 2019, 12%-18% in 2020,13%-17% in 2021, and 13%-17% in 2022; Tables 1-3). The
first nationwide state of emergency concerning COVID-19 wasfrom April 7 to May 25, 2020, in Japan; since then, the increase
in web-based interest in COVID-19 polymerase chain reaction
testing (represented by the search volume of “corona-PCR”)
roughly corresponded to the peaks and troughs of new
COVID-19 infection cases in recent waves of the COVID-19
pandemic in Japan during mid 2021, early 2022, and late 2022.
In contrast, the web-based interest in general HIV testing
represented by the search term “HIV test” appeared to berelatively stable (Figure 1). Although the sex distribution of the“corona-PCR” search volume varied between 2020 and 2022,
people aged 40-49 years consistently showed the highest
web-based interest (26%-27%) for COVID-19 polymerase chain
reaction testing, followed by those aged 50-59 years (21%-23%)
and 30-39 years (15%-18%). In line with the characteristics ofpeople with an increased risk of HIV infection, 57%-60% of
the “HIV test” search volume between 2020 and 2022 werefrom male internet users, and people aged between 20 and 29
years (30%-31%) showed the most interest in general HIV
testing within this period, followed by those aged between 30
and 39 years (24%-27%) and 40 and 49 years (17%-20%; Table
1).

JMIR Form Res 2024 | vol. 8 | e52306 | p. 3
(page number not for citation purposes)

JMIR FORMATIVE RESEARCH

Kanamori et al

Table 1. Search volumes of “HIV test” and “corona-PCR” by the sex and age of internet users in the years 2020, 2021, and 2022.
Year 2020, n (%)
Internet usera

Searchterm“HIV検Year 2021, n (%)
Search term
“コロナpcr”cInternet usera

Search
term
“HIV検
査”

Search term
“コロナpcr”

Internet userd

Search Search term
term
“コロナpcr”“HIV検査”

99,499,669
(100)

2700
(100)

2000 (100)99,499,669
(100)

2330
(100)

2380 (100)査”bOverall

1300 (100)Year 2022 (January to October), n (%)

96,688,079
(100)

2500
(100)

Male

49,119,275(51)

1500 (60) 640 (50)50,286,908(51)

1600 (59) 820 (41)50,286,908
(51)

1320
(57)

910 (38)

Female47,568,804(49)

980 (40)640 (50)

49,212,761(49)1100 (41) 1200 (59)49,212,761
(49)

1010
(43)

1470 (62)110 (5)Sex

Age group (year)<20

13,386,518(14)

170 (7)20 (2)

13,787,372(14)280 (10)100 (5)

13,787,372(14)

150 (6)

20-29

11,777,729(12)770 (30)130 (10)

12,432,946(13)

840 (31)280 (14)

12,432,946(13)700 (30) 350 (15)30-39

13,547,255(14)670 (27)

190 (15)

13,615,333(14)680 (25)310 (16)

13,615,333(14)570 (24) 430 (18)40-49

17,429,796(18)

470 (19)340 (26)

17,491,018(17)

460 (17)540 (27)

17,491,018(17)

470 (20) 610 (26)50-59

15,451,255(16)

230 (9)300 (23)

16,258,923(16)250 (9)440 (22)

16,258,923(16)240 (10) 510 (21)60-69

12,716,666(13)

130 (5)190 (15)

12,887,755(13)

130 (5)230 (12)

12,887,755(13)

130 (6)200 (8)≥70

12,378,860(13)

70 (3)

110 (9)13,026,322(13)

80 (3)

80 (4)

13,026,322(13)

70 (3)

170 (7)a

The internet user population is the number of internet users throughout Japan, calculated based on the “Telecommunications Usage Trends Survey”
published by the Ministry of Internal Affairs and Communications [21].
bHIV検査: HIV test (in Japanese).

c

コロナpcr: corona-PCR (in Japanese).

d

The internet user population in 2022 uses the figures for 2021.

