Online Program

Current use and perceptions of HIV post-exposure prophylaxis and pre-exposure prophylaxis in Japan

Tuesday, November 3, 2015 : 8:30 a.m. - 8:50 a.m.

Anthony DiStefano, PhD, MPH, Department of Health Science, California State University, Fullerton, Fullerton, CA
Ayako Kurimoto, California State University, Fullerton, Fullerton, CA
Background: Biomedical HIV prevention strategies are playing an increasing role in addressing HIV epidemics globally, but little is known about their use in Japan, where persistent HIV disparities and a recently stable, but not declining, national epidemic indicate the need for evolving approaches. Situated within a broader ethnographic study of HIV epidemics in the Kansai region and Greater Tokyo Area, this nested analysis examined the use and perceptions of two biomedical prevention strategies, post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), to inform future practice. Methods: Ethnographic fieldwork in Japan (January-August 2013) included observations at public health centers, community based organizations, clinics, hospitals, and community sites (n=177; 459 pages of field notes); qualitative interviews with stakeholders in local HIV epidemics (n=32); and document research (n=111). Follow-up research on Japanese public and private sector websites continued to January 2015. Analyses comprised three stages of coding using grounded theory across the triangulated data. Results: PEP was available but reserved for occupational exposures by health care workers. Neither PEP for sexual and injection drug exposures nor PrEP were approved by the Ministry of Health, Labor and Welfare; there was inconsistent knowledge of both, including among persons working in the HIV field; there was no insurance coverage, and neither an open dialogue nor a culture of acceptance in the current medical and public health spheres. Participants cited concerns of drug resistance and increased unprotected sex. Conclusions: Japanese health officials should prioritize a national discussion, weigh empirical evidence, and strongly consider approving PrEP and nonoccupational PEP.

Learning Areas:

Protection of the public in relation to communicable diseases including prevention or control
Public health or related research

Learning Objectives:
Differentiate among the current uses of occupational PEP, nonoccupational PEP, and PrEP in Japan. List two concerns raised in Japan about PrEP and nonoccupational PEP. Evaluate whether PrEP and nonoccupational PEP should be approved for use in Japan.

Keyword(s): HIV Interventions, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the principal investigator on this study of HIV in Japan, led the data collection, analyzed the data, and interpreted the results. I have a PhD and 15 years of experience conducting research in the realm of HIV.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.