Japan’s Response to the Spread of
HIV/AIDS

The Japan Center for International Exchange wishes to thankOpen Society InstituteJapan’s Response to the Spread of
HIV/AIDSJapan Center for International ExchangeTokyo • New York© 2004 Japan Center for International Exchange
All rights reserved.
Copyediting by Pamela J. Noda.
Cover design, typographic design, and typesetting by Patrick Ishiyama.
Printed in Japan.
ISBN 4-88907-075-3
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Contents

Preface .................................................................................................... 7
Executive Summary ...............................................................................9

I. Present State and Future Trends in the Spread of ..............12
HIV/AIDS in JapanThe State of the Epidemic.................................................................12
Populations Vulnerable to HIV-Infection....................................... 16
Impact of the HIV-Tainted Blood Scandal ..................................... 19
Public Perception of HIV/AIDS ...................................................... 22
Future Perspectives ..........................................................................24
II. Japanese Government Policies on HIV/AIDS ......................26

Domestic Policies on HIV/AIDS .....................................................26
Role of the Ministry of Health, Labour and Welfare .............................26
Existing Framework for Fighting HIV/AIDS ........................................ 27
Foreign Policy Initiatives on HIV/AIDS ......................................... 33
HIV/AIDS in Foreign Policies ............................................................ 33
Priority of HIV/AIDS Relative to Other Infectious Diseases ................... 35
Regional Policies and HIV/AIDS ........................................................ 36
Projects Under the Okinawa Infectious Diseases Initiative (IDI) ............ 37
Joint Collaboration on HIV Vaccine Development ...............................40

III. Non-Governmental Actors in the Fight Against AIDS ...... 42

Civil Society Involvement ................................................................ 42
NGOs Working on HIV/AIDS Issues .................................................. 43
Private Foundations .......................................................................... 47
Role of the Media ............................................................................. 50
Mass Media...................................................................................... 50
Documentary Photography ............................................................... 55
Corporate Attitudes Towards HIV/AIDS........................................ 56
Workplace Management of HIV/AIDS ................................................ 56
Corporate Philanthropy and Awareness-Raising Programs .................... 59
Labor Unions .................................................................................................. 61

Bibliography......................................................................................... 63
List of Key Informants ........................................................................66
Appendices ..........................................................................................69

Preface

This report examines the current state of the Japanese response to thedomestic and global spread of HIV/AIDS, by both the public and private
sectors. The purpose of the report is to identify the key actors in the combat
against the epidemic and to ascertain achievements and challenges that lay
ahead. For the beneﬁt of those living outside Japan, pages are devoted toa description of the domestic background for a better comprehension ofJapan’s stance on the epidemic, i.e., current epidemiological situation in
Japan, historical background, domestic discussion and public perception
on HIV/AIDS.
The Japan Center for International Exchange (JCIE) would like to thankthe Open Society Institute for commissioning this report and for providing
the opportunity to conduct a challenging survey. It is probably the ﬁrst
effort to portray in the English language how various actors in Japan havebeen addressing the epidemic. Making use of the comparative advantage ofJCIE as one of the very few independent, nonproﬁt, nonpartisan organizations in international affairs in Japan, the report focuses on government
policy and civil society/business sector’s involvement with HIV/AIDS.
Reference to medical aspects and related activities pertaining to the diseaseis kept to a minimum as the technical aspects are outside the realm of theauthors and already dealt with by medical experts in scientiﬁc papers.
As the time allowed for research was a limited four-month period startingin November 2003, coverage is far from comprehensive. Rather, it is hopedthat the content will serve as a basis for future studies and stimulate debate
to attract greater attention from Japanese leaders in political, business,media and civil society circles to the urgency of implementing effective
measures to combat HIV/AIDS.
The report was compiled and written by a project team at JCIE headedby Satoko Itoh, chief program ofﬁcer of the CivilNet Program, also serving
as editor. Contributions to chapter 1 and chapter 2, section 1 were written
by Satoko Itoh and Tomone Kozen, assistant program ofﬁcer; for chapter 2,

section 2 by Tomoko Suzuki, program ofﬁcer, with the assistance of Akiko
Horiba; and for chapter 3 by Satoko Itoh. The English version of the reportoriginally drafted in Japanese has been put together by Sachiko Aoki, program associate. The authors would welcome comments and feedback.
The authors are grateful for the information and revealing insights given
to them by many experts on HIV/AIDS. Their names are listed at the end of
the report. Among them, the authors would like to extend their appreciation to Masayoshi Tarui, professor of ethics at Keio University and Kazuo
Miyata, editorial writer of Sankei Shimbun newspaper, both board membersof the Japan AIDS and Society Association, for carefully reading through thedraft report and giving helpful comments. The ﬁrst draft of the report was
distributed at the Asia Society/JCIE Joint Conference on “Human Security
Challenges of AIDS and Communicable Diseases in Asia” held in Tokyo in
March 2004. Comments received from the participants were incorporated
whenever possible in this ﬁnal version for publication. It should be notedthat JCIE is solely responsible for the content of the report and that theopinions and analysis presented herein do not necessarily represent thoseof the Open Society Institute or the people consulted.
Tokyo
April 2004

Executive Summary

The State of the Epidemic in Japan
There are an estimated 20,000 people living with HIV/AIDS in Japan asof 2003. With prevalence still so low, HIV/AIDS is generally regarded asa disease that only affects faraway countries or other people not close tohome. The epidemic was ﬁrst identiﬁed domestically among hemophiliacs
who had been infected through contaminated blood products. When thecontamination was linked to the failure of pharmaceutical companies andgovernment ofﬁcials to exercise proper safeguards, scandal erupted. Thisso-called tainted blood scandal peaked during the early to mid-1990s andbecame the climactic point in the history of HIV/AIDS in Japan, but oncea legal settlement was reached, the issue of AIDS appeared to have been
put to rest in the eyes of the general public. Ever since, the level of interest
in HIV/AIDS in Japanese society has remained very low.
Statistics reveal, however, that the number of newly reported HIV infections and AIDS diagnoses continues to climb steadily, making Japan an
exception among high-income countries. Experts point out that the epidemic may be spreading much more quickly than available ﬁgures indicate,
and that this increase may be linked to changes in the sexual behavior ofyoung people, greater migration across national borders, and delays in theearly identiﬁcation of infection due to inadequate availability of testing
and counseling. Unless effective preventive action is taken, the number of
infected is likely to more than double to 50,000 by the year 2010.

Government Policies on HIV/AIDS
HIV/AIDS issues are not yet on the mainstream policy agenda in Japan. Many
point out that the absence of a national commission on HIV/AIDS impedes thedevelopment of effective national responses at the policymaking level. SeparateJapan’s Responses to the Spread of HIV/AIDS
measures are pursued independently by different government ministries andagencies with little or no coordination. The Ministry of Health, Labour andWelfare is at the forefront of domestic policies while the Ministry of Foreign
Affairs formulates foreign policies on HIV/AIDS, and no concerted national
policy has yet been articulated to bridge the various efforts in the ﬁght against
the domestic and global spread of the epidemic.
Domestic policy: Much of Japan’s present-day legal and regulatory
framework, social welfare coverage, promotion of basic and clinical researchand provision of medical care and treatment concerning HIV/AIDS in
Japan has arisen out of the 1996 settlement agreed to by representativesof the HIV-infected hemophiliacs and the Ministry of Health, Labour andWelfare. However, the implementation of effective measures to promote
prevention and awareness-raising regarding sexual transmission of thedisease, in comparison, lags far behind. There is a growing demand for
greater efforts to counter the rapid spread of the epidemic among populations vulnerable to HIV infection.
Foreign policy: Fighting infectious diseases has been given priority inJapan’s Ofﬁcial Development Assistance (ODA) scheme, and the government has pledged a total of US$3 billion under the Okinawa Infectious
Diseases Initiative (IDI) for the ﬁve-year period from 2000 to 2004.
Although Japan can boast considerable expertise in treating tuberculosis,
polio, and parasitic diseases, the same cannot be said in the case of HIV/
AIDS, an area where Japan’s potential contribution is seen as relatively
limited. Consequently, the Japanese government has resorted to taking acomprehensive approach to ﬁght all infectious diseases rather than focusing solely on HIV/AIDS. In this sense, the IDI fails to give high priority to
HIV/AIDS, including it as one of many targeted infectious and parasitic
diseases. Indeed, projects under this initiative that are speciﬁcally related
to HIV/AIDS have only accounted for 8 percent of total expenditures.

Non-Governmental Actors in the Fight Against
HIV/AIDS
Civil society involvement: The civil society sector in Japan is extremely
vibrant, but remains at a much less advanced state of development thanin many Western countries. The approximately 100 community-based
nongovernmental organizations (NGOs) involved in HIV/AIDS issues on
the domestic scene are mostly run on a volunteer basis by medical experts

10

Executive Summaryor people living with HIV/AIDS. They have been effective in conducting
prevention programs and offering care and support for population groups
vulnerable to HIV infection and not adequately reached by public agencies. Also, a very limited number of NGOs are active abroad, promoting
prevention, testing, and care and support. However, it is rare for individual
Japanese HIV/AIDS-related NGOs to be active both on the domestic andinternational fronts at the same time. This is not unrelated to the relatively
small scale of Japan’s NGOs, a product of the great challenges they facein terms of funding, human resources, and the creation of a supportive
operating environment.
Private ﬁnancial resources for NGOs involved in HIV/AIDS issues areseverely limited. Grants from private foundations seldom go to support
NGOs engaged in grassroots activities. Meanwhile, although many foundations fund research and offer scholarships in the ﬁelds of health, medicine
and welfare, none give top priority to HIV/AIDS. For Japan to play any
important role in the domestic and global ﬁght against the epidemic, it
seems clear that measures must be introduced to strengthen the ﬁnancial
and organizational structure of NGOs and pave the way for a more enabling environment.
Corporate involvement: Corporate awareness of HIV/AIDS issues
remains at a low level. A business forum to discuss HIV/AIDS policies
and a number of HIV/AIDS-related programs targeted at the corporate
sector were launched in the mid-1990s, but they have since fallen dormant.
Since there is little sense of crisis, the need for HIV/AIDS policies in theworkplace is barely recognized, even at the headquarters of Japanese corporations operating in heavily affected countries and regions. A numberof corporations have taken a more active stance in other areas to combat
the pandemic, particularly in terms of corporate philanthropy and awareness-raising programs, but these few are typically Japanese subsidiaries
of foreign-based corporations. Most Japan-based corporations stick to
traditional areas in their corporate philanthropy and community involvement programs, primarily the promotion of environmental, cultural andartistic causes and welfare measures for the senior citizens and the disabled,
and tend to shy away from more controversial issues such as HIV/AIDS.
However, the recent decision by the national confederation of labor unions
to highlight HIV/AIDS as a top priority in its international activities comes
as a promising sign. It is hoped that such efforts will raise the level ofrecognition given to the epidemic by employers and encourage them toaddress this issue.

11

I. Present State and Future Trends in the Spreadof HIV/AIDS in JapanThe State of the Epidemic
It is estimated that, as of 2003, there are approximately 20,000 people living with HIV/AIDS in Japan.1 The prevalence of HIV/AIDS is still very
low and little public attention is given to the epidemic as a serious issue
confronting Japanese society. Statistics reveal, however, that the numberof newly reported HIV infections and AIDS diagnoses continues to show
a steady increase, if not as serious as in African and other Asian countries.
The upward trend in AIDS cases, in particular, is rare for a high-income
country, given modern medical breakthroughs in halting the disease’s
progression from HIV to AIDS. Experts point out that the epidemic may
be spreading much more quickly than available ﬁgures indicate. Various
underlying factors may be cited for the trend, the most predominant beingchanges in the sexual behavior of young people, greater migration acrossnational borders, and delays in the early identiﬁcation of infection due toinadequate availability of testing and counseling.

Epidemiological Situation
According to the 2002 Annual Report of the National AIDS SurveillanceCommittee2 and other available data, the state of the epidemic is assessed
as follows.
• Both the number of newly reported HIV seropositive cases and new
AIDS diagnoses has been increasing, reaching 614 and 308, respectively,
in 2002 (see ﬁg. 1-1). These ﬁgures are nearly double those recorded in
the mid-1990s.

1

According to Hashimoto (2000), the forecast for the year 2003 of the estimated numberof HIV cases among Japanese is 15,400 and AIDS cases is 3,300, while statistics forthe non-Japanese population total 700 for HIV cases and 900 for AIDS cases.
2
See National AIDS Surveillance Committee (2002).

Present State and Future Trends
Figure 1-1: Annual Reports of New HIV/AIDS Cases

Source: National AIDS Surveillance Committee, Annual Report 2002.
Note: Number of people excludes those infected by contaminated blood products.

• Reports of AIDS patients at initial diagnosis are steadily rising.3• Age distribution of reported cases: The largest share, approximately 35
percent, of all newly reported cases of HIV seropositive Japanese nationals involved young people in their twenties (see ﬁg. 1-2). The spread of
HIV in this age group has shown a steady increase, especially among themale population (see ﬁg. 1-3).
• Location of infection: For 77.2 percent of newly reported cases, transmission occurred most likely within Japan.
• Geographic focus: The largest number of reported cases is clusteredin the Tokyo area. Including the surrounding metropolis areas (Tokyo,
Kanagawa, Chiba and Saitama), these account for 57.0 percent of all the
newly reported cases.

3

According to Kimura (2003, 5), the number of cases where the patient is unawareof having developed AIDS at initial diagnosis has soared from 28 percent of those
detected in 1995 to 80 percent in 2000.

13

Japan’s Responses to the Spread of HIV/AIDS
Figure 1-2: Age Distribution of Newly Reported HIV-Positive
Japanese Nationals (2002)

Source: National AIDS Surveillance Committee, Annual Report 2002.

Figure 1-3: HIV Prevalence Among Japanese Nationals in Their
Twenties

Source: National AIDS Surveillance Committee, Annual Report 2002.

14

Present State and Future Trends
Table 1-1: Cumulative HIV/AIDS Cases Reported by Gender,
Nationality and Mode of Transmission at the End of 2002
Non-Japanese

Total

Mode of Transmission

Male Female

Japanese
Total

Male Female Total

Male Female Total

HIV

Heterosexual contact
Homosexual contact
Injecting drug use
Mother-to-infant
Other
Unknown
HIV Total

1,013
1,621
10
12
40
313
3,009

348
1
0
7
26
45
427

1,361
1,622
10
19
66
358
3,436

214
148
16
3
14
217
612

1,227
965
1,769
1
26
1
15
14
54
37
530
501
3,621 1,519

AIDS

Heterosexual contact
Homosexual contact
Injecting drug use
Mother-to-infant
Other
Unknown
AIDS Total

799
553
5
8
32
359
1,756

94
1
1
3
12
39
150

893
554
6
11
44
398
1,906

155
57
11
1
13
203
440

112
1
0
3
7
87
210

267
58
11
4
20
290
650

954
610
16
9
45
562
2,196

206 1,160
2
612
1
17
6
15
19
64
126
688
360 2,556

HIV/AIDS cases infected by
1,413
contaminated blood products

18

1,431

−

−

−

1,413

18 1,431

617
831
0
148
1
17
7
10
11
25
456
673
1,092 1,704

2,192
1,770
27
29
91
1,031
5,140

Source: National AIDS Surveillance Committee, Annual Report 2002.