https://formative.jmir.org/2024/1/e52306

XSL• FO
RenderX

JMIR Form Res 2024 | vol. 8 | e52306 | p. 4
(page number not for citation purposes)

JMIR FORMATIVE RESEARCH

Kanamori et al

Table 2. Search volumes for “HIV test kit” and “HIV test health center” by the sex and age of the internet users by year (2018-2020).
Year 2018, n (%)

Year 2019, n (%)

Year 2020, n (%)

Internet user

Internet user

Internet user

populationa

Search term
Search“hiv検査キッ term “hiv
検査 保
ト”b

populationa

健所”cOverall

Search term
Search“hiv検査キッ term “hiv
ト”
検査 保
健所”

populationa

Search
term
“hiv検
査キッ
ト”

Search term
“hiv検査 保
健所”

580 (100)

95,590,219(100)

780 (100)940 (100) 107,480,629(100)

850 (100)960 (100) 96,688,079
(100)

790
(100)

Male

48,932,966(51)

540 (69)530 (56)

53,862,486(50)

560 (66)

540 (56)

49,119,275(51)

560 (71) 280 (48)

Female46,657,253(49)

240 (31)410 (44)

53,618,143(50)

290 (34)420 (44)

47,568,804(49)

230 (29) 300 (52)Sex

Age group (years)<20

12,760,379(13)

20 (3)

30 (3)

13,710,441(13)

30 (4)

30 (3)

13,386,518(14)

30 (4)

50 (9)

20-29

12,381,162(13)200 (26)280 (30)

12,514,936(12)

220 (26)310 (33)

11,777,729(12)

210 (26) 160 (27)30-39

14,321,086(15)

250 (31)300 (32)

14,167,245(13)250 (28)270 (28)

13,547,255(14)210 (27) 140 (24)40-49

18,127,686(18)

190 (24)

180 (19)

18,214,081(16)

160 (19)190 (20)

17,429,796(18)

180 (23) 90 (16)50-59

14,891,256(16)

90 (12)90 (10)15,903,690(15)100 (12)80 (8)

15,451,255(16)

90 (11)60 (10)60-69

12,991,502(14)

30 (4)

40 (4)

14,688,962(14)

60 (7)

60 (6)

12,716,666(13)

40 (5)

50 (9)≥70

10,117,148
(11)

0 (0)

20 (2)

18,281,274(17)

30 (4)

20 (2)

12,378,860(13)

30 (4)

30 (5)a

The internet user population is the number of internet users throughout Japan, calculated based on the “Telecommunications Usage Trends Survey”
published by the Ministry of Internal Affairs and Communications [22].
bhiv検査キット: HIV test kit (in Japanese).

c

hiv検査 保健所: HIV test health center (in Japanese).

https://formative.jmir.org/2024/1/e52306

XSL• FO
RenderX

JMIR Form Res 2024 | vol. 8 | e52306 | p. 5
(page number not for citation purposes)

JMIR FORMATIVE RESEARCH

Kanamori et al

Table 3. Search volumes for “HIV test kit” and “HIV test health center” by the sex and age of the internet users by year (2021 and 2022).
Year 2021, n (%)

Year 2022 (January to October), n (%)

Internet user popu- Search term “hiv検 Search term “hiv検 Internet user popu- Search term “hiv検 Search term “hiv検査キット”
査 保健所”
lationa査キット”b
査 保健所”clation (2021)d
Overall

99,499,669 (100)900 (100)640 (100)

99,499,669 (100)570 (100)

280 (100)Male

50,286,908 (51)590 (66)

290 (45)

50,286,908 (51)390 (68)

100 (36)

Female49,212,761 (49)310 (34)350 (55)

49,212,761 (49)180 (32)

180 (64)<20

13,787,372 (14)30 (3)

50 (8)

13,787,372 (14)40 (7)

30 (11)

20-29

12,432,946 (13)280 (32)230 (35)

12,432,946 (13)110 (19)

