Workers on the front lines of the AIDS epidemic say they are fighting a losing battle against ambivalence in this country, which they say has led to a record number of HIV and AIDS cases in Japan, with worse probably yet to come.

Some examples of what they face:

*At a hospital in Tokyo, there are only four specialists on hand to help about 800 patients who are HIV-positive or have full-blown AIDS.

*A health official who gives about 200 AIDS lectures each year has been urged to tone down his talks on HIV prevention.

*A support group is trying to combat the notion that you can only get the AIDS virus in sex parlors, from foreigners or from gay men.

Last year, 780 people were diagnosed as HIV-positive and 385 were diagnosed as having AIDS, according to health ministry statistics. Both figures set annual records.

The cumulative number of reported HIV-positive and AIDS cases also exceeded 10,000 for the first time in 2004. Some experts predict a total of 50,000 HIV-positive and AIDS patients in five years.

Despite those numbers, the health ministry's budget to deal with AIDS has decreased. In fiscal 2000, about 12.7 billion yen was set aside for such programs, but in fiscal 2005, the figure was cut by about 30 percent to roughly 8.6 billion yen.

``If measures are weakened, we will face a dangerous situation in 10 years,'' said Chizuko Ikegami, who heads the nonprofit organization PLACE (Positive Living and Community Empowerment) Tokyo.

It provides support for HIV-positive and AIDS patients.

Health ministry officials are now reviewing HIV-prevention guidelines created five years ago. Changes being considered include improving school programs on prevention as well as establishing a system to make it easier to be tested for HIV.

However, those working in the field of prevention face a number of major problems.

Shinya Iwamuro, who heads the Health Promotion Research Center at the Japan Association for Development of Community Medicine, typically gives about 200 speeches a year at schools, companies and community centers.

His main argument for protecting oneself from AIDS is to either abstain from sex or to use condoms. However, Iwamuro said he has been increasingly pressed to forgo the topic, especially from conservatives opposed to liberal sex education in schools.

The same pressure came to bear on an organization associated with the health ministry that published a pamphlet titled the ``Love and Body Book.'' Intended for use in sex education classes for junior high school students, the book went out of print in 2002 after critics said it was too explicit for students.

Since then, Iwamuro has seen about a 30-percent decrease in requests from schools for talks on preventing HIV.

``Critics have taken one aspect of sex education and called it inappropriate, but the sexual activity of children today has progressed beyond the imagination of adults,'' Iwamuro said.

NPO chief Ikegami said part of the problem is mistaken ideas and low awareness, even a decade after information on AIDS has been widely disbursed.

Many people have told her or staff at the NPO that they believe they can avoid AIDS by not going to sex shops or not having sex with foreigners, she said. Others believe it is a disease that only affects male homosexuals.

``Many people do not correctly understand AIDS,'' Ikegami said.

Fewer people are now participating in events to raise awareness of the disease, she said.

That's probably because there has been less coverage of such cases as the blood-tainted AIDS scandal that affected hemophiliacs or because most people do not know anybody who has AIDS, she said.

Another problem in Japan's battle against AIDS is that only a few hospitals are treating most of the patients that are HIV-positive or have full-blown AIDS.

For example, according to official statistics, about 30 percent of the nation's AIDS patients as well as about 40 percent of the people with HIV cases live in Tokyo.

Although there are 42 hospitals in Tokyo designated as special facilities for AIDS and HIV-positive patients, about 75 percent of those patients are receiving treatment at just four hospitals, including the International Medical Center of Japan.

About 800 patients are being treated at Komagome Tokyo metropolitan hospital, with about 50 individuals seeking out-patient care on any given day. There are only four specialists to treat those patients, and they have paired off on a rotation system.

``Unless something is done, we will be unable to set aside adequate time to look after our patients,'' said Masayoshi Negishi, who heads the Infectious Diseases Division at Komagome.

The Tokyo metropolitan government conducted a study last May on the issue of patient distribution and suggested that quality would be improved if patients would just spread out among hospitals.

But that seems unlikely unless more is done to create the network of support that each patient needs.

Because of advances made in AIDS research, drugs have been developed to prevent HIV from developing into life-threatening AIDS. However, for those drugs to be truly effective, hospitals have to provide patients with medical and lifestyle support.

For example, at Komagome hospital, HIV-positive patients are cared for by a team of specialists, including doctors specializing in infectious diseases and psychiatry, as well as counselors and social workers.

There is also a patients' group at the hospital to provide support and advice as well as ties with volunteer groups that help patients in other ways, such as finding them jobs.