• Table 1-1 gives a breakdown of the cumulative number of HIV/AIDS
cases reported since the beginning of surveillance in 1984 through to
2002.
– The cumulative number of reported cases includes approximately 5,000
HIV cases and 2,500 AIDS cases. In addition, the surveillance statistics
do not include the approximately 1,400 hemophiliacs infected withHIV by contaminated blood products.
– Cases by gender: Prevalence among males was conspicuous, accounting for 70 percent of HIV positive cases and 85.9 percent of thosewith AIDS.
– Cases by nationality: Thirty-three percent of HIV cases are found to
involve non-Japanese nationals. As for females with HIV, the share ofcases involving non-Japanese nationals jumps to 71.9 percent.
– Mode of transmission: The majority of HIV/AIDS cases involved sexualtransmission. The rate of infection identiﬁed with injecting drug use
and mother-to-child transmission is low. Among the Japanese males
found to be infected with HIV, the largest percentage (53.9 percent)of the cases is among men who have sex with men (MSM).

15

Japan’s Responses to the Spread of HIV/AIDS

Populations Vulnerable to HIV Infection
As in other countries, there are certain groups considered to be at high risk
and vulnerable to the epidemic. Among them, men who have sex with men
are considered to be at the highest risk. Although a smaller proportion,
migrant workers, especially unregistered non-Japanese nationals without
legal status, are similarly considered vulnerable and seriously at risk of HIV
infection. The situation regarding sex workers and injecting drug users is
yet to be fully assessed.

Men Who Have Sex With Men
Commonly cited statistics estimate the MSM population in Japan at approximately 1.5 percent of the male population, many of whom reside in downtown
Tokyo and Osaka, which are said to have the largest gay communities in Asia.
However, as Japanese society generally shows little tolerance for diversity insexual orientation, most of these people do not openly declare themselves
as MSM. As a result, preventive education and awareness-raising measures
speciﬁcally targeted at MSM have not been implemented until recently. MSM
transmitted cases account for the largest share of HIV infections among theJapanese male population, amounting to approximately half of the cumulative number of cases reported. The number of newly reported cases involving
homosexual contact is more than twice that of those involving heterosexualtransmission, and continues to show an upward trend.4 Especially among
younger MSM, the lack of sufﬁcient knowledge about HIV/AIDS and sexuallytransmissible infections (STIs) seems to contribute to low rates of condom
usage and a greater likelihood of engaging in high-risk behaviors.5

Migrant Workers
The cumulative total of non-Japanese nationals identiﬁed with HIV/AIDS isapproximately 1,700, or 33 percent of all reported cases. Since non-Japanesenationals comprise less than 2 percent of the entire population in Japan,
4

It should be noted that the greater number of reported cases attributed to homosexualtransmission is said to be due in part to the higher level of awareness among MSM
about the epidemic and thus a greater frequency of HIV testing.
5
See Kimura et al. (2001, 127–129).

16

Present State and Future Trends
they are clearly over-represented. By nationality, those from Southeast Asia
are the most numerous, followed by those from Latin America and subSaharan Africa. A particularly high ﬁgure was recorded for cases reported
in 1992,6 but the number has leveled off since. It is not clear whether theapparent stabilization of this trend line is an indication of a decline in thenumber of non-Japanese residents identiﬁed with HIV/AIDS or simply
that such cases have not been promptly reported.
For this population group, the language barrier is cited as a key impediment to accessing information. There is an obvious lack of information on
prevention in languages other than Japanese. The absence of appropriate
medical interpretation services has also limited the access of non-Japanese
speakers to proper testing, care and treatment.
For unregistered foreigners or those without valid legal status, medical bills pose a great obstacle. In Japan, foreign nationals are eligible for
medical insurance, provided they have proper visas, and they can receive
treatment under the insurance system. However, at present over 200,000
foreign nationals residing in Japan are said to be of unregistered status andthus are unable to apply for health insurance. The bulk of non-Japanesepeople living with HIV/AIDS fall into this latter category.
Given this situation, many such non-Japanese have never been tested for
HIV and tend not to visit medical institutions until they are in the advanced
stages of AIDS or carried in near death.7 Another problem lies in the numerous
cases of non-Japanese residents not covered by health insurance. Because they
are unable to pay for expensive HIV treatment, some hospitals are reluctant
to accept such patients. In the case of tuberculosis, the government covers the
medical expenses for non-Japanese patients even without proper legal status,
but no equivalent system is yet in practice for HIV/AIDS treatment.8 The
state of affairs whereby uninsured foreigners are left without access to proper
medication not only poses a social problem on humanitarian grounds, butalso a potential threat in terms of the further spread of HIV.
The number of non-Japanese residents has grown rapidly since the mid1980s, doubling in the past twenty years. Having long been characterized
6

Employers in the sex industry hiring women from abroad have collectively required
them to undergo HIV testing in 1992.
7
For details on foreigners who have overstayed their visas and are infected with HIV,refer to Yamamura and Sawada (2002).
8
In Kanagawa Prefecture and a number of other prefectures, the municipal government compensates medical institutions for unpaid medical expenses by uninsured
foreigners. However, such practices are rare elsewhere in Japan.

17Japan’s Responses to the Spread of HIV/AIDS
by its relative homogeneity, Japanese society has not yet adjusted to its
evolution in the direction of a multi-ethnic and multi-cultural society inthis age of globalization. Policy measures are lagging behind contemporary needs, leading to numerous problems in the health and medical ﬁeld
as well as in areas such as education, housing, labor management, andhuman rights.

Sex Workers9Sex workers are also a vulnerable population at high risk of HIV infection, although the actual number of reported HIV/AIDS cases that involvesex workers is unknown. Prostitution has been prohibited in Japan since
the enforcement of the Anti-Prostitution Law in 1957. However, the sex
industry never disappeared and continued to diversify since the 1980s
as certain adult entertainment businesses were legitimized under laws
regulating their establishments and services. Among these businesses, itappears that use of condoms has not become a general practice and therisk of HIV infection is high.
Since the latter half of the 1980s, many women from neighboring Asian
countries have entered Japan and been involved in the sex industry. These
non-Japanese female sex workers are particularly vulnerable to infection as
an ever widening segregation between them and native-born Japanese sex
workers has led to a tendency for the foreign nationals to engage in higherrisk practices. Furthermore, language barriers hinder access to adequate
information on prevention and care and the workers’ lack of valid visas
prevent them from applying for the health insurance that would enable
access to treatment and medication.10

Injecting Drug Users
The ﬁrst case of HIV infection transmission from injecting drug use was
9This section draw heavily on the presentation by an NGO, Sex Work and Sexual
Health, at a workshop on “HIV/AIDS and the Vulnerable Community in Asia” held
on November 24, 2003, in Tokyo.
10
The Thai Ambassador to Japan Kasit Pirom remarked to the Thai newspaper, Nation,of November 2, 2003, that “About 50 Thai women forced into prostitution in Japan
die there from AIDS every year.”18

Present State and Future Trends
identiﬁed in 1989. The share of cases involving HIV transmission via
injecting drug use has remained below 1 percent of all seropositive cases
reported and thus is not considered a major channel for spreading theepidemic in Japan, and not nearly as serious a concern as in the UnitedStates. This may, in part, be due to the fact that the most common methodof illicit drug ingestion in Japan is inhalation rather than injection.11
As illegal drug usage is strictly prohibited and socially unacceptable inJapan, it is possible that some may claim that their infection was sexuallytransmitted rather than admit to injecting drugs. Because drug abuse isspreading, especially among young people, there is the potential for thismode of transmission to become a more serious cause for concern. Thereis a clear need for prevention measures targeted towards injecting drug
users to be strengthened.

Impact of the HIV-Tainted Blood Scandal
In Japan, the ﬁrst outbreak of the epidemic was among hemophiliacs infected by contaminated blood products that were imported primarily fromthe United States. Between 1982 and 1985, approximately 40 percent, or
1,400, of the hemophiliac patients treated with these blood products were
infected and, until the mid-1990s, over half of the Japanese people livingwith HIV/AIDS had been infected by contaminated blood products. The
history of the epidemic in Japan differs greatly from that in the North
American and European countries where HIV/AIDS was originally identiﬁed in the public mind with sexual transmission.
As the link between the tainted blood products and the outbreak cameto light, criticism mounted against the Ministry of Health and Welfare andthe pharmaceutical companies for neglecting to take any preventive actions
while being aware of the potential dangers of the blood products.12 In 1989,
the HIV-infected hemophiliacs successively ﬁled lawsuits in Osaka andTokyo demanding compensation from the national government (Ministryof Health and Welfare) and ﬁve pharmaceutical companies.13 Fearing
11

See Wada et al. (2003, 18).
For details, see Feldman (1999).
13
Representing the prosecutors for the group of patients in Osaka was Satoru Iyenishi,
who later was elected to the House of Representatives (Japan Democratic Partyof Japan). The mother of Ryuhei Kawada, Etsuko Kawada, also ran for ofﬁce andserved in the House of Representatives until 2003.
1219

Japan’s Responses to the Spread of HIV/AIDS
prejudice and discrimination, the names of the plaintiffs were withheld,
except for the leader of the Osaka group. However, once Ryuhei Kawada(then age 19), a plaintiff from Tokyo, revealed his identity in 1995, the casereceived much greater attention, eventually developing into a major social
issue. The fact that an infected teenager came forward prompted for theﬁrst time the younger generation to actively join others forming activist
groups to organize and participate in demonstrations and sit-down strikes.
The media likewise pointed out the gravity of the scandal, turning public
opinion decidedly in favor of the hemophiliacs as victims of gross neglect
by the government and the pharmaceutical companies.
The litigation had appeared hopelessly protracted until a sudden shift
in national politics occurred in 1993 when the ruling Liberal Democratic
Party (LDP) suffered electoral defeat for the ﬁrst time in over three decades. The party lost its majority of seats in the Diet, and a coalition
government emerged to take its place. The legal battle took a turn with
the January 1996 appointment of a new minister of health and welfare
without allegiance to the LDP, Naoto Kan (then a member of the newly
formed Sakigake party, and now head of the Democratic Party of Japan).
His ﬁrst public act was to release notes conﬁrming the ministry’s awareness of the potential dangers of HIV infection through blood products as
early as 1983. The notes were based on documents claimed to have been
“missing” by ministry bureaucrats. Thus a battle unfolded between theminister and the career bureaucrats, ending in a victory for the former andpublic scandal for the latter.
In March 1996, the minister made a formal apology to the patients andtheir families and compelled both the ministry and the pharmaceuticalcompanies to admit their responsibility for the spread of the HIV infection
and the resulting damage. A settlement agreement was reached whereby
each patient would be given ¥45 million (US$409,000)14 in a lump sum
payment and the government promised to institute various permanentmeasures to ensure that the victims received adequate support. The present-day state of Japan’s legal and regulatory framework, social welfare
coverage, promotion of basic and clinical research, and provision of medical care and treatment concerning HIV/AIDS has, in large part, stemmed
from the reconciliation and conﬁrmation notes exchanged as a result of
the lawsuits. Litigation over the HIV-contaminated blood products had
14

Unless statistics are available in both Japanese yen and U.S. dollars, the ﬁgures inJapanese yen are converted to U.S. dollars at the rate of US$1= ¥110.

20

Present State and Future Trends
been the climactic point in the history of HIV/AIDS in Japan, a history
that was animated by intense public involvement and the demonstrationof strong political leadership.
On the other hand, HIV/AIDS cases involving sexual transmission werealso gradually increasing, but they were given little attention. People infected through sexual transmission remained almost invisible in debates overJapan’s AIDS policy, having taken refuge behind the HIV-infected hemophiliacs. Stigmatization has been even stronger for them than for infected
hemophiliacs, and they were close to being ostracized from society. Since
the majority of people infected through sexual transmission are MSMs,
it is especially difﬁcult for them to publicly acknowledge their HIV/AIDS
status in a society with little tolerance for homosexual orientation. Asidefrom MSMs, sex workers, unregistered migrant workers, and other marginalized populations were also left outside the mainstream discussion as
they maintained silence about their HIV status. As such, Japanese society
tended to neglect or not be aware of their existence.
Despite various efforts to lift this stigmatization, a social climate stillprevails in which those infected through HIV-contaminated blood products are considered innocent victims while those sexually infected arethought to be responsible for having contracted HIV and thus deservingof punishment. Simply put, the former cases are regarded as “good AIDS”
and the latter as “bad.” The phenomenon may not be unique to Japan yet
the dichotomy cannot be ignored, especially since infected hemophiliacs
had been united in a concerted effort to win the litigation and were offered ofﬁcial government apologies and the subsequent implementationof measures to help them with their lives. The stronger stigma attached
to sexually transmitted HIV/AIDS cases, on the other hand, has delayednecessary preventive measures, while the lack of attention to these cases
impeded cooperation and networking among the people infected throughsexual transmission. It is only recently that recognition is being given to
those who have been neglected in the shadow of the tainted blood scandal.
One example of recent movement is the creation of a nationwide networkthat attempts to bring together all of the people living with HIV/AIDS
regardless of the mode of infection.

21

Japan’s Responses to the Spread of HIV/AIDS

Public Perception of HIV/AIDS
Climate of Ignorance and Indifference
The level of interest in AIDS among the general Japanese public is very low.
As the spread of the epidemic is much less conspicuous than in other Asian
countries and African countries, HIV/AIDS is often regarded as a disease
that only affects faraway countries, or just other people not close to home.
There are also many that believe the disease only affects certain kinds ofpeople like hemophiliacs and MSMs and poses no threat to “normal” people
outside such circles. According to a government survey conducted in 2000,
80 percent of respondents expect the number of HIV/AIDS cases in Japan toincrease in the coming years, but only 20 percent expressed concern about
being exposed to the disease themselves.15 Ironically, the settlement of the
conﬂict over the contaminated blood products gave many the impressionthat the issue of AIDS in Japan had been put to rest and ever since the levelof interest in the topic has remained very low.