90 (32)30-39

13,615,333 (14)270 (30)

170 (27)

13,615,333 (14)180 (32)

90 (32)

40-49

17,491,018 (17)190 (21)110 (17)

17,491,018 (17)140 (25)40 (14)50-59

16,258,923 (16)90 (10)60 (9)

16,258,923 (16)80 (14)20 (7)

60-69

12,887,755 (13)30 (3)

10 (2)

12,887,755 (13)

0 (0)

0 (0)

≥70

13,026,322 (13)

10 (1)

10 (2)

13,026,322 (13)20 (4)

10 (4)Sex

Age group (years)a

The internet user population is the number of internet users throughout Japan, calculated based on the “Telecommunications Usage Trends Survey”
published by the Ministry of Internal Affairs and Communications [22].
bhiv検査キット: HIV test kit (in Japanese).

c

hiv検査 保健所: HIV test health center (in Japanese).

d

The internet user population in 2022 uses the figures for 2021.

Figure 1. Monthly web-based search interest in HIV testing and COVID-19 genetic testing and the number of new COVID-19 cases from 2020 to2022. The monthly search volumes of search terms “HIV検査” (HIV test in Japanese, blue line) and “コロナPCR” (corona-PCR in Japanese, red line)from January 2020 to October 2022 according to the search engine Yahoo! JAPAN are shown. The number of new COVID-19 cases in the corresponding
months, according to the Ministry of Health, Labour and Welfare in Japan, is also shown in green bars in this figure.

https://formative.jmir.org/2024/1/e52306

XSL• FO
RenderX

JMIR Form Res 2024 | vol. 8 | e52306 | p. 6
(page number not for citation purposes)

JMIR FORMATIVE RESEARCH
Web-based interest in HIV testing was further refined as either
facility-based HIV tests or self-instructed HIV-testing kits. The
search volume for HIV facility-based testing was high in late
2018 and decreased in several instances over the next 3 years,
especially in 2020 and 2022 (Figure 2). The search volume of“HIV test kit” (used as a representative search term for HIV
self-testing) was lower than that for HIV facility-based testingat the end of 2018. However, the interest remained high overthe next 4 years relative to facility-based testing, particularly
during the COVID-19 pandemic (Figure 2). Around 66%-71%
of the search volume of “HIV test kit” was attributable tosearches made by male internet users between 2018 and 2022,
and the top three contributing age groups were those 30-39 years(27%-32%), 20-29 years (19%-32%), and 40-49 years(19%-25%). The overall search volume of HIV test healthcenters decreased from 950 in 2018/2019 to 580 in 2020. The
actual search volume for “HIV test kit” versus “HIV test health

Kanamori et al
center” was 560 versus 280 among male internet users in 2020
and 590 versus 290 in 2021; while among female internet users
the actual search volume for “HIV test kit” versus “HIV test
health center” were similar: 230 versus 300 in 2020 and 310
versus 350 in 2021. Hence, the main population searching for“HIV test health center” shifted from male to female users(n=300, 52%) in 2020 and the following years (n=350, 55% in
2021 and n=180, 64% in 2022). Internet users aged 20-29 years(27%-35%), 30-39 years (24%-32%), and 40-49 years(14%-20%) were the top three representative age groups for the
search volume of “HIV test health center” (Tables 2 and 3).
The quarterly number of newly infected HIV cases remained
relatively stable since the declaration of a nationwide state of
emergency concerning COVID-19, and the search interest
remained high for self-testing relative to facility-based testing(Figure 3).

