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HIV/AIDS Surveillance and Healthcare Systems in Japan

This article discusses the challenges and countermeasures for HIV/AIDS in Japan, including the expansion of infections in high-risk groups, the importance of early detection and treatment, and the strengthening of healthcare provision systems. It also highlights Japan's universal health insurance system and the recognition of HIV-related immunodeficiency as a form of disability.

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HIV/AIDS Surveillance and Healthcare Systems in Japan

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  1. Health Systems for Long-term Care –A Lifecycle Approach– Eiji Hinoshita Director-General, Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM), Japan

  2. COI Disclosure Information I have no financial relationships to disclose.

  3. Newly diagnosed HIV/AIDS in Japan . Total HIV-Infected Persons AIDS patients HIV/AIDS surveillance report (MHLW, 2018)

  4. Problems surrounding HIV/AIDS in Japan withapointofviewofitssurveillance results • HIV-infection has been expanding in a male homosexual contact group (MSM: Men who have Sex with Men).　→　A specific measure is required for MSM as a high-risk group. • About 30% cases (or 50% depending on location) are newly diagnosed after developing AIDS even though its early detection and treatment are important for its prognosis.In the city areas: HIV-infection > AIDS In the rural areas: AIDS > HIV-infection →　Countermeasures in response to the situation of each community are required. • The majority of the newly diagnosed HIV-infection cases are from 20’s to 30’s. And the majority of the newly diagnosed AIDS cases are more than 30’s.　→　Particular concern about HIV-infection expansion in 20’s.

  5. Countermeasures for HIV/AIDS in Japan • Japan’s countermeasures for HIV/AIDS have been implemented under the AIDS Prevention Guidelines which was made based on ‘Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases’. • The Guideline has been reviewed periodically. October, 1999 Establishment of the Guidelines March, 2006 The 1st revision January, 2012 The 2nd revision January, 2018 The 3rd revision (current)

  6. Overview of the 2nd revision (2012) 1. Improvement in response to the change of the concept for HIV/AIDS From a “special incurable disease” to a “common controllable disease” 2. Clear division of roles between national and local governments • National: Leadership, technical support (e.g. research) • Local governments: enlightenment, testing, rebuilding of medical system 3. Prioritized measures Enlightenment and education, enhancement of the testing system, the rebuilding of the medical service system

  7. Overview of the 3rd revision (2018) • Effective enlightenment Elimination of prejudice and discrimination, appropriate implementation of prevention of infection as well as strengthening enlightenment (to high-risk group such as MSM) 2. Strengthening HIV/AIDS surveillance Strengthening analysis of HIV/AIDS surveillance, considering regional differences, continuous implementation of epidemiological survey and researches which facilitate the evaluation of care cascade 3. Strengthening testing at public heath centers and medical institutions Simultaneous testing with the other STDs, promoting to expand opportunities of testing, enhancing further testing system by mail 4. Provision of healthcare services in response to new challenges caused by the improvement of prognosis Strengthening to build comprehensive healthcare system with a focus on central hospitals for AIDS treatment in collaboration with local healthcare services as well as long-term care and welfare services, and to collaborate among relevant departments of the hospitals • Enhancement of testing and consulting system • Rebuilding healthcare provision system

  8. Health Insurance System in Japan • Japan achieved universal health insurance system in 1961. • Japanese people can access to necessary healthcare services including HIV/AIDS without financial hardship under this system. • Moreover, immuno-deficiency caused by HIV has been defined as disability under the former “Act on Welfare of Physically Disabled Persons” （Act on General Supports for Persons with Disabilities） in 1998. • →subjected to a kind of disabilities whose medical expenses are paid by the public as services and supports for persons with disabilities (the upper limitation of the OPP in a month is determined by each municipality)

  9. Healthcare Provision System in Japan ○　To promote strengthening functions of the national core medical institutions for HIV/AIDS treatment such as National Center for Global health and Medicine (NCGM), Regional AIDS Centers, Core Hospitals and Central Hospitals ○　Moreover, immuno-deficiency caused by HIV has been subjected to be a kind of disabilities whose medical expenses are paid by the public as ‘services and supports program for persons with disabilities’ Healthcare Provision System for AIDS AIDS Clinical Center (ACC), NCGM [Top Center of healthcare provision system for AIDS in Japan] Regional AIDS Centers (14) One and more centers have been established in each region (8: Hokkaido, Tohoku, Hokuriku, Kanto-Koshinetsu, Tokai, Kinki, Chugoku-Shikoku, Kyushu).Take care of high-levelmedicalcareandresearches Collaborate with each other Collaboration Core Hospitals (59) Each prefectural government establishes more than one. Take care of high-evel medical care Collaboration Established by each prefectural government. Provide Comprehensive AIDS treatment not necessarily with all the departments Central Hospitals (382) As of the end of March, 2018

  10. HIV care cascade in Japan Source The HIV care cascade: Japanese perspective. PLoSONE 12(3):e0174360.

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