Inadequate Knowledge of HIV/AIDS
The lack of sufﬁcient knowledge about the epidemic is also frequently identiﬁed as a problem. In schools, the subject of AIDS tends to be taught as ahuman rights issue rather than as a sexually transmissible infection.16 As aresult, basic knowledge about HIV—for example, that it is not transmitted
by handshakes or sharing eating utensils—has permeated to some extent,
but few are aware that having a sexually transmitted disease such as chlamydia can increase the risk of acquiring and transmitting HIV. Although
sex education is essential to promote awareness and prevention, there is
still a strong taboo against talking openly about sex in Japanese society.
Introducing condoms in classrooms, for example, has triggered criticism
from schools and boards of education as openly encouraging sexual activity. Likewise, in 2002, a booklet on sex education distributed to juniorhigh schools throughout the country was condemned in a Diet session
as overly stimulating for students and was withdrawn from circulation,
eventually being forced out of print. At times, those calling for a return15
16

See Cabinet Ofﬁce (2000).
See Kumamoto (2001).

22

Present State and Future Trends
to a more orthodox sexual morality have turned their criticism toward
organizations promoting preventive AIDS education. The fact remainsthat sexual intercourse among young people is on an upward trend andthe spread of the epidemic is conspicuous among youth. If current trends
are to be reversed, there is an urgent need to diffuse more practical anddown-to-earth knowledge on prevention and awareness.

Stigma and Discrimination
In a 2000 public opinion survey, a majority (84 percent) voiced their belief
that people living with HIV/AIDS should not be discriminated against
or treated differently. Over half the respondents (59 percent) claim thatthey will continue to treat friends and family members in the same manner even if they were to discover that they are HIV positive.17 Contrary
to such exemplary responses, in actuality, numerous cases are reported ofoutright discrimination against people living with HIV/AIDS. It is clear
from media reports and litigation that unfair discrimination has taken place
in a wide range of areas. One recent case involved a man who was denied
employment by the metropolitan police department after being forced toundergo HIV testing without his consent (in Tokyo). In another case, achild was refused admission to a day-care center simply on the grounds
that a parent was HIV positive (in Yamanashi prefecture). Other cases thathave not been made public include violations of basic human rights suchas privacy and conﬁdentiality, termination of employment, and the denialof treatment at medical institutions.18
Not only are actual cases of discrimination interfering with the daily livesof those infected, but the problem of “felt stigma” is also a major issue. Felt
stigma refers to the “shame associated with the illness and the fear of being
discriminated against on account of the illness.”19 Due to fear of this stigma
and a sense of self-preservation, it is common for people living with HIV/AIDS to conceal their infection even from those close to them, preventing
them from beneﬁting from various available welfare and health services.
The phenomenon of isolation from society triggered by felt stigma has beenreported in other countries, but no comprehensive study has measured the17

See Cabinet Ofﬁce (2000).
Details on the human rights issues concerning people living with HIV/AIDS in Japanare given in Tarui (2001).
19
See de Bruyn (1998).
18

23

Japan’s Responses to the Spread of HIV/AIDS
degree of the problem in Japan. Many people living with HIV/AIDS andtheir families, however, admit to their own avoidance of society, which inturn keeps them from enjoying an independent life of their own.
The extent of HIV-related stigma and discrimination is obvious in theextremely limited number of Japanese having openly acknowledged being
HIV positive. At present, only about ten Japanese individuals, a surprisingly
low number, have had the courage to come out publicly.

Future Perspectives
Many medical specialists warn of the imminent spread of the epidemic
based on several sets of reliable data. For one, the rate of HIV-positive
readings among blood donors is increasing steadily (see ﬁg. 1-4). The rapid
increase of STIs and abortion among young people since the latter half ofthe 1990s has been accompanied by a simultaneous decline in condom sales(see ﬁg. 1-5). Cause for concern is also seen in the declining average age ofﬁrst sexual intercourse and diversiﬁcation in sexual behavior. According to
the latest estimates, the number of HIV-infection and AIDS cases appears
to be doubling at a rate of four years. Unless some effective preventive
measures are applied, the count is likely to reach 50,000 by the year 201020
for Japanese nationals alone, not taking into account the increasing numberof foreign residents also affected by the epidemic.

20

See Hashimoto et al. (2002, 11).

24

Present State and Future Trends
Figure 1-4: HIV-Positive Rate of Donated Blood

Source: National AIDS Surveillance Committee, Annual Report 2002.

Figure 1-5: Annual Shift in Rate of Abortion, Spread of Chlamydia
and Domestic Sales of Condoms in Japan

Source: Kihara and Kihara (2003). Data updated by JCIE.

25

II. Japanese Government Policies on HIV/AIDS
HIV/AIDS issues are not yet on the mainstream policy agenda in Japan.
Many point out that the absence of a national commission on HIV/AIDS
impedes the development of effective national responses at high politicallevels. In fact, there has not been any recent cabinet or ministerial meetingthat effectively coordinates efforts among the vertically divided government
ministries and agencies. As described below, there is no comprehensive
national policy on HIV/AIDS, only separate measures being pursued independently of each other on the domestic and foreign policy areas. The
Ministry of Health, Labour and Welfare is at the forefront of domestic
policies while leaving research and educational issues to the Ministry of
Education. The Ministry of Foreign Affairs is acting on its own in forming
foreign policies on HIV/AIDS.

Domestic Policies on HIV/AIDS
Role of the Ministry of Health, Labour and Welfare
Domestic HIV/AIDS policies are set mainly by the Ministry of Health, Labourand Welfare (MHLW). The annual budget for HIV/AIDS-related measuresand programs within the ministry amounts to ¥11.3 billion (US$103 million)
for ﬁscal year 2003, a level that has been maintained for the past few years(see the “MHLW Budget” side bar for a budget breakdown). Various permanent measures to provide special beneﬁts for HIV-infected persons, support
research, and create an appropriate system for care and treatment have beenpromoted by the MHLW following the tainted blood scandal. However, theimplementation of effective public prevention measures, in comparison, has
lagged behind. The delay may in part be due to the priority placed on responding to the demands of the plaintiffs in the tainted blood case. Given the recent
increase in the sexual transmission of the virus, especially among JapaneseMSMs, recognition is growing within the MHLW for the need to accelerate
the implementation of prevention and awareness-raising measures targeted at
MSM. Yet all in all, it appears that HIV/AIDS hardly stands out as top priority
for the ministry, which is dealing with many other infectious diseases requiring
immediate attention such as SARS, avian inﬂuenza and leprosy, all of which
are seen as being in competition with one another.

Japanese Government Policies
The actual implementation of HIV/AIDS measures is mainly the taskof the Japanese Foundation for AIDS Prevention (JFAP), which was established in 1987. JFAP is a semi-governmental foundation created with thesupport and cooperation of private businesses and politicians and fundedbasically by the MHLW. Its purpose is to widely disseminate knowledge
on the prevention of AIDS to the public, offer counseling to people living with HIV/AIDS, and provide training on HIV/AIDS for counselors at
hospitals and local health centers. It also serves as an intermediary thatcollects donations from individuals and redistributes them to NGOs as
grants. On an international level, JFAP invites government administrators
working in the ﬁeld of HIV/AIDS from neighboring Asian countries toJapan to undergo training programs on HIV/AIDS issues.
MHLW Budget for HIV/AIDS Programs for Fiscal Year 2003
1. Research on Epidemiological Origin¥1,218 million
and Prevention
2. Provision of Medical Care and Treatment ¥2,369 million
3. Promotion of R&D¥4,611 million
4. International Cooperation¥657 million
5. Human Rights, Awareness-Raising and ¥2,039 million
Cooperation with Other Related Organizations
6. Subsidies to Prefectural Efforts to¥400 million
Promote AIDS Control Measures(US$11 million)

Total(US$102.7 million)¥11,295 million(US$21.5 million)(US$41.9 million)(US$5.97 million)(US$18.5 million)(US$3.6 million)

Source: Unofﬁcial translation of the JFAP website.

Existing Framework for Fighting HIV/AIDS
Legal and Regulatory Framework
Domestic measures to combat infectious diseases are introduced mainly
in compliance with the Law Concerning the Prevention of Infectious
Diseases and Patients with Infectious Diseases that was enacted in 1999.
This law classiﬁes infectious diseases into ﬁve categories, Types I throughV, based upon their infectiousness and the seriousness of their symptoms.
HIV/AIDS is categorized as Type V, which comprises the bulk of infectious
diseases, including inﬂuenza and chlamydia, and is considered as having theweakest rate of infection among the ﬁve. Previously measures had fallen
under the Law Concerning the Prevention of Acquired Immunodeﬁciency

27

Japan’s Responses to the Spread of HIV/AIDS
Syndrome (AIDS Prevention Law) of 1989. However, this law was replaced due
to criticism that it was more concerned with secondary infection rather thanthe provision of appropriate care and treatment for those with HIV/AIDS.
With the implementation of the new law, the MHLW announced the
National Guidelines for HIV/AIDS Prevention and Care to promote antiAIDS measures (see the “National Guidelines” side bar). They form thebasis of present-day domestic HIV/AIDS policy.

Support for Research
As part of the settlement to the HIV-tainted blood litigation, the AIDS
Clinical Center (ACC) was established in 1997 in order to provide thelatest treatment and promote clinical research on potential cures and newtreatment. The Health and Labour Sciences Research Grants21 under thejurisdiction of the MHLW also designated funds to support research on
HIV/AIDS. These grants have funded some 30 projects in ﬁscal year 2003
on HIV/AIDS in the areas of basic medicine, clinical studies, epidemiological research, social medicine, and other research that might help promotecomprehensive approaches to ﬁghting the epidemic. These grants havetotaled approximately ¥1.2 billion (US$10.9 million).
Initially, these research grants were available only to universities andresearch institutions, but eligibility has been expanded to include NGOs
involved in prevention and epidemiological studies and surveys.22 Their
contributions have been especially important in reaching out to vulnerable
populations such as MSM, sex workers and unregistered migrant workers
not easily accessed by governmental agencies.

The HIV/AIDS Surveillance System in Japan23
The HIV/AIDS surveillance system in Japan began collecting data on thenumber of AIDS patients in 1984 and on the number of HIV-infected
21

These grants are awarded to research projects selected on an open application system
in 28 designated research areas, including HIV/AIDS, amounting to a total of ¥41.7
billion, or US$379 million, (distributed to 1,400 projects) in ﬁscal year 2003.
22
It should be noted, however, that such support amounts to only 3 percent of the total
spending on HIV/AIDS research conducted with the Sciences Research Grants of
the MHLW.
23
Details on the HIV/AIDS Surveillance System in Japan and its problems are delineatedin Kihara et al. (2003).

28

Japanese Government Policies

National Guidelines for HIV/AIDS Prevention and Care
Issued by the Ministry of Health, Labour and Welfare(Unofﬁcial translation of excerpts)• Investigation of Causes: Strengthen research and analysis on AIDS
prevalence patterns and incorporate the results in future measures.
• Prevention of Infection and Further Spread: Maintain and strengthen
HIV testing and counseling services and improve measures speciﬁcallytargeted at populations vulnerable to HIV infection. Also integrate efforts with measures against sexually transmitted infections (STIs).
• Provision of Medical Care: Secure access to appropriate medical care aswell as support the daily lives of people living with HIV/AIDS.
• Promotion of R&D: Promote research to prevent further spread of theepidemic and advance research and development on cures, vaccines,
diagnostics and testing methods.
• International Networks: Encourage international information exchange
among governments, researchers and NGOs and incorporate it into domestic HIV/AIDS policies. Contribute to the international prevention
efforts by supporting UNAIDS and strengthening bilateral cooperation in
health care projects. Also, in coordination with the Ministry of Foreign
Affairs, promote international cooperation in prevention and care withcountries from which people are actively migrating to Japan, especiallywith the countries in Asia and Central and South America.
• Respect for Human Rights: Protect the basic human rights of people
living with HIV/AIDS and their rights to privacy and conﬁdentiality.
Coordinate efforts between the Ministry of Education, the Ministry ofLabour, and the Ministry of Justice to abolish discrimination against
people living with HIV/AIDS. On the medical front, provide treatment
based on informed consent and respect for the individual.
• Information and Education: Strengthen prevention education campaign
and permeate basic knowledge of HIV/AIDS among the general public
and in particular to populations especially vulnerable to the epidemic.
Also, offer training to medical practitioners.
• New Ties with Related Institutions: Recognize the importance of establishing cooperative relationships between ministries, various governmental agencies and organizations, NGOs and all involved in the ﬁght
against the epidemic.
Note: For full translation of the guidelines, see Japan Association for the Lesbian & Gay
Movement OCCUR (1999, 74–85).

29

Japan’s Responses to the Spread of HIV/AIDS
persons in 1987. With the implementation of the 1999 law on infectious diseases, physicians are required to report HIV/AIDS diagnoses. The amassed
data is analyzed and disclosed every three months by the National AIDS
Surveillance Committee. The most critical problem in Japan’s reporting
system is the absence of personal identiﬁers such as name, address, dateof birth, or occupation, preventing the detection of duplication as well as
the tracking of the disease progression from HIV to AIDS.
In Japan, there is regular nationwide serosurveillance for blood donations, but unlike in other countries, there is no mandatory testing during
pregnancy nor is there any military draft that requires medical check-ups
for young adults. Thus, there is still much to be done to establish a soundsystem for collecting data and to reﬁne the surveillance system so that it
can accurately assess the true status of the epidemic in Japan.

Voluntary HIV Testing
In order to gain a better grasp of the spread of the epidemic, data obtained
from voluntary HIV testing is also important. In the last decade, free HIV
testing at local health centers has become available in all the prefectures
throughout Japan, but the number of people undergoing testing is still
very small, only about 50,000 annually.
One of the reasons for low HIV testing rates is the limited ofﬁce hoursof local health centers, which are open only during daytime hours andweekdays and require appointments. In order to make voluntary HIV testing services more readily available, some testing sites are now being kept
open on weekends, holidays, and during evening hours; testing is being
made available without an appointment; and the results are being given
immediately. Initially, NGOs and private clinics with greater ﬂexibility thanthe more bureaucratically operated health centers were at the forefront of
introducing such innovative measures. Gradually, some municipal agencies
have begun to give serious consideration to offering free testing services
on weekends and evenings in central downtown areas. Such services wereﬁrst offered by health centers in metropolitan Tokyo, followed by the cityof Nagoya and Osaka prefecture.