Figure 2. Monthly web-based search interest in HIV self-instructed and facility-based tests and the number of new COVID-19 cases from 2018 to2022. The monthly search volumes of search terms “HIV検査キット” (HIV test kit in Japanese, orange line) and “HIV検査 保健所” (HIV test healthcenter in Japanese, purple line) from November 2018 to October 2022 according to the search engine Yahoo! JAPAN are shown. The number of new
COVID-19 cases in the corresponding months, according to the Ministry of Health, Labour and Welfare in Japan, is shown with green bars.

https://formative.jmir.org/2024/1/e52306

XSL• FO
RenderX

JMIR Form Res 2024 | vol. 8 | e52306 | p. 7
(page number not for citation purposes)

JMIR FORMATIVE RESEARCH

Kanamori et al

Figure 3. Monthly web-based search interest in HIV self-instructed and facility-based tests and quarterly number of new infected HIV cases from 2019
to 2022. The monthly search volumes of search terms ”HIV検査キット" (HIV test kit in Japanese, orange line) and "HIV検査 保健所” (HIV test
health center in Japanese, purple line) from January 2019 to December 2022 according to the search engine provided by Yahoo! JAPAN are shown.
The number of new HIV cases in the corresponding quarter, according to the AIDS Trend Committee Quarterly Report from the AIDS Prevention
Foundation, API-Net AIDS Prevention Information Net, is shown with blue bars.

Discussion
The analysis in our study illustrated that the web-based searchinterest in general HIV testing remained stable in Japan during
the ongoing pandemic. Furthermore, compared to a decrease in
HIV facility-based testing, the web-based interest in HIV
self-testing has not changed in Japan. The findings suggest thata proportion of the population interested in getting an HIV test
or obtaining relevant information may have a lower preference
for HIV facility-based testing. This could imply that individuals
might have opted for HIV self-testing during the COVID-19
pandemic.
A prolonged decreasing trend in the search volume of “HIV test
health center” from late 2018 was observed in this study. Thischange in search volume was related to the real-world situation
reported by recent publications that underscored the situationof facility-based HIV testing during the pandemic [7,8,23]. A
trend analysis study exploring data from 2015 to the second
quarter of 2020 (during the nationwide state of emergency inJapan) reported a significant decline in the number of HIV tests
performed by public health centers in the second quarter of 2020
(n=9584 vs n=35,908 in Q2 2019) [7] and that this decrease
coincided with the increase in the number of new HIV caseswith an AIDS diagnosis in Japan [7]. Similar situations werereported in other countries, where an approximately 31% tohttps://formative.jmir.org/2024/1/e52306

XSL• FO
RenderX

50% reduction in the number of HIV tests performed by publichealth centers was observed between 2019 and 2020 due todifficulty accessing testing facilities, shortage of medical staff
for HIV-testing services, or closure of HIV-testing facilities[23,24].
Our search trend showed that the web-based search volume for
HIV self-tests was relatively unaffected in Japan. Furthermore,
we noted the trend for HIV-testing preference was more evident
among male internet users. In Japan, men who have sex withmen (MSM) constitute more than 70% of newly diagnosed
people living with HIV [3,25]; therefore, the difference in searchvolume for different HIV-testing services most likely reflects
the changing preferences among male internet users. This isconsistent with the real-world situation reported by othercountries. Investigators focusing on the high-risk population’s(MSM) HIV-testing behavior in China during the COVID-19
pandemic found the use of HIV self-testing increased comparedto facility-based HIV testing, which decreased by more than
50% overall [26,27]. Earlier investigations in Sweden and Japan
showed the interest and demand for HIV self-testing in high-risk
populations such as MSM even before the COVID-19 pandemic[12,28]. A study in France also reported that the number of HIV
self-testing kits sold in 2021 increased by 3% compared to 2020[29]. Together, these publications further emphasized the

JMIR Form Res 2024 | vol. 8 | e52306 | p. 8
(page number not for citation purposes)