30

Japanese Government Policies

HIV Treatment
HIV/AIDS treatment in Japan is available at central medical centers called
AIDS Care Core Hospitals. The AIDS Care Core Hospitals system emerged
as a result of the lawsuits and the 1996 reconciliation agreement. It is
intended to offer the latest information on the epidemic and the most upto-date care and treatment. Over 300 hospitals have been designated as
AIDS Care Core Hospitals and 14 chosen as regional block headquarters.
The AIDS Clinical Center (ACC) sits at the top of a pyramid-shaped systemof these core hospitals, and is the place where information is compiled andleadership is exerted, both in the areas of treatment and research advancement. The block headquarter hospitals are expected to have special outpatient treatment services and hospital beds speciﬁcally for people with
HIV/AIDS, as well as offer counseling and training to medical staff fromother AIDS Care Core Hospitals.
Sharing of updated information and coordination between hospitals
should lead, in principle, to high-quality care. However, in reality, certain
hospitals have proven to be well-equipped to handle HIV/AIDS cases
while others have failed to keep up with the latest treatment. There areconsiderable disparities between one hospital and another, as well as between regions.
Counseling plays an important role as part of the package of support
and care offered to people living with HIV/AIDS. However, there is nonational examination to certify counselors in Japan since counselors are
not considered to be medical professionals. In Japan’s medical system,
exceptions are made for having counselors employed in relation to HIV/AIDS programs; however, they are not professional counselors per se but
rather medical staff with special training or capable of offering counseling.
Efforts have been made to use the example of HIV/AIDS counseling to help
introduce counseling services in other branches of medicine, but this has
not yet been adopted. Progress on making counseling more widely available has stalled as the economic downturn has led to budget cutbacks for
programs promoting the spread of the concept of counseling, even in theﬁeld of HIV/AIDS treatment.

Social Security System
Depending on the extent of their physical disabilities, HIV-infected people
are entitled to welfare measures under the Law for the Welfare of People

31Japan’s Responses to the Spread of HIV/AIDS
with Physical Disabilities. This is another beneﬁt included in the settlement signed between the group of infected hemophiliacs and the MHLW.
People living with HIV/AIDS recognized to have disabilities are provided
with subsidies for medical expenses, tax-exemption, disability pension, access to visit-care staff (home-helpers), discounts on fees for public services
and other measures.
Ofﬁcial status as disabled also permits people living with HIV/AIDS to
beneﬁt from the law promoting the employment of people with disabilities. This law provides incentives for employers to hire people living withdisabilities by offering special beneﬁts. It should be noted that despite
such measures, only about 40 percent of corporations actually fulﬁll thelegal quota set for hiring people with disabilities (not exclusive to thosewith HIV/AIDS). At the same time, most Japanese corporations have yetto establish concrete AIDS policies in the workplace and have much to
improve in terms of protecting the privacy of their employees.

AIDS Education and Awareness-Raising
In Japan, the main public sector outreach activities are awareness-raising
campaigns centered on the World AIDS Day in December and educational
programs organized at schools from the primary through to the senior highschool levels. There are, however, no systematic nationwide school-based programs. In 1993, there was one attempt to institute such a systematic program
when the Ministry of Education, Culture, Sports, Science and Technology(hereafter referred to as Ministry of Education) embarked on a three-yearseries of educational programs at schools within designated target regions ineach prefecture.24 A number of schools with highly motivated school nurses
or physical education and hygiene teachers expanded on the program, coordinating with local NGOs, arranging for students to meet people living with
HIV/AIDS, and implementing other innovative ideas.
Systematic prevention programs targeted at high-risk populations havebeen recently developed for the gay community. In 2003, the MHLW and
the Japanese Foundation for AIDS Prevention jointly established prevention centers speciﬁcally for MSMs in downtown Tokyo (Shinjuku 2-chome
district) and Osaka (Doyama district), both of which are considered to beamong the largest gay communities in all of Asia. These two centers are the24

The Ministry of Education has an annual budget of about ¥30 million (US$273,000)
for the educational programs and has at present 39 regions designated for the promotion of the programs.

32

Japanese Government Policies
ﬁrst publicly operated prevention centers in Japan. Managed in partnershipwith NGOs specializing in HIV/AIDS prevention for MSMs, they offer
information and serve as headquarters for outreach efforts. There are nosuch centers run by the public sector for other vulnerable populations.

Foreign Policy Initiatives on HIV/AIDS
HIV/AIDS in Foreign Policies
On the international front, Japanese foreign policy addresses HIV/AIDS
together with other infectious diseases as an issue requiring concerted
global efforts. It is considered an important area of assistance in the government’s Ofﬁcial Development Assistance (ODA) scheme. The conceptof human security has been a pillar of Japanese foreign policy since 1998,
and HIV/AIDS is also regarded as one of the main challenges to humansecurity. HIV/AIDS policies are set forth in the Global Issues Initiatives
on Population and AIDS (GII), which operated from 1994 to 2000, and in
the Okinawa Infectious Diseases Initiative (IDI), underway from 2000 to
2004. These initiatives are indicative of the Japanese government’s commitment to ﬁght the global spread of the epidemic and make constructive
contributions to prevention efforts. To this end, many projects are being
supported by ODA (for the structure of ODA, see appendix 2).

Global Issues Initiatives on Population and AIDS: 1994–2000• This series of initiatives was announced as part of the Japan-U.S.
Common Agenda25 cooperation in the ﬁeld of health care. The projects
supported include those dealing with basic health care, assistance toprimary education by way of constructing school buildings, empowerment of women, HIV/AIDS control, and reproductive health.
• In the seven years between 1994 and 2000, a total of US$3 billion was furnished as ODA. Of this total, a 2 percent share was speciﬁcally earmarked for25

Drawn up in July 1993, the Japan-U.S. Common Agenda for Cooperation in Global
Perspective is an agreement on a Japan-U.S. partnership to coordinate efforts in addressing global issues. One of the priority areas of collaboration is the promotionof health and human empowerment. To address more speciﬁc issues, the Japanese
government announced the Global Issues Initiatives on Population and AIDS in
February 1994 to focus on population and health, and also on emerging and reemerging infectious diseases with special emphasis on HIV/AIDS.

33

Japan’s Responses to the Spread of HIV/AIDS
HIV/AIDS projects. The projects supported were in the areas of blood supply, research and development and improved testing technology. Particularstress was placed on supplying blood-testing equipment.

The Okinawa Infectious Diseases Initiative: 2000–2004• The Okinawa Infectious Diseases Initiative was announced on the occasion of the Kyushu-Okinawa G8 Summit held in July 2000. It aims tocontinue the efforts of GII and strengthen measures against infectious
and parasitic diseases including tuberculosis, malaria and polio, in addition to HIV/AIDS.
• In the ﬁve years between 2000 and 2004, a total of US$3 billion will beoffered in ODA. As part of this fund, a special grant aid was set up inﬁscal year 2000 to support infectious disease projects. Since ﬁscal year
2001, Japan has been giving ¥10 billion (US$91 million) annually in
special grant aid. In an age when the overall ODA budget is declining(the total amount was cut by 27.1 percent in ﬁscal year 2001, as comparedto the previous ﬁscal year), the securing of a special grant demonstrates
the high priority given by the Japanese government to infectious andparasitic diseases.
• The focus of the actual measures supported was on health sector institution strengthening in developing countries, human resource development, partnerships with civil society, donor countries and internationalorganizations, South-South cooperation, the promotion of research
activities, and the promotion of public health on the community level.
• All of Japan’s major efforts for tackling infectious and parasitic diseases
are pursued under the IDI, which to date has distributed a total of US$2
billion in assistance. Of this total, assistance for measures speciﬁcallyrelated to HIV/AIDS amounts to an 8 percent share.26 Spending on
HIV/AIDS, although limited, enjoys the second largest share followingthat of polio.
• As a follow-up to the Kyushu-Okinawa G8 Summit, two international
conferences were held to boost international and domestic discussion on
the subject. They are the Okinawa International Conference on Infectious
Diseases held in December 2000 and a public symposium held on “Global
Partnership in the Fight Against Infectious Diseases” in October 2001.

26

Analysis by the Economic Cooperation Bureau of the Ministry of Foreign Affairs.

34

Japanese Government Policies

Priority of HIV/AIDS Relative to Other Infectious Diseases
As the measures listed above indicate, the Japanese government is taking
initiatives to comprehensively combat infectious and parasitic diseases.
However, HIV/AIDS is not at the top of the list of these diseases. Statistics
indicate that the ratio of funding for projects speciﬁcally targeted to
HIV/AIDS is low (in fact, it only amounts to 2 percent of the overall GII
spending and 8 percent of that of the IDI). Several explanations can begiven for this peculiar situation.
First, Japan has a comparative advantage in the treatment of tuberculosis, polio and parasitic diseases, but not in combating HIV/AIDS. A
considerable amount of experience on tuberculosis, polio, and parasitic
diseases has been accumulated over the past several decades through efforts
to combat them at home and abroad, permitting Japan to demonstrateparticular expertise in treating these diseases and responding to the needsof developing countries. However, the same cannot be said in the case of
HIV/AIDS, an area where Japan’s potential contribution in terms of human and technical resources is seen as relatively limited. Consequently,
the Japanese government has called for a comprehensive approach to ﬁght
all infectious diseases.27 Thus the number of projects speciﬁcally geared to
HIV/AIDS do not outweigh others.
Second, Japan has placed priority on the promotion of basic educationand securing safe water supplies, which is considered essential to control
infectious diseases. Thus the percentage share of assistance given speciﬁcally to HIV/AIDS-related activities is quite small relative to total Japanese
foreign aid in the area of infectious diseases. (Basic education and similar
programs that indirectly contribute to the prevention of HIV/AIDS are notincluded in the above-mentioned 8 percent of IDI spending.)
Third, it should be remembered that Japanese funding for HIV/AIDSrelated measures remains mainly in the areas of prevention, awarenessraising and technical support, all of which do not require large budgets.
Thus the total expenditure in these areas appears small in comparison tothat on efforts related to polio and other infectious diseases, which typicallyinvolve the supply of vaccines.
27

At the 2001 Kyushu/Okinawa G8 Summit, the Japanese government proposed theimplementation and enhancement of actions to ﬁght various infectious and parasitic diseases and to not just focus on HIV/AIDS. It was the ﬁrst attempt to forge aconcerted effort to combat the various kinds of infectious and parasitic diseases.

35

Japan’s Responses to the Spread of HIV/AIDS
However, for the Japan International Cooperation Agency (JICA), an
ODA agency that implements government-based technical assistanceprograms, HIV/AIDS is given special priority instead of being lumped into
a comprehensive approach to all infectious and parasitic diseases. JICA
activities are targeted speciﬁcally to ﬁghting the epidemic, but a lack of human resources is commonly cited as an obstacle. JICA usually dispatches
experts from Japan to developing countries in order to transfer technicalskills and promote self-sustaining projects, but there seems to be an obvious lack of such experts in the ﬁeld of HIV/AIDS.
Another characteristic of JICA, as with all Japanese ODA agencies, isthe tendency to initiate projects mainly at the request of recipients. Since
1997, JICA has been adopting a more proactive approach of offering
assistance by seeking the input of developing country governments injointly formulating appropriate ODA programs. However, the subject of
HIV/AIDS programs has yet to be included in the guidelines formulated
for each recipient country, and it has been pointed out that Japanese ODA
has so far had little strategic impact on recipient countries’ HIV/AIDS policies. Assistance still centers on projects to promote voluntary counselingand testing and improve blood testing, in response to the needs expressedby recipient countries. JICA’s overall expenditures on HIV/AIDS-related
programs thus do not amount to much in the past several years, comprising only about 3.5 percent (approximately ¥550 million or US$5 million
in ﬁscal year 1999)28 of spending in the health and medical areas. Since
2003, a different approach is being attempted through JICA’s JapaneseOverseas Cooperation Volunteers (JOCV) program, which is dispatching
trained HIV/AIDS volunteers, apart from medical service providers, tooffer technical cooperation related to prevention and care.

Regional Policies and HIV/AIDS
Looking at regional policies, those targeted at Africa place high priority on the epidemic. In the regular meetings of the Tokyo International
Conference on African Development (TICAD),29 which was started in 1993,
28
29

See Japan International Cooperation Agency (2002, 21–22).
An international conference co-sponsored by the Japanese government, the United
Nations, the Global Coalition for Africa (GCA) and the World Bank on the themeof African development. The ﬁrst meeting (TICAD I) was held in 1993, the second(TICAD II) in 1998 and the third (TICAD III) in 2003.

36

Japanese Government Policies
HIV/AIDS is given weight in the discussions and constantly incorporated
in the agenda and outputs of the conference.
In regards to policies for Asia, there are some bilateral HIV/AIDS assistance schemes targeted towards individual countries in Southeast Asia, but
no clear commitment on a regional level. Little reference to HIV/AIDS, ifany, is made, in the recently launched Initiative on Development of East Asia
(IDEA)30 and the proposals announced in December 2003 to commemorate
the ASEAN-Japan Exchange Year 2003.31 The only exception is the JapanASEAN Information and Human Network for Infectious Diseases Control,
an endeavor to create a network to promote the region-wide developmentof human resources and technical cooperation in the ﬁght against infectious diseases started in November 2001. Operating with a much broader
mandate than the area of HIV/AIDS, it is hoped that this undertaking will
expand on previous bilateral efforts. Such a regional network would enable
experts in the region to exchange information and strengthen coordination
between international organizations, donor countries and NGOs.

Projects Under the Okinawa Infectious Diseases Initiative32
Partnership with Civil Society and Other Donor Countries
Partnership with NGOs: At the local community level, NGOs play animportant role in the effective implementation of HIV/AIDS measures.
Japan supported the HIV/AIDS-related activities of Japanese and overseas
NGOs by providing approximately US$1 million in grant aid in ﬁscal year
2001. Since 2003, even JICA, which is known for working independently ofNGOs in dispatching experts, has been giving greater authority to NGOs
in carrying out programs that are undertaken at the request of recipient
governments.

30

This ministerial-level conference is held between ASEAN nations, China, Korea andJapan. Started in 2002, it aims to realize a spirit of “act together, advance together” inthe ﬁeld of development in Asia and to coordinate efforts in East Asian countries.
31
The Japanese government declared 2003 to be the ASEAN-Japan Exchange Year andannounced a Tokyo Declaration and Basic Guidelines for enhancing the relationshipbetween Japan and the ASEAN nations.
32
This section is based on information obtained from Ministry of Foreign Affairs
publications on the IDI. For details, see <http://www.mofa.go.jp/policy/oda/category/health/index.html>.

37

Japan’s Responses to the Spread of HIV/AIDSPartnerships with other donors: As a preliminary step in the effort toﬁght infectious disease, joint project formulation missions with other donor countries are dispatched to countries afﬂicted with HIV/AIDS. Thesemissions examine potential project areas such as HIV/AIDS measures,
reproductive health, mother-child health care, tuberculosis, malaria, polio,
and parasitic diseases. In cooperation with the United States, missions
were dispatched to Zambia in 1998, to Bangladesh and Cambodia in 2000,
to Tanzania in 2001 and to Nigeria and Nepal in 2002. A similar joint
Canada-Japan mission was conducted in Malawi in 2002.

Strengthening Institutions
With the Japan Bank for International Cooperation (JBIC) and JICA as
the core agencies, the Japanese government is constructing and repairing
university buildings, hospitals, medical clinics, testing sites, and research
centers. The research institutions built as core sites for regional research
activities include the Kenya Medical Research Institute, the National
Institute of Health of Thailand, and the Ghana Noguchi Memorial Institute.
Also, assistance is given for supplying blood testing equipment (in thePhilippines, India, Pakistan, Brazil and Tanzania) and for the constructionof a national blood transfusion center in Sri Lanka.

Promotion of Research Activities
Japan has offered technical assistance to improve the quality of HIV/AIDS
testing and diagnosis at the above mentioned core research centers andother research institutes. In Kenya, for example, ﬁnancial support was given
to enable the local production of HIV/AIDS blood-screening kits.

Human Resources Development
Assistance has been extended to provide training for policymakers andmedical experts in the areas of HIV testing, the diagnosis of STIs and
HIV/AIDS, and the management and control of tuberculosis. One example
is the AIDS management course for staff from Japan and the Indochina
region that is offered in Vietnam by the Foundation for Advanced Studies
on International Development (FASID), in joint collaboration with
USAID. Plans are also underway for a senior project management course
in Thailand. Similar programs are being funded by the Japan Special Fund

38

Japanese Government Policies(JSF) of the Asian Development Bank (ADB) in Cambodia, Laos and Vietnam.
JICA also offers AIDS education courses and personnel training programs for
those involved in HIV testing and voluntary counseling and testing.

South-South Cooperation
Training courses and workshops to share knowledge, technology and experience on combating HIV/AIDS with neighboring countries are organized
at research centers constructed with Japanese assistance, such as the Kenya
Medical Research Institute and the Ghana Noguchi Memorial Institute. As
mentioned previously, in the ASEAN region, measures are being taken tostrengthen the training of specialists on HIV/AIDS and networks of experts.
In March 2003, a conference bringing together HIV/AIDS experts fromAfrica and Asia was hosted by Japan in order to promote the sharing ofexperiences and knowledge between the two regions. Other seminars arebeing conducted by the MHLW in the ASEAN nations to similarly encourage the development of health and medical services for the treatment andcare of people living with HIV/AIDS.

Contributions to Multilateral Cooperation
Japan’s contributions to the UN agencies and other international organizations in ﬁscal year 2002 (April 2002 to March 2003) are as follows.33• Asian Development Bank
Funding total: ¥39.26 billion (US$357 million)
Funding source: Ministry of FinanceNote: HIV/AIDS-related projects funded by the Japan Special Fund (JSF)and the Japan Fund for Poverty Reduction (JFPR).
• Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)
Funding total: ¥3.12 billion (US$28 million)
Funding source: Ministry of Foreign Affairs and Ministry of FinanceNote: Amount of contribution totaled US$160 million from ﬁscal years
2001 through 2003. A pledge of an additional US$100 million forﬁscal year 2004 was announced in late 2003.
33

Data taken from “Kokusai kikan tou heno kyoshutsukin shusshikin ni kansuru
houkokusho (Heisei 15 nendo ban)” (Report on contributions to internationalorganizations, ﬁscal year 2003). <http://www.mofa.go.jp/mofaj/gaiko/oda/siryo/
siryo_1/k_kikan_15/15_5.html>.

39

Japan’s Responses to the Spread of HIV/AIDS• International Planned Parenthood Federation (IPPF)
Funding total: ¥1.92 billion (US$17 million)
Funding source: Ministry of Foreign Affairs
Note: Approximately US$1.3 million in ﬁscal year 2002 provided to theJapan Trust for HIV/AIDS, which was established in 2000.
• Joint United Nations Programme on HIV/AIDS (UNAIDS)
Funding total: ¥620 million (US$5.6 million)
Funding source: Ministry of Health, Labour and Welfare
Note: Funding includes assistance extended to the Asia Paciﬁc Leadership
Forum on HIV/AIDS and Development (APLF).
• The United Nations Population Fund (UNFPA)
Funding total: ¥4.94 billion (US$45 million)
Funding source: Ministry of Foreign Affairs• The United Nations Trust Fund for Human Security
Funding total: ¥4.15 billion (US$37.7 million)
Funding source: Ministry of Foreign Affairs
Note: This trust fund was created in the United Nations in 1999 witha total amount of US$203 million donated by Japan. Part of thefund is for projects related to the combat of infectious diseases.
• World Health Organization (WHO)Funding total: ¥1.27 billion (US$11.5 million)
Funding source: Ministry of Health, Labour and Welfare

Joint Collaboration on HIV Vaccine Development
One of the best-known examples of pioneering international collaborationin the ﬁeld of HIV/AIDS is the joint Japan-Thai research project to develop
a preventive HIV vaccine. This research was undertaken through the cooperation of the National Institute of Health of Thailand and the Japan
Science and Technology Corporation,34 with the Japanese contributing abudget of ¥700 million (US$6.4 million). Over a ﬁve-year period startingin 1998, approximately 40 experts from the National Institute of Health of34

Cooperating organizations were the MHLW, the National Institute of Infectious
Diseases, the Japanese Foundation for AIDS Prevention, the Sasakawa Memorial
Health Foundation, and the Ministry of Education, Culture, Sports, Scienceand Technology on the Japanese side and on the Thai side, Mahidol University,
Chulalongkorn University, Chiang Mai University, and the Red Cross ofThailand.

40

Japanese Government Policies
Thailand and the National Institute of Infectious Diseases of Japan worked
together on this collaboration. Vaccine development was pursued using
the most common subtype of HIV found in the Asian region, namely, theclade-E virus as opposed to the clade-B type more frequently found inEurope and the United States. This same subtype is also found increasingly
among people living with HIV/AIDS in Japan, calling for urgent attention
to prevent its further spread.
Some promising results have been obtained through pre-clinical tests
using monkeys for this particular vaccine that uses recombinant BCG(vaccine for tuberculosis) as its vector. It is said that adapting on the BCG
vaccination already in wide application has the merit of being safe andeasily distributed, and expectations are mounting for clinical tests. An
NPO named the AIDS Vaccine Development Association (AVDA) wasestablished in 2004 in order to secure funding and advance this vaccine toclinical trials where safety and efﬁcacy can be tested.
Although efforts are being made, Japanese expenditures on vaccine
development, however, are yet extremely small. Total spending on vaccine
development throughout the world is estimated at US$430 million–US$470
million (in 2001), approximately 60 percent of which was provided by
the U.S. National Institutes of Health.35 With a renewed global commitment to invest more resources in vaccine development, there are calls forJapan’s contribution in this area to be raised to a level more beﬁtting of its
economic position in the world.

35

See UNAIDS (2003, 21–22).

41

III. Non-Governmental Actors in the Fight
Against HIV/AIDS

Civil Society Involvement
The civil society sector in Japan is extremely vibrant, but remains at a muchless advanced state of development than in many Western countries andfaces great challenges in terms of funding, government regulation and thecreation of a supportive environment.
In the eyes of the Japanese public, responsibility for deciding the “publicgood” has long rested on the shoulders of the national government andthe bureaucracy.36 The actual implementation of measures deemed to be
for the public good, in many instances, has been given over to the public
interest corporations, the class of civil society organizations that includes
endowed foundations and membership associations. There are currently
some 26,000 public interest corporations, and they are incorporated undera system established over a century ago. The majority over a certain sizeare closely connected to government agencies, have been established withfunds from government sources, and rely heavily on the continuation ofthis funding for their operations. Government control is strong even forthe public interest corporations that have been initiated in a purely private
manner as the current legal framework places them under government
jurisdiction, often limiting their ability to undertake innovative works in
keeping with the spirit of civil society organizations. Although it seems theyought to be central actors in the struggle to promote the development ofcivil society in Japan, in reality, many of them lack the ﬂexibility to readily
respond to contemporary needs.
A new breeze to promote the development of the Japanese nonproﬁt
sector has been brought about by the newer types of civil society organizations and citizens’ groups at the grassroots level. Not as constrainedby government regulation, these organizations strive to play a greater andmore effective role in addressing social needs. They had long faced severe
difﬁculty in gaining incorporation and have had to make do operating
without formal legal status. It is only since 1998 with the enactment of a
36

For background on civil society organizations in Japan and the evolution of theconcept of how the public good is decided, refer to Yamamoto (1999).

Non-Governmental Actors
new legislation on nonproﬁt organizations (the Law to Promote Speciﬁed
Non-Proﬁt Activities, or the NPO Law) that they were given formal legal
recognition. This represents a major step forward for the Japanese nonproﬁt
sector, but there are still numerous challenges ahead, especially in the areaof funding. In particular, obtaining tax-exempt status remains extremely
difﬁcult, leaving many civil society organizations with serious ﬁnancial
hurdles in a country where there has been little tradition of private giving.
Approximately 90 percent of the nonproﬁts incorporated under the NPO
Law operate on an annual income of under ¥30 million (US$270,000),
and the average organization employs 1.3 full-time paid staff and pays annual average wages of approximately ¥1.18 million (US$10,000).37 Thus,
organizational capacity is typically quite limited. Still, it is these newly
emerging nonproﬁt organizations, ones that operate with minimum government control, that are at the forefront of efforts to tackle HIV/AIDS
and other social issues.

NGOs Working on HIV/AIDS Issues
Many of the Japanese NGOs working on HIV/AIDS issues tend to be active
on either the domestic or the international fronts, and are rarely involved
with both. In addition, the two groups of NGOs tend to operate independently of one another, with little exchange of information and personnel.
Just as the vertical divisions between ministries is underscored by thetendency for the MHLW and the Ministry of Foreign Affairs to strike out
with their own independent policies, there is also minimal coordination
between domestic and international civil society organizations in theirapproach to ﬁghting the epidemic. (A brief description of major JapaneseNGOs involved in this area is given in appendix 3.)

Community-based NGOs
In Japan, there are approximately 100 community-based NGOs involvedin domestic HIV/AIDS-related activities. These include organizations
providing AIDS services to speciﬁc target populations and still more promoting prevention and awareness-raising programs for the general public.
Mainly, they tend to be small-scale entities founded after 1990 that are led
37

See Research Institute of Economy, Trade and Industry (2003).

43

Japan’s Responses to the Spread of HIV/AIDS
by doctors, medical staff, social workers or people living with HIV/AIDS.
Despite the fact that most are young, developing organizations, they haveundertaken enormous tasks, for example, offering telephone counselingservices to those affected by the epidemic. In their effort to expand prevention
and education on HIV/AIDS, these NGOs have been able to reach out where
public agencies have failed, especially in regards to marginalized populations.
While many have developed considerable expertise on HIV/AIDS issues, it
is only recently that the public sector has started to heed their opinion by
including them in advisory committee meetings held by the MHLW and in
the formation of government policies on HIV/AIDS.
The contribution of community-based NGOs can also be seen in theirservice on organizing committees and through their interactions withoverseas NGOs at the various international HIV/AIDS-related conferencesthat have been held in Japan, including the International Congress on AIDSin Asia and the Paciﬁc (ICAAP) and the International AIDS Conference.
The seventh meeting of the ICAAP, which was scheduled for 2003, waspostponed due to SARS outbreak, but the preparatory process has helped
build momentum to strengthen the network of ties among communitybased Japanese NGOs and their counterparts in the Asia Paciﬁc region.

NGOs in International Cooperation
Many of the Japanese NGOs involved in the ﬁght against HIV/AIDS
overseas have not yet developed extensive HIV/AIDS expertise, but rather
operate in the broader ﬁeld of health and medicine. Along with largescale international NGOs with Japanese branches, there are a number ofsmaller indigenous NGOs that are active in the Asian and African regionsin the ﬁelds of prevention, awareness-raising, HIV-testing, diagnosis andgeneral support to people living with HIV/AIDS. The number of NGOs
involved in overseas HIV/AIDS-related activities is smaller than that of
the aforementioned community-based NGOs, consisting of less than 10
percent of the approximately 230 Japanese NGOs38 said to be engaged in
substantial international cooperation projects.
These NGOs have forged a working relationship with government ministries and agencies, most notably through a joint effort to share information
and advance the goals set forth in the GII and IDI. Regular meetings of
38

This ﬁgure of 230 refers to the number of NGOs that meet or exceed certain minimum standards set forth in the Directory of NGOs Concerned With International
Cooperation 2002 (JANIC 2002).

44

Non-Governmental Actors
members of the Ministry of Foreign Affairs and 42 NGOs involved withhealth and population issues commenced in 1994, and these have included
some of the NGOs engaged in HIV/AIDS-related programs.

Challenges for Japan’s HIV/AIDS-related NGOs
The hardships faced by NGOs involved in HIV/AIDS-related activities are
no different from those confronting other newly emerging civil society
organizations in Japan. Leadership on issues related to the prevention of
the spread of infectious diseases such as HIV/AIDS and leprosy has long
been monopolized by the government. NGOs have only recently been
allowed to participate in this area, and the inclusion of NGOs in government-supported joint research or prevention programs that involve
coordination among government agencies, public hospitals and NGOs isa recent phenomenon. Of the 100 NGOs said to be involved in domestic
HIV/AIDS-related issues, the majority still has no legal status, and less thanten have managed to gain incorporation under the new NPO Law.
At present, NGOs cannot anticipate signiﬁcant philanthropic support from foundations, corporations, private donations, or membershipcontributions, especially given the current low level of interest in AIDS
issues among the general public. Still, despite their lack of a ﬁrm ﬁnancial
foundation, domestic NGOs are struggling to meet the increasing needsof society, both qualitatively and quantitatively.
On the other hand, HIV/AIDS-related NGOs in Japan that are active in
the international ﬁght against the epidemic tend to operate on a relatively
larger ﬁnancial scale. However, with the exception of a few major international organizations with overseas headquarters and ofﬁces in Japan, they,
too, are typically unable to garner sufﬁcient backing from foundations,business and private donations.
Tight ﬁnancial conditions have made it even more difﬁcult than before
for many HIV/AIDS-related NGOs to hire full-time, paid staff. Even if they
manage to scrape together funds to hire one staff member, they are usually
forced to set wages far below standard levels. For the most part, organizations have resorted to relying on medical professionals, people living with
HIV/AIDS, and students to work on a volunteer basis in their free time. For
Japan to play any important role in the ﬁght against the epidemic on thedomestic and global levels, measures are needed to strengthen the ﬁnancial
and organizational structure of these NGOs and build capacity by enablingthem to hire full-time staff and enhancing their expertise.

45

Japan’s Responses to the Spread of HIV/AIDS
NGOs active in the ﬁght against HIV/AIDS, both domestically and internationally, are being affected by recent moves to make public funds available
for the support of NGO activities. The MHLW allowed NGOs to apply
for its Sciences Research Grants, and an increasing amount of Ministry ofForeign Affairs grant aid has been ﬂowing to NGOs. Although such grants
contribute to the development of these NGOs, a complete dependency on
public funds is perilous. Establishing a system to ensure a ﬂow of private
funds is thus an urgent task.