JMIR FORMATIVE RESEARCH
preference for HIV self-tests for males in the ongoing
COVID-19 pandemic and beyond.
In this study, interest in HIV self-testing has remained relatively
high during the COVID-19 pandemic. Even though web-based
search interest only indicates clinical information-seeking
behavior, recent infodemiology studies, including that by Ornoset al [15], showed that search volume indices correlated
positively with HIV prevalence and negatively with financial
and health care service status. Another recent study in Japan by
Ishimaru et al [30] also observed a positive correlation between
internet search frequency for HIV/AIDS–related terms and thenumber of voluntary tests.
The change in search volume on HIV-testing preferences inJapan, which highlights the availability, accessibility, andregulatory approval status of HIV self-tests, may be imperative
to reduce new HIV infection [7,8]. The pros and cons ofalternative HIV-testing approaches such as the use of dried
blood spot (DBS) test cards delivered by postal service havebeen investigated in Japan [8]. So far, DBS-based tests havenot been approved as clinical samples for HIV testing in Japan;
however, their use has steadily increased in the last two decades,
most likely due to convenient and easy self-preparation of blood
spots without the need to visit medical facilities [8]. Although
the use of DBS is less sensitive than with a plasma sample, thefeasibility and reliability of postal DBS have been preliminarily
demonstrated in an outreach study in Japan [12]. Other HIV
testing to be considered should include the introduction of HIV
self-testing, DBS, or oral swabs as an alternative to plasma or
serum specimens. However, since HIV self-testing is not yet
approved by health authorities, individuals with positive test
results may not have been referred to medical facilities for
consultations after the test or received appropriate HIV care andtreatment. This concern was illustrated in the study by Ejima
et al [7], which reported that both the number of HIV tests andconsultations performed by public health centers declined during

Kanamori et al
the COVID-19 pandemic in Japan. We believe relevant
supporting services, for instance, the provision of web-based
counseling services and referral services after HIV self-testing,would be necessary to mitigate the potential concerns andnegative impact of using HIV self-test kits without counselingand medical follow-up. Soon, the development of artificial
intelligence chatbots may be used to provide real-time
instruction and counseling for HIV self-testing users, which
may offer potential solutions to this problem [31].
Several factors may limit the generalizability of the preliminary
findings presented in this report. First, the data source was solely
from Yahoo! JAPAN, and the internet searches conducted using
other search engines were not included. Second, the dataobtained from a web-based search engine may be subject to thenonrepresentative sampling or methodology bias inherent tothe search platform. Third, there could be considerable
differences in clinical information-seeking behavior between
the internet user population and actual men and women who
are affected by HIV; direct and causal relationships cannot be
inferred from this study. Nonetheless, most previous studies
using search engines have used Google Trends data, but inJapan, Yahoo! JAPAN is the most visited digital service in the
country. In addition, sex and prefecture adjustment is possible
with Yahoo! JAPAN data, making it appropriate to research
topics likely affected by sex differences. Therefore, ourpreliminary infodemiology using the search engine provided
by Yahoo! Japan Corporation is likely representative of thegeneral trend in Japan.
Our infodemiology study indicated that there was a notabledecrease in search volume for HIV facility-based testing during
the COVID-19 pandemic. Further, a change in HIV-testing
preference and interest in HIV self-testing was noted in Japan.
To fully delineate and comprehend the changes in HIV-testing
behavior, the situation should be continuously monitored andvalidated by clinical studies.

Acknowledgments
The authors would like to thank 4DIN Ltd, Japan, for the data analysis and for assisting with preparing the manuscript and othermaterials for journal submission. This work was supported by the Ministry of Health, Labour and Welfare Research on HIV/AIDS(program grant JPMH21HB1005).

Data Availability
The data sets generated or analyzed during this study are not publicly available, complying with the Yahoo! Japan Corporation
regulation, but they are available from the corresponding author upon reasonable request.

Authors' Contributions
FU and TN conceptualized this study. RK and KU are responsible for the methodology. NF and MY collected the data. RK, FU,
KU, TM, SV, MS, and HM analyzed the data. RK, NF, MY, and TN prepared the initial draft. RK, FU, KU, TM, SV, MS, HM,
and TN critically revised the manuscript. HM and TN obtained the funding. MS was responsible for project administration. All
authors approved this version of the manuscript to be submitted.