Efforts to Build Networks of NGOs in Asia
One of the most noteworthy trends among HIV/AIDS-related NGOs in
Japan is the strengthening of their networking with counterpart organizations in Asia. The preparatory activities undertaken in conjunction withthe 7th ICAAP meeting added momentum to this movement, rapidly
advancing working relations between Japanese NGOS and their Asian
counterparts. Some of the seven regional Asia Paciﬁc HIV/AIDS networks
have counterpart organizations in Japan, creating focal points for collaboration. The establishment of these networks has enabled many Asian NGOs
to visit Japan since the fall of 2003 and participate in various workshops.
These growing ties include:• Asia Paciﬁc Council of AIDS Service Organizations (APCASO) and theJapan AIDS & Society Association (JASA)• Asia-Paciﬁc Network of People Living with HIV/AIDS (APN+) and theJapanese Network of People Living with HIV/AIDS (JaNP+)• Co-ordination of Action Research on AIDS and Mobility in Asia
(CARAM-ASIA) and Services for the Health in Asian & African Regions(SHARE)• Asia-Paciﬁc Network of Sex Workers (APNSW) and Sex Work and Sexual
Health (SWASH)• Asia Paciﬁc Network of Lesbians, Gays, Bisexuals and Transgenders(AP-Rainbow) and Japan Association for the Lesbian & Gay Movement
OCCUR• A counterpart Japanese organization is yet to be designated for the AsianHarm Reduction Network (AHRN).
Although the Japanese NGOs are not known for being as outspoken
as their Asian and African counterparts, one noteworthy initiative by the46

Non-Governmental Actors
Japanese is the attempt to create a network of people living with HIV/AIDS
in Northeast Asia, inviting Korea and Taiwan to join the effort. Korea,
Taiwan and Japan have a lower prevalence of HIV/AIDS relative to China
and Southeast Asia and thus are rarely mentioned at international meetingsand studies assessing global HIV/AIDS trends. However, these very threeplaces appear to be experiencing an upsurge in reported cases despite thepresence of well-established health systems and economic conditions thatenable access to the latest treatments. Another common trait is the extent
to which societal and cultural stigma make it difﬁcult for people livingwith HIV/AIDS to publicly reveal their identities, which in turn hinders
communication among them. Sharing so much in common with others
living with HIV/AIDS around the region, Japanese NGOs and individuals affected by the epidemic are trying to see if their experiences can help
others in the region. They hope to exchange information and share theirexperiences with policy advocacy and preventive education, particularly
preventive education conducted by HIV-positive people themselves. An
attempt to do this is being led by the Japanese Network of People Livingwith HIV/AIDS (JaNP+), which was established in 2002 as the ﬁrst nationwide organization to bring together the diverse range of people livingwith HIV/AIDS in Japan.

Private Foundations
There are approximately 1,000 private grant-making foundations in Japan,39
and the average size of their assets is much smaller than in Western countries
such as the United States. The relatively small scale of Japan’s foundation
sector is highlighted by the fact that the combined dollar value of the assetsof these 1,000-odd foundations was ¥1.4 trillion (approximately US$12.5
billion) as of April 2001, or half the amount of the assets held by the Bill andMelinda Gates Foundation and comparable in size to those of individual
foundations such as the Lilly Endowment or the Ford Foundation.40 Thesefoundations operate more than 300 grant programs in the ﬁelds of health,39

There is no legal framework classifying grant-making foundations as separate fromthe more numerous operating foundations, and thus there is no completely reliable count of the actual number of foundations falling under this category. The
ﬁgures given in this section are based on the analysis made by the Japan Foundation
Center and taken from its website on “An Outlook of Japanese Grant-Making
Foundations.”

47

Japan’s Responses to the Spread of HIV/AIDS
medicine and welfare, making this the second largest grantmaking ﬁeld in
sheer numbers, after the ﬁeld of science and technology. However, very
few foundations put HIV/AIDS high on their list of priorities.

Academic Research Grants
Each year one or two relatively minor academic research grants are extended by private foundations to researchers at universities and research
institutions for HIV/AIDS-related projects. However, no foundations
offer strategic funding for HIV/AIDS-related research on a sustained
basis. Most of the research being conducted on the epidemic relies on
government sources, primarily the signiﬁcant allocations made as part of
the Sciences Research Grants of the MHLW and by the Japan Science andTechnology Corporation, which is under the jurisdiction of the Ministryof Education.

Support for NGO Programs on HIV/AIDS
In general, private foundations ought to play a more important role thangovernment funding sources in providing operational grants to support
NGO activities. Nevertheless, the outlook for sustained, signiﬁcant foundation support of HIV/AIDS-related NGO programs remains dim. In the ﬁrst
place, Japanese grant-making foundations do not have a strong tradition offunding NGOs. Most private foundation grants are either research grants
or scholarships, and very few are made as operational funding to support
the type of activities pursued by NGOs. With the rapid expansion of thecivil society sector, the number of funding programs accepting applications from NGOs is gradually increasing. However, of the approximately
2,000 grant programs currently operational listed in the Japan Foundation
Center’s database, only about a ﬁfth encourage applications from citizens’
groups.41
Of these, there are only two funding programs that prioritize HIV/AIDS,
40

Estimates of the value of assets held by Japanese foundations are drawn from theJapan Foundation Center survey and U.S. statistics are derived from The Chronicleof Philanthropy’s annual survey.
41
The term “citizens’ groups” is used in the survey by the Japan Foundation Centerand has no ﬁxed deﬁnition, although it generally refers to grass-roots organizations
without legal status as well as those nonproﬁt organizations incorporated under
the new NPO Law.

48

Non-Governmental Actors
the Japan Stop AIDS Fund set up by the Japanese Foundation for AIDS
Prevention and the Levi Strauss Foundation Donor Advised Fund operated by the Japan Center for International Exchange (JCIE). Both target
domestic operations, and thus there are few funding options for JapaneseNGOs engaged in overseas projects in Asia and Africa. A philanthropic
initiative to support international programs is greatly needed, similar to the
30-year campaign to eradicate leprosy around the world that was undertaken by the Nippon Foundation, Japan’s largest grant-making foundation,in cooperation with WHO and the World Bank.41

Japan Stop AIDS Fund
The Japan Stop AIDS Fund was established in 1993 by the JapaneseFoundation for AIDS Prevention as an intermediary to receive and distribute donations to support NGOs working on HIV/AIDS issues. Its target
program areas are (a) social support for people living with HIV/AIDS, (b)telephone counseling services and (c) awareness-raising programs. For ﬁscal year 2003, the Fund distributed a total of ¥13.2 million (US$120,000)
to 43 NGOs. In the 11 years since its establishment, it has made ¥220
million (US$2 million) in grants, serving as a valuable source of funding
speciﬁcally for HIV/AIDS-related NGOs in Japan.
Recently, donations to the Fund have been in decline. During the mid1990s as much as ¥70 million (US$636,000) was received annually from
corporations, but poor economic conditions and a general decline inpublic awareness of HIV/AIDS issues have driven a downward trend inincoming contributions. Annual amounts have fallen as low as ¥40 million(US$360,000). It is important that corporations and individuals interested
in supporting efforts to ﬁght the epidemic be matched with NGOs in needof funds. In this sense, the Fund offers an ideal mechanism, one which has
the potential to beneﬁt from wider publicity and energize the activities ofJapan’s struggling HIV/AIDS-related NGOs.

41

The Nippon Foundation is a grant-making foundation that was founded with revenues
from the speedboat racing industry. In ﬁscal year 2002, it awarded a total of ¥33.1
billion (US$301 million) in grants, the largest sum extended in Japan. The founder,
the late Ryoichi Sasakawa, devoted himself to bringing leprosy under control and,for more than 30 years, was engaged in the ﬁght against the disease through the
Sasakawa Memorial Health Foundation. The current president, Yohei Sasakawa, hasbeen appointed to be the WHO’s Ambassador for Leprosy Elimination.

49

Japan’s Responses to the Spread of HIV/AIDS

Levi Strauss Foundation Donor Advised Fund of JCIE
This donor advised fund (DAF) was created in 1997 as a partnership between the U.S.-based Levi Strauss Foundation and JCIE. The Levi Strauss
Foundation makes a grant to JCIE, which then issues a call for grant applications and conducts the selection process for regranting to NGOs in
Japan. Grants are made in the three categories falling under the main
theme of promoting social justice: (a) preventing the spread of HIV/AIDS,(b) achieving economic independence for marginalized people and (c)ensuring access to education for marginalized youth. In the HIV/AIDS
category, top priority has been given to prevention and awareness-raisingprograms aimed at young people. The total annual grant amount for all
three categories is approximately ¥20 million (US$180,000), and in ﬁscal
year 2003, ¥6.3 million (US$52,000) was awarded to six HIV/AIDS-related
programs. Over the past six years, ¥31.2 million (US$250,000) in grants
have been awarded to a total of 34 HIV/AIDS-related NGOs.
Although the actual grants distributed to individual NGOs are small inscale, the DAF program represents the ﬁrst effort to channel funds from aforeign foundation to domestic Japanese NGOs. As such, it has the added
beneﬁt of transmitting innovative grant-making practices to Japan, forexample, the extension of support for institution-building at new andemerging organizations, the provision of multi-year grants, the coverageof personnel and overhead costs and the promotion of capacity-building.
(A record of past grants can be found at <www.jcie.or.jp/levi/e/>.)Separate from its support for the DAF program, the Levi Strauss
Foundation made an additional grant to the Japan AIDS & Society
Association (JASA) and JCIE to support “Positive Lives,” an international
photography exhibition project on HIV/AIDS touring Japan from 2002 to
2004. This ¥18 million (US$150,000) grant enabled the exhibition to beheld in more than 100 communities throughout Japan.

Role of the Media
Mass MediaThe mass media can play a key role in the dissemination of accurate information and knowledge about HIV/AIDS and the elimination of discrimination. However, media coverage on the subject is far from sufﬁcient in50

Non-Governmental Actors
contributing to widespread public exposure to HIV/AIDS-related issues inJapan today. The results of a survey on the number of articles containingreference to HIV or AIDS in the four major national newspapers are given
in ﬁgure 3-1. For a few years from around 1992, the number of newspaper
articles on the subject of HIV/AIDS showed an increasing trend due to a
rapid rise in the number of reported cases and the high media proﬁle ofthe International AIDS Conference held in Yokohama. The epidemic had
the greatest media coverage in 1996 when a settlement was reached on thecase involving HIV-infections caused by contaminated blood products.
However, once the case was settled, coverage immediately dropped andhas since leveled off.
Figure 3-1: Number of Newspaper Articles with Reference to theTerm “HIV” or “AIDS” (1987–2003)

Source: Compiled by JCIE.
Note: Data was obtained by searching the Nifty Business Data Base and the Nikkei
Data Base for newspaper articles in December 2003. All articles appearing in themorning and evening papers of the four major newspaper companies (Asahi,
Yomiuri, Mainichi and Nikkei) were searched for any reference to the term HIV or
AIDS. Since all four publish regional editions as well as the central Tokyo edition,
there may be some duplications.

After looking more closely at newspaper articles, it is apparent that theappearance of the term HIV/AIDS alone is not necessarily synonymouswith coverage of the disease. For example, less than half of the articles
appearing in 2002 with references to HIV or AIDS actually covered issues
related to HIV/AIDS (see ﬁg. 3-2). The other half made mention of the51

Japan’s Responses to the Spread of HIV/AIDS
disease as a lesson of the past in talking about other infectious diseases
and drug-induced problems, or mentioned it as one aspect in the overall
context of poverty and development issues in developing countries. The
meager coverage speaks for itself with regard to Japanese society’s view ofthe disease as a remote issue far from the central concerns of contemporary Japan.
Figure 3-2: Share of Newspaper Articles Actually Highlighting HIV/AIDS Issues or Those Referring to the Term “HIV” or “AIDS” (2002)

Source: Compiled by JCIE.
Note: Based on a search of the Nifty Business Data Base conducted in December
2003. All articles printed in 2002 with reference to the term HIV or AIDS from bothmorning and evening papers of the four major newspaper companies of Asahi,
Yomiuri, Mainichi and Sankei were searched. To prevent duplicate counts with
regional issues, only the central Tokyo issue was examined (indicated as the actual
total number of articles). Of the actual total, articles that focus speciﬁcally on HIV/AIDS issues were selected by the following manner and indicated its share:• Automatically selected all articles with the term HIV and/or AIDS included in theheadline.
• Individually searched through all the articles not mentioning the terms in the headline, but which included the terms such as “infection,” “blood products,” and/or
events or names of people closely associated with HIV/AIDS and discerned whether
the content of the article had speciﬁc focus on the epidemic or not.

In terms of coverage patterns, there seems to be a concentration ofinterest in HIV/AIDS around World AIDS Day on December 1. Many
newspapers seem to feature articles on the topic from the end of November
to early December, but then lose interest altogether (see ﬁg. 3-3). The only52

Non-Governmental Actors
Figure 3-3: Monthly Trend in the Appearance of the Term “HIV” or“AIDS” in Newspaper Articles (2002)

Source: Compiled by JCIE.
Note: Based on a search of the Nifty Business Data Base conducted in December
2003. All articles printed in 2002 with reference to the term HIV or AIDS from bothmorning and evening papers of the four major newspaper companies of Asahi,
Yomiuri, Mainichi and Sankei were selected. Since all four have various issues byregions other than the central Tokyo issue, there may be some duplications in the
count of articles.

national newspaper that has demonstrated a sustained interest in following
issues related to HIV/AIDS is Sankei Shimbun. From 2000 to 2001, thenewspaper ran a regular series on “AIDS and society” on a weekly basis, followed by a series on “a new age of infectious diseases” that started in 2002.
(These series account for the large share of articles speciﬁcally highlighting
HIV/AIDS in Sankei Shimbun as compared to the other three newspaper
companies shown in ﬁgure 3-2.) The Sankei articles in the series examine
the subject of HIV/AIDS from various angles, for example, covering insights
into the epidemic as a domestic concern and the global response in termsof the worldwide efforts to ﬁght the disease.
The Nippon Press Club, a national press organization, organizes seminars
on a variety of subjects for member correspondents from various newspapers, television and radio networks. One continuous program that has been
held at regular intervals is a series on HIV/AIDS-related issues, featuringlectures by experts on the epidemic (see the “List of Invited Lecturers”
side bar). It is hoped that wide attendance of such seminars will enhance
understanding of the epidemic among journalists.

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Japan’s Responses to the Spread of HIV/AIDS
List of Invited Lecturers
Seminars on HIV/AIDS Organized by the Nippon Press Club
(Titles are as of the date of the lecture)• May 2002:

Seth F. Berkley, President and CEO, International AIDS Vaccine
Initiative• May 2002: Masahiro Kihara, Professor, Department of Global Health andSocio-epidemiology, Kyoto University School of Public Health• June 2002: Chizuko Ikegami, President, PLACE Tokyo• July 2002:
Assane Diop, Executive Director, Social Protection Sector, ILO• July 2002: Nobuya Iwamuro, Urologist and Doctor of Public Health• Aug. 2002: Tatsuo Hayashi, President, Africa-Japan Forum• Sept. 2002: Aikichi Iwamoto, Professor, The Institute of Medical Science,
The University of Tokyo• Oct. 2002: Noriaki Fushimi, Writer, Gay Activist• Nov. 2002: Richard Feachem, Executive Director, The Global Fund to Fight
AIDS, Tuberculosis and Malaria• Jan. 2003:
Osamu Kunii, Economic Cooperation Bureau, Ministry ofForeign Affairs• Mar. 2003: Takatoshi Kato, former Member, Commission on Macroeconomics and Health, WHO• Apr. 2003: L. Montagnier, World Foundation for AIDS Research andPrevention• June 2003: Shuji Hashimoto, Professor, Fujita Health University• Sept. 2003: Kevin Ryan, Project Director, Positive Lives• Dec. 2003: Satoru Ienishi, former Member, House of Representatives(Democratic Party of Japan); HIV-positive
Seminars Coordinator: Kazuo Miyata, Feature News Editor, Sankei Shimbun
Newspaper
Further research is needed to assess the extent of interest held by othermedia channels such as television,43 radio and magazines.

43

The participation of NHK Japan Broadcasting Corporation in the Roundtable Meeting
to combat HIV/AIDS held in January 2004 and hosted by UN Secretary-General
Koﬁ Annan with over 20 world media leaders was the ﬁrst such involvement ofJapanese media on the international scene.

54Non-Governmental Actors

Documentary Photography
There has been a surge of documentary photography exhibitions being
held on the theme of HIV/AIDS. Documentary photography relays thereality of the epidemic in a visual form that can have a strong impact on
the public, making it a powerful means to convey a message. One such
example is “Positive Lives,” an international photography exhibition project
touring Japan from 2002 to 2004. This exhibition features photographsof people living with HIV/AIDS and their families, friends and caretakers,
which were taken in 17 countries and regions by a network of professional
photographers from all over the world. It was started and continues tobe managed by the major British HIV charity, the Terrence Higgins Trust,and the international photo documentary agency, Network Photographers.
Sponsored by the Levi Strauss Foundation, local exhibitions have been held
thus far in about 100 different communities throughout Japan as part ofan educational program to disseminate information on HIV/AIDS andpromote prevention. A major exhibition of 120 works was held in theautumn of 2003 at the UN Gallery in Tokyo. Over 2,200 people visitedthe major exhibition over the period of one month. The local and major
exhibitions were organized by JASA with the cooperation of JCIE. Other
documentary photographers shooting on the theme of HIV/AIDS are listed
in the “Some Documentary Photographers” side bar.

Some Documentary Photographers Shooting on the Theme of
HIV/AIDS

Masaru Goto:

Andy Rain:

A Japanese photographer residing in Thailand who has
been taking photographs of people living with HIV/AIDS in
Cambodia. His works can be viewed on his website and havebeen displayed at exhibitions held in Tokyo and Bangkok.
A special exhibition was held in Yokohama in 2003.
<http://www.freewebs.com/reminders/us/about.html>
A British photographer living in Tokyo who has been
taking photographs of people living with HIV/AIDS in
Thailand and Cambodia. His works were exhibited at the
UN Gallery several times from 2001 to 2003 in cooperation with the Japanese NGO, SHARE, which is involved in
the prevention of the epidemic and caretaking of people
living with HIV/AIDS in Thailand.

55

Japan’s Responses to the Spread of HIV/AIDS
Osamu Kikuchi: A Japanese photographer in Tokyo. Since being chosen
to take photos in Japan for the international photography
exhibition “Positive Lives,” he has continued photographing the HIV community in Japan. A private exhibitionof his works was held in Kobe and Tokyo in the winterof 2003, and a collection of his photographs is to be
published in 2005.
Other efforts in raising awareness on HIV/AIDS are starting to emerge,
including documentary ﬁlms on the subject and the use of art as a medium
for expression to cope with the epidemic.

Corporate Attitudes Towards HIV/AIDS
Workplace Management of HIV/AIDS
The level of interest in HIV/AIDS in the workplace is currently very low
in Japanese business corporations. Not one Japanese corporation is listed
among the members of the Global Business Coalition on HIV/AIDS. Nor
is there a comparable organization within Japan.
In 1995, the MHLW (then the Ministry of Labour) issued a series ofguidelines for workplace management of the epidemic. At that time, HIV/AIDS cases caused by contaminated blood products had become a majorsocial issue and an increasing number of sexually transmitted infections
were being reported. As many among the HIV positive were in their productive prime, the issue of how to deal with people living with HIV/AIDS
in the workplace became a matter of serious concern. The outline of theguidelines is as follows:• Provide HIV/AIDS education to employees.
• Create a workplace environment that accepts people with HIV/AIDS. (No HIV
testing will be required of employees and prospective staff, and conﬁdentiality
on their HIV seropositivity or the fact that they have AIDS will be respected.)• Introduce best practices concerning and management of HIV/AIDS in
the workplace, offering appropriate treatment for those living with HIV/
AIDS. (Those workers living with HIV who are in good health shouldbe treated in the same manner as other employees; those with AIDS
should be treated as others with illnesses; and HIV-positive status shall56

Non-Governmental Actors
not pose a reason for prohibition or termination of employment.)• Educate employees about speciﬁc work-related transmission hazards
and safeguards (such as unforeseen bleeding).
As a result of these guidelines, a number of Japanese corporations haveintroduced policies to address HIV/AIDS in the workplace.44 However,many express doubt as to whether they are in actual practice today. Evenif guidelines are set, the extent of their accessibility to employees, monitoring, and implementation are separate issues that are not being addressed.
On the domestic front alone, several publicized lawsuits have been ﬁled
with regard to unfair dismissal, with many more that have not been madepublic. In 1994, a group of corporations was formed to discuss and exchange information on HIV/AIDS policies. This forum, called the Japan
Inter-Company Meeting Against AIDS, had at one point 26 member corporations, in addition to afﬁliated health and economic organizations (seethe “Member Companies” side bar).

Member Companies and Organizations Having Participated in
the Japan Inter-Company Meeting Against AIDS
Aichi Medical Foundation of Diagnostic Technology; Baron Corporation;
Dai Nippon Printing Co., Ltd.; Daiwa Securities Co.; Eisai Co., Ltd.;HOYA Health Insurance Society; Industrial Bank of Japan; Japan Travel
Bureau (JTB); Kajima Corporation; Kanematsu Corporation; Labour
Welfare Corporation: Japan Overseas Health Administration Center;
Levi Strauss Japan; Matsushita Electric Industrial Co., Ltd. (Panasonic)
Health Insurance Society; Nomura Securities Co., Ltd.; Recruit Co., Ltd.;
Saison Pallet Corporation; Sony Corporation; TOBU Department Store;
The Tokyo Chamber of Commerce and Industry; Tokyo Gas Co., Ltd.;
Toshiba Corporation; and ﬁve others.

Secretariat: Medical Support Center
Source: Japan Inter-Company Meeting Against AIDS website.
44

HIV/AIDS policies in the workplace for Sony Corporation, Tokyo Gas Co., Ltd. andJapan Travel Bureau (JTB) can be found on the website of the Japan Inter-Company
Meeting Against AIDS. According to Bendell (2003, 47), among the 100 largest
transnational companies (TNCs) surveyed on workplace HIV/AIDS policies, three
Japanese companies positively contributed their responses, namely, Hitachi, C. Ito& Co. and Marubeni Corporation.

57

Japan’s Responses to the Spread of HIV/AIDS
The forum held regular workshops, inviting lecturers and speakers, andserved as a venue for exchanging information related to the creation of appropriate workplace HIV/AIDS policies. Gradually, however, the perceived
need for this type of exchange has declined, and the forum now has become
dormant. Aside from this forum, the Tokyo Chamber of Commerce andIndustry and JASA conducted programs during the mid-1990s in an effort
to promote the adoption of HIV/AIDS policies in the workplace. However,these programs also eventually became dormant.
One of the most recent undertakings to raise awareness of this issue
within the business sector is the Forum on Company HIV/AIDS Policies,
held in July 2002 in Tokyo and Kobe under the joint sponsorship of theInternational Labor Organization (ILO) and Sankei Shimbun newspaper. The forum was convened on the occasion of the publication of theJapanese translation of ILO’s Code of Practice on HIV/AIDS and the Worldof Work. The level of interest among corporate representatives was not,however, high.
Due to the low prevalence of the epidemic in Japan and the fact thatthe country in general does not feel as much of a threat as compared toother countries, HIV/AIDS has not been given serious consideration in theworkplace since the late 1990s. The situation calls for a change, however, forthe following two reasons. First, with the development of better treatment,
the progress from HIV-positive status to AIDS can be slowed and more
people can lead a normal life while ﬁghting the disease. Many corporations have not yet been made aware of this fact and need to introduce newworkplace management measures that reﬂect the new circumstances. The
second development is the alarming spread of the epidemic throughout
Asia as a whole. The overseas expansion of Japanese corporations has
extended to 130 countries around the world with a concentration in Asia
(see table 3-1). For those corporations operating in heavily affected countries, HIV/AIDS policies in the workplace become essential for employees
both hired locally and dispatched from Japan. Some local branches may
feel pressure to set guidelines in order to continue their operations. For
those based at headquarters in Japan, however, the need is barely recognized, as the sense of crisis is very weak. From the viewpoint of corporatesocial responsibility, it is hoped that Nippon Keidanren (Japan Federationof Economic Organizations), Keizai Doyukai (Japanese Association of
Corporate Executives), Council for Better Corporate Citizenship (CBCC)
and others at the forefront of the sector demonstrate greater leadershipon these issues.

58Non-Governmental Actors
Table 3-1: Regional HIV/AIDS Statistics and Japanese Corporate
Presence
RegionAdults and
Adult
No. ofName of Major
Children Living Prevalence Japanese Corporations
with HIV/AIDS
Corporations

Sub-Saharan Africa(South Africa)

25.0–28.2 million−

7.5–8.5−

90(34)

North Africa and the
Middle East
South Asia andSoutheast Asia
(India)0.47–0.73 million

0.2–0.4119

4.6–8.2 million

0.4–0.8

3,927

−

−

(135)

−

−

(574)

0.7–1.3 million−

0.1–0.1−

3,971(2,630)

1.3–1.9 million
0.35–0.59 million
1.2–1.8 million

0.5–0.7
1.9–3.1
0.5–0.9

600
28
224

0.52–0.68 million
0.79–1.2 million
0.012–0.018 million

0.3–0.3
0.5–0.7
0.1–0.1

2,359
1,996
383

0.011

13,697(Indonesia)
East Asia and the Paciﬁc(China)Latin America
Caribbean
Eastern Europe andCentral Asia
Western Europe
North America
Australia and
New ZealandTotal

40 million

Toyota Motor Corporation
Nissan Motor Co.,Ltd
Mitsubishi Electric Corporation

Honda Motor Co., Ltd.
Suzuki Motor Corporation
Denso Corporation
Yazaki Corporation,
Yamaha Motor Co.,Ltd
Matsushita Electric Industrial Co.,Ltd
Matsushita Electric Industrial Co.,Ltd
Olympus Corporation
Sanyo Electric Co.,Ltd

Source: Compiled by JCIE drawing on AIDS Epidemic Update (UNAIDS 2003b) for the numberof HIV/AIDS cases and prevalence; and on Directory of Overseas Japanese Corporations by Country(Toyo Keizai Shinpo Publishing Co., 2003) for the number of Japanese corporations. Major Japanese
corporations listed are manufacturers in Asia and Africa with large numbers of employees.

Corporate Philanthropy and Public Awareness-Raising Programs
Although the general level of interest remains low for most corporations, there
are some that are showing a willingness to take more active measures to tackle
the HIV/AIDS-related issues through corporate philanthropy and awarenessraising programs. Levi Strauss Japan, for example, has been organizing for overa decade efforts run by employees on a volunteer basis to distribute condoms.
The Body Shop Japan conducts campaigns at its branch stores on World AIDS
Day to raise donations for HIV/AIDS prevention efforts and gives the collected
donations and part of its sales proﬁts to HIV/AIDS-related NGOs. MTV
Japan not only airs international HIV/AIDS programs, but also has created aunique program in Japan to send out HIV/AIDS-related messages to young
people using cell phones.

59

Japan’s Responses to the Spread of HIV/AIDS
It should be noted that these programs are all conducted by foreign-based
international corporations whose headquarters are already well known
for their involvement in the ﬁght against the disease. It may be easier forJapanese branch ofﬁces of such corporations to pursue programs by following the global guidelines already set forth by the parent company. Theirefforts, however, tend to remain within the sphere of providing support
for domestic NGOs and conducting awareness-raising programs and do
not go beyond the domestic realm to address the issue of overseas areas
threatened by the rapid spread of the disease.
For Japan-based corporations, corporate philanthropy and community
involvement are conﬁned to traditional social issues more readily acceptedby the public, such as the promotion of environmental, cultural or artistic
causes, or welfare measures for the aged and the disabled. It appears that
HIV/AIDS-related issues are too new and perhaps too controversial forthem to get involved. It is unclear to what extent Japanese corporations
operating overseas are involved in local activities independent of their
headquarters to prevent the spread of the epidemic.

The Body Shop JapanThe Body Shop, a high-quality skin and body care retailer based in London,
is known for its active involvement in the protection of human rights, preservation of animal life and environmental conservation. The Body Shop
Japan was opened in 1990 under a licensing contract with a subsidiary of amajor Japanese retailer. Since the commemoration of its ﬁfth anniversary
in 1995, the Body Shop Japan has embarked on an anti-AIDS campaign
every December around World AIDS Day. Funds raised from the call for
donations and sale of special campaign goods in support of HIV/AIDSrelated NGOs amount to approximately ¥1 million (US$9,000). An essay
contest on the subject of AIDS is also held concurrently with the campaign.
In 2003, it offered ﬁnancial support to the Youth Forum, held as one of
the numerous programs organized around the International Congress on
AIDS in Asia and the Paciﬁc (ICAAP).

MTV Japan, Inc.
MTV Japan only started broadcasting in 2001, but its presence is growing rapidly. It airs HIV/AIDS-related news and special programs created
for worldwide broadcasting around World AIDS Day. In addition, it has

60

Non-Governmental Actors
developed original programs that take advantage of the expansion of theInternet and its popularity with young people, one of which is an information release service using mobile telephones. The service offers information
about HIV/AIDS and STIs and feedback through websites accessible to cell
phone users. The communication is two-way and targets young adults.