Conflicts of Interest
None declared.

References

https://formative.jmir.org/2024/1/e52306

XSL• FO
RenderX

JMIR Form Res 2024 | vol. 8 | e52306 | p. 9
(page number not for citation purposes)

JMIR FORMATIVE RESEARCH
1.
2.

3.
4.
5.

6.

7.

8.
9.

10.

11.

12.

13.
14.

15.

16.
17.

18.
19.
20.
21.
22.
23.

UNAIDS data 2019. UNAIDS. URL: https://www.unaids.org/sites/default/files/media_asset/2019-UNAIDS-data_en.pdf[accessed 2022-11-14]
Naito T, Suzuki M, Fukushima S, Yuda M, Fukui N, Tsukamoto S, et al. Comorbidities and co-medications among 28 089
people living with HIV: a nationwide cohort study from 2009 to 2019 in Japan. HIV Med. May 2022;23(5):485-493. [FREEFull text] [doi: 10.1111/hiv.13206] [Medline: 34821006]
Annual AIDS Occurrence Report 2019 (article in Japanese). API-Net. 2020. URL: https://api-net.jfap.or.jp/status/japan/
nenpo2019.html [accessed 2022-11-14]
UNAIDS data 2020. UNAIDS. URL: https://www.unaids.org/sites/default/files/media_asset/2020_aids-data-book_en.pdf[accessed 2022-11-14]
Hayes RJ, Donnell D, Floyd S, Mandla N, Bwalya J, Sabapathy K, et al. HPTN 071 (PopART) Study Team. Effect of
universal testing and treatment on HIV incidence - HPTN 071 (PopART). N Engl J Med. Jul 18, 2019;381(3):207-218.
[FREE Full text] [doi: 10.1056/NEJMoa1814556] [Medline: 31314965]
DiNenno EA, Delaney KP, Pitasi MA, MacGowan R, Miles G, Dailey A, et al. HIV testing before and during the COVID-19
pandemic - United States, 2019-2020. MMWR Morb Mortal Wkly Rep. Jun 24, 2022;71(25):820-824. [doi:10.15585/mmwr.mm7125a2] [Medline: 35737573]
Ejima K, Koizumi Y, Yamamoto N, Rosenberg M, Ludema C, Bento AI, et al. HIV testing by public health centers andmunicipalities and new HIV cases during the COVID-19 pandemic in Japan. J Acquir Immune Defic Syndr. Jun 01,
2021;87(2):e182-e187. [FREE Full text] [doi: 10.1097/QAI.0000000000002660] [Medline: 33625066]
Oka S. HIV testing in COVID-19 pandemic and beyond in Japan. Glob Health Med. Dec 31, 2021;3(6):356-357. [FREEFull text] [doi: 10.35772/ghm.2021.01103] [Medline: 35036615]
Dorward J, Khubone T, Gate K, Ngobese H, Sookrajh Y, Mkhize S, et al. The impact of the COVID-19 lockdown on HIV
care in 65 South African primary care clinics: an interrupted time series analysis. Lancet HIV. Mar 2021;8(3):e158-e165.
[FREE Full text] [doi: 10.1016/S2352-3018(20)30359-3] [Medline: 33549166]Simões D, Stengaard AR, Combs L, Raben D, EuroTEST COVID-19 impact assessment consortium of partners. Impactof the COVID-19 pandemic on testing services for HIV, viral hepatitis and sexually transmitted infections in the WHO
European Region, March to August 2020. Euro Surveill. Nov 2020;25(47):2001943. [FREE Full text] [doi:10.2807/1560-7917.ES.2020.25.47.2001943] [Medline: 33243354]
Hung C, Banerjee S, Gilada I, Green K, Inoue Y, Kamarulzaman A, et al. Impact of COVID-19 on the HIV care continuumin Asia: insights from people living with hiv, key populations, and hiv healthcare providers. PLoS One. 2022;17(7):e0270831.
[FREE Full text] [doi: 10.1371/journal.pone.0270831] [Medline: 35857755]
Takano M, Iwahashi K, Satoh I, Araki J, Kinami T, Ikushima Y, et al. Assessment of HIV prevalence among MSM in
Tokyo using self-collected dried blood spots delivered through the postal service. BMC Infect Dis. Dec 05, 2018;18(1):627.
[FREE Full text] [doi: 10.1186/s12879-018-3491-0] [Medline: 30518333]
Perazzo J, Haas S, Webel A, Voss J. Role of the internet in care initiation by people living with HIV. Res Nurs Health. Feb
2017;40(1):43-50. [FREE Full text] [doi: 10.1002/nur.21769] [Medline: 27686871]
Higgins TS, Wu AW, Sharma D, Illing EA, Rubel K, Ting JY, et al. Correlations of online search engine trends withcoronavirus disease (COVID-19) incidence: infodemiology study. JMIR Public Health Surveill. May 21, 2020;6(2):e19702.
[FREE Full text] [doi: 10.2196/19702] [Medline: 32401211]
Ornos EDB, Tantengco OAG, Abad CLR. Global online interest in HIV/AIDS care services in the time of COVID-19: a
Google Trends analysis. AIDS Behav. Jun 2023;27(6):1998-2004. [FREE Full text] [doi: 10.1007/s10461-022-03933-w][Medline: 36441409]
Top trends of 2021: digital landscape in Japan. The Nielsen Company. 2021. URL: https://www.nielsen.com/ja/insights/
2021/tops-of-2021-digital-in-japan/ [accessed 2023-12-20]
Ishizuka K, Miyagami T, Tsuchida T, Saita M, Ohira Y, Naito T. Online search interest in long-term symptoms of coronavirus
disease 2019 during the COVID-19 pandemic in Japan: infodemiology study using the most visited search engine in Japan.
PLoS One. 2023;18(11):e0294261. [FREE Full text] [doi: 10.1371/journal.pone.0294261] [Medline: 37967057]
DS.INSIGHT manual (article in Japanese). DS.LAB. URL: https://datasolution.yahoo-net.jp/view/knowledgebase/641[accessed 2023-08-30]
Visualizing the data: information on COVID-19 infections. Ministry of Health, Labour and Welfare. URL: https://covid19.
mhlw.go.jp/en/ [accessed 2022-11-28]
四半期報告 2023年［令和5年]. API-Net. 2023. URL: https://api-net.jfap.or.jp/status/japan/index.html [accessed 2023-03-24]
The ethical guidelines for Medical and Health Research Involving Human Subject (in Japanese). Ministry of Health, Labourand Welfare of Japan. URL: https://www.mhlw.go.jp/content/001077424.pdf [accessed 2024-1-16]
Telecommunications usage trends survey. Ministry of Internal Affairs and Communications. URL: https://www.soumu.go.jp/
johotsusintokei/statistics/statistics05.html [accessed 2023-12-18]
Zhang K, Chen S, Chan PS, Fang Y, Cao H, Chen H, et al. Changes in HIV testing utilization among Chinese men who
have sex with men during the COVID-19 pandemic in Shenzhen, China: an observational prospective cohort study. Front
Med (Lausanne). 2022;9:842121. [FREE Full text] [doi: 10.3389/fmed.2022.842121] [Medline: 35755039]

https://formative.jmir.org/2024/1/e52306

XSL• FO
RenderX

Kanamori et al

JMIR Form Res 2024 | vol. 8 | e52306 | p. 10(page number not for citation purposes)

JMIR FORMATIVE RESEARCH
24.

25.
26.

27.

28.

29.

30.
31.

Kanamori et al

Chow EPF, Ong JJ, Denham I, Fairley CK. HIV testing and diagnoses during the COVID-19 pandemic in Melbourne,
Australia. J Acquir Immune Defic Syndr. Apr 01, 2021;86(4):e114-e115. [FREE Full text] [doi:10.1097/QAI.0000000000002604] [Medline: 33346567]
Infectious Disease Surveillance Center; National Institute of Infectious Diseases. HIV/AIDS in Japan, 2019. Infect Agents
Surveillance Rep. Oct 2020;41(10):175-176.
Zhang KC, Fang Y, Cao H, Chen H, Hu T, Chen YQ, et al. The impacts of the COVID-19 pandemic on HIV testing
utilization among men who have sex with men in China: cross-sectional online survey. JMIR Public Health Surveill. May
25, 2022;8(5):e30070. [FREE Full text] [doi: 10.2196/30070] [Medline: 35486811]
Jiang H, Xie Y, Xiong Y, Zhou Y, Lin K, Yan Y, et al. HIV self-testing partially filled the HIV testing gap among men
who have sex with men in China during the COVID-19 pandemic: results from an online survey. J Int AIDS Soc. May
2021;24(5):e25737. [FREE Full text] [doi: 10.1002/jia2.25737] [Medline: 34036750]
Kinnman E, Herder T, Björkman P, Månsson F, Agardh A. HIV self-testing for men who have sex with men in Sweden.
A cross-sectional study concerning interest to use HIV self-tests. Glob Health Action. Dec 31, 2022;15(1):2021631. [FREEFull text] [doi: 10.1080/16549716.2021.2021631] [Medline: 35289717]
Bulletin de santé publique VIH-IST. Santé Publique France. Dec 2022. URL: https://www.santepubliquefrance.fr/
maladies-et-traumatismes/infections-sexuellement-transmissibles/vih-sida/documents/bulletin-national/
bulletin-de-sante-publique-vih-ist.-decembre-2022 [accessed 2023-02-02]
Ishimaru T, Yoshida T, Fujino Y. Correlation between voluntary HIV testing and public awareness of HIV using Google
Trends in Japan. Asia Pac J Public Health. Jan 2022;34(1):113-117. [doi: 10.1177/10105395211051251] [Medline: 34668410]
Chen S, Zhang Q, Chan C, Yu F, Chidgey A, Fang Y, et al. Evaluating an innovative HIV self-testing service with web-based,
real-time counseling provided by an artificial intelligence chatbot (HIVST-Chatbot) in increasing HIV self-testing use
among Chinese men who have sex with men: protocol for a noninferiority randomized controlled trial. JMIR Res Protoc.
Jun 30, 2023;12:e48447. [FREE Full text] [doi: 10.2196/48447] [Medline: 37389935]

Abbreviations
ART: antiretroviral therapy
DBS: dried blood spot
MSM: men who have sex with men
UNAIDS: Joint United Nations Programme on HIV and AIDS

Edited by A Mavragani; submitted 31.08.23; peer-reviewed by Y Xiong, S Chen; comments to author 23.10.23; revised version received
27.11.23; accepted 28.11.23; published 18.01.24
Please cite as:
Kanamori R, Umemura F, Uemura K, Miyagami T, Valenti S, Fukui N, Yuda M, Saita M, Mori H, Naito T
Web-Based Search Volume for HIV Tests and HIV-Testing Preferences During the COVID-19 Pandemic in Japan: Infodemiology
Study
JMIR Form Res 2024;8:e52306
URL: https://formative.jmir.org/2024/1/e52306
doi: 10.2196/52306
PMID:©Rie Kanamori, Futaba Umemura, Kosuke Uemura, Taiju Miyagami, Simon Valenti, Nobuyuki Fukui, Mayumi Yuda, Mizue
Saita, Hirotake Mori, Toshio Naito. Originally published in JMIR Formative Research (https://formative.jmir.org), 18.01.2024.
This is an open-access article distributed under the terms of the Creative Commons Attribution License(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information,a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

https://formative.jmir.org/2024/1/e52306

XSL• FO
RenderX

JMIR Form Res 2024 | vol. 8 | e52306 | p. 11(page number not for citation purposes)