Levi Strauss Japan, K.K.
Levi Strauss Japan was established in 1982, and its employees have been
actively involved in volunteer work from the very outset. As part of thecompany’s anti-AIDS campaign, employees have helped distribute condoms
every December. It is the very ﬁrst company to engage in the ﬁght against
HIV/AIDS in Japan and has been offering ﬁnancial support to HIV/AIDSrelated NGOs. In 2003, the company sponsored the publicity efforts topromote “Positive Lives,” an international photography exhibition showing
photographs of people living with HIV/AIDS and other people who livewith and support them.

Labor Unions
One of the encouraging developments in the private sector is the recent
interest shown by labor unions in combating the pandemic. The nationalorganization of labor unions, the Japanese Trade Union Confederation(Rengo), has recently decided to focus on HIV/AIDS as one of the top
priority areas in its international activities and is now in the process ofdeveloping relevant programs.
The guidelines announced by Rengo for ﬁscal years 2004 and 2005 reﬂect
the emphasis being placed on HIV/AIDS. For example, in coordination
with other national labor organizations, it will strengthen its calls fortransnational corporations to abide by labor standards and establish concrete workplace policies on public health and safety in order to eliminate
child labor and combat infectious diseases such as HIV/AIDS and SARS.
In addition, it plans to embark on international cooperation projects forthe elimination of poverty, child labor and the spread of the epidemic. As
the ﬁrst step, the international division of Rengo is conducting a feasibility
study on the joint implementation of an HIV/AIDS program in Africa with
the Japan International Labour Foundation (JILAF). Some programs underconsideration include the training of specialists to educate employees on

61

Japan’s Responses to the Spread of HIV/AIDS
HIV/AIDS, care and support for people living with HIV/AIDS and support
for children orphaned by AIDS. These programs are being discussed at therequest of the International Confederation of Free Trade Unions African
Regional Organization (ICFTU-AFRO).
Apart from Rengo, some labor unions afﬁliated with individual corporations45 are starting to show signs of giving serious thought to HIV/AIDS
issues in the locations of their overseas branches. It is hoped that effortson the part of labor unions will have a considerable impact on the levelof recognition given to the epidemic by employers and encourage themto address the issue.

45

Unlike in the United States, private business corporations in Japan each have their own
labor unions. These individual labor unions then form confederations, organized
by industry sector. Rengo is the national center for labor union confederations.

62

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Japan’s Responses to the Spread of HIV/AIDS

List of Key Informants
The following people were interviewed or consulted in the production ofthis report.
Keiji AMEMIYA
Masaki INABA
Katsumi ISHIGURO
Sukesada ITO

Osamu KIKUCHI
Kana KINOSHITA
Kazuo MIYATA

Yorimasa NAGAI
Shigeru NAKAJIMA

Midori SASAKI

Yasushi SAWAZAKI

Keiichi TAKEMOTO
Masayoshi TARUIKotaro UCHIDA

Keiko WATANABE
Hiroko YAMAMOTO

66

Corporate Communications Manager, Corporate
Communications Department, Levi Strauss Japan
Board Member, Africa Japan Forum (AJF)
International Programs Division, World Vision
Japan
Advisor, Japan Trade Union Confederation (JTUCRENGO); former Member, Governing Body,
International Labour Organization (ILO)
Photographer
Marketing Department, MTV Japan, Inc.
Feature News Editor, The Sankei Shimbun Newspaper; Board Member, Japan AIDS & Society
Association (JASA)
Operation Manager, Japan Stop AIDS Fund, JapaneseFoundation for AIDS Prevention (JFAP)
Executive Director, Department of International
Affairs, Japanese Trade Union Confederation (JTUCRENGO)
Deputy Director, Research and Public Affairs
Department, Japan International Labour Foundation(JILAF)
Chief of International Cooperation and Chief ofResearch and Training, Japanese Foundation for
AIDS Prevention (JFAP)
Planning Division, Medical Cooperation Department,
Japan International Cooperation Agency (JICA)
Professor of Philosophy / Ethics, Keio University;
Vice President, Japan AIDS & Society Association
Director, International Division, Department
of International Affairs, Japanese Trade Union
Confederation (JTUC-RENGO)
Japan/Asia Program Coordinator, International AIDS
Vaccine Initiative (IAVI)
Research and Programming Division, Economic
Cooperation Bureau, Ministry of Foreign Affairs

AppendicesAppendices

Appendix 1: Chronological Table of HIV/AIDS History inJapan
Major Domestic Events
Year

Domestic HIV/AIDS
Milestones

1978

Imports of unheated blood
products from the U.S. begin

World Events

International Cooperation
on HIV/AIDS

1981

Announcement of theﬁrst AIDS case in the
United States

1982–1985 Approx. 40% of hemophiliacs
infected by HIV-contaminatedblood products
1983

AIDS Task Force established by the
Ministry of Health and Welfare

1985

Identiﬁcation of the ﬁrst Japanese
AIDS patient

1987

Ministerial meeting held on HIV/AIDS measures

First International AIDS
Conference

Announcement of HIV/AIDS
measures by the Ministry of Healthand Welfare
Establishment of the JapaneseFoundation for AIDS Prevention(JFAP)
1988
1989

First World AIDS Day
Enactment of the AIDS Prevention
Law
Lawsuit ﬁled by HIV-infected
hemophiliacs

1990

1992

First International
Congress on AIDS in Asiaand the Paciﬁc (ICAAP)Tokyo Chamber of Commerce andIndustry founds the Forum on
Company HIV/AIDS Policies

1993

First meeting of the Tokyo
International Conference on
African Development (TICAD)

1994

Creation of the Japan InterCompany Meeting Against AIDS

1996

Settlement reached on the tainted
blood product litigation

Establishment of the
Joint United Nations
Programme on HIV/AIDS (UNAIDS)

Designation of AIDS Care
Core Hospitals in all of Japan’s
prefectures

Introduction of Highly
Active Antiretroviral
Treatment (HAART)

Global Issues Initiatives on
Population and AIDS (GII),
1994 to 2000

Paris AIDS Summit

10th International AIDS Conference (Yokohama)

1997

Establishment of the AIDS ClinicalCenter (ACC)71

Japan’s Responses to the Spread of HIV/AIDS(Appendix 1 continued)
Major Domestic Events
Year

Domestic HIV/AIDS
Milestones

1998

PWHA become entitled to welfare Commencement of joint JapanThai collaboration on HIVbeneﬁts under the Law for thevaccine development
Welfare of People with Physical
Disabilities

1999

Enactment of the Law Concerning
the Prevention of Infectious
Diseases and Patients with
Infectious Diseases; superseding the
AIDS Prevention Law

World Events

International Cooperation
on HIV/AIDS

Second meeting of TICAD

2000

Thirteenth International
AIDS Conference held
in Africa
Okinawa Infectious Diseases
Initiative (IDI), 2000 to 2004

Kyushu-Okinawa G8
SummitOkinawa International
Conference on Infectious
Diseases
2001

2002

Creation of the UN Trust Fundfor Human Security

UN General AssemblySpecial Session on
HIV/AIDS

Implementation of grant aid for
infectious diseases in theJapanese ODA scheme

Seventh ASEAN Summit
Declaration on HIV/
AIDS

Japanese Government pledges
Establishment of the Japanese
US$200 million to GFATM
Network of People Living with
HIV/AIDS (JaNP+), the ﬁrst
organization to create a nationwide
network of PWHA in Japan

2003

Third meeting of TICAD

Establishment of the
Global Fund to Fight
AIDS, Tuberculosis &Malaria (GFATM)
Announcement by US
President George W. Bushof an Emergency Plan for
AIDS Relief in the Stateof the Union address

Plans for 7th International Congress on AIDS in Asia and the Paciﬁc (ICAAP) to be held in Kobe
postponed until 2005
Japanese government pledges
an additional US$100 million to
GFATM for FY 2004

Source: Compiled by JCIE.

72

WHO’s 3 by 5 Initiative

Appendices

Appendix 2: ODA Schemes for HIV/AIDS Programs

Ofﬁcial Development
Assistance (ODA)

Multilateral ODA*

Bilateral ODA* Contributions to United Nations agencies
and international organizations

Technical
Cooperation

Grant Aid

ODA Loans• General Grant Aid (Grant Aid For
Infectious Diseases Prevention andTreatment, etc.)• Grant Assistance for Grassroots
Human Security Projects• Grant Aid for Japanese NGO Projectsetc.
• Technical training of overseas participants• Dispatch of technical cooperation experts• Project-related technical cooperation• Development studies• Japan Overseas Cooperation• Development cooperation• JICA Partnership Program
etc.

73

Japan’s Responses to the Spread of HIV/AIDS

Appendix 3: Selected List of Major Japanese NGOs Pursuing
HIV/AIDS Programs46

NGOs in Domestic HIV/AIDS Activities
Japan AIDS & Society Association (JASA)
An umbrella organization for AIDS-related NGOs, JASA was created in1990 at the initiative of researchers, doctors, representatives from NGOs,
people living with HIV/AIDS and journalists involved in AIDS issues inJapan. Its activities center on holding regular forums, workshops and events
to promote knowledge and understanding on HIV/AIDS issues. It also
disseminates information by issuing newsletters and other publications,
including a directory of AIDS service organizations operating in Japan, andby making available Japanese translations of important documents released
by international organizations such as UNAIDS and WHO on the website.
From 2002 to 2004, it is serving as the secretariat for the nationwide tourof the “Positive Lives” photograph exhibition.

JAPAN HIV CENTER (JHC)
JHC was founded in Osaka in 1988 by HIV-positive people, their friends
and supporters, and is now operating branch ofﬁces in eight locations
throughout Japan. It is the ﬁrst Japanese NGO to specialize in HIV/AIDS
activities. It provides telephone hotline service, care support to Japanese as
well as non-Japanese and a peer education program for the young called the“Young Sharing Program.” It is also involved in policy advocacy, researchand public awareness-raising programs as well as managing a shelter for
people living with HIV/AIDS.

JaNP+ (Japanese Network of People Living with HIV/AIDS)
Created in 2002, this is the ﬁrst organization to form a nationwide networkof people living with HIV/AIDS in Japan. It offers medical and welfare
information through the Internet to people living with HIV/AIDS, supports
peer networking and opportunities for them to speak out and promotes
policy advocacy. In a regional outreach effort, it acts as the Japanese46

The list is representative, but not necessarily comprehensive, of NGOs active in this
ﬁeld.

74

Appendicescounterpart organization to GNP+ (Global Network of People Livingwith HIV/AIDS) and APN+ (Asia Paciﬁc Network of People Living with
HIV/AIDS). It is planning to issue a bimonthly journal by and for people
living with HIV/AIDS.

PLACE TOKYO (Positive Living and Community Empowerment
TOKYO)
Established in 1994, this NGO is presided over by Chizuko Ikegami, a sexologist long working in the ﬁeld of HIV/AIDS and who served as directorof the community liaison committee as a representative of NGOs for the
10th International AIDS Conference held in Japan. The main activities are
direct support to people living with HIV/AIDS, such as providing telephone
hotline service on HIV/AIDS, holding peer group meetings (called NEST),
managing a shelter and dispatching buddies. It has a high reputation for
its public outreach efforts that include dispatch of lecturers, research anddevelopment, and prevention and awareness-raising campaigns especiallytargeted at young people.

CHARM (Center for Health and Rights of Migrants)
Established in 2001 to create a clinical center that offers medical information, counseling, care and treatment in the mother tongue of foreign
nationals residing in Japan. It offers counseling on HIV/AIDS as well asother aspects of sexual health in various languages, dispatches medical
interpreters and, at the commission of the Osaka city administration,
conducts free HIV testing on weekends.

CRIATIVOS (Center for Reference and Support on HIV/AIDS)CRIATIVOS has been active since 1999 in promoting prevention andsupport programs mainly by and for Latin Americans, the most rapidly
expanding group of immigrants in Japan. The activities are community
based in offering telephone hotline service, supporting people living with
HIV/AIDS, and conducting surveys on effective prevention measures for
non-Japanese residents. It has a working relationship with the Brazilian
government regarding HIV/AIDS prevention.

SHARE (Services for the Health in Asian and African Regions)
SHARE was founded in 1983 by doctors, nurses and students motivatedby their experiences in developing countries and wanting to help improve
the health of people in need. It has given greater emphasis to HIV/AIDS75

Japan’s Responses to the Spread of HIV/AIDS
programs in recent years and actively pursues prevention and support
programs in Thailand and Cambodia. It is one of the very few organizations active both in Japan and abroad in this ﬁeld. The expertise acquired
through its long involvement in Thailand is now being applied to prevention programs, telephone hotline services and medical counseling tohelp Thai people residing in Japan. It also serves as the Japanese contact
organization for CARAM-Asia (Coordination of Action Research on AIDS
and Mobility).

Japan Association for the Lesbian Gay Movement OCCUR
Established in 1986, the objective is to protect the basic human rights oflesbians and gay people. To this end, it is involved in policy advocacy, telephone counseling, prevention and awareness-raising campaigns, support
services to people living with HIV/AIDS, speaker’s bureau activities andresearch and development. It acts as the Japanese contact organization for
the Asia-Paciﬁc Network of Lesbians, Gays, Bisexuals and Transgenders(AP-Rainbow).

MASH Osaka (Men and Sexual Health, Osaka)
Active in a central gay community of Doyama in Osaka since 1998, MASH
Osaka aims to improve the sexual health of MSM, promote HIV/STI prevention programs and offer care and support to MSM living with HIV/
AIDS. Its activities comprise of organizing seminars on STI, conducting
HIV testing for MSM and strengthening prevention campaigns as wellas making a survey of MSM on the effectiveness of prevention measures.
Enjoying a solid partnership with medical service providers and municipal
administrators, it has operated a drop-in center in the community since2003 for information exchange and event organization.

Yokohama AIDS Forum
This forum was created at the initiative of local citizens and ﬁrst convened in conjunction with the 10th International AIDS Conference heldin Yokohama in 1994. Every year, approximately 40 to 50 NGOs involvedin HIV/AIDS and international cooperation gather together to give presentations and panel exhibitions, attracting some 4,000 to 5,000 visitors
composed of NGO volunteers, medical service providers, school nurses,
counselors, students and the general public. Yokohama YMCA serves as thesecretariat, but the event is planned and managed by numerous volunteers
and offers a valuable opportunity of networking for citizens interested in76

Appendices
HIV/AIDS issues.

Campus AIDS Interface
An organization created in 1993 by young people to call attention of theirpeers to safer sex and awareness-raising in the prevention of HIV/AIDS.
Composed mainly of students in their teens and early twenties, the organization incorporates the perspective of its members to appeal to theyouth in promoting prevention campaigns, distribution of condoms, andinformation dissemination through the internet. It is one of the leading
youth organizations active in the ﬁeld of HIV/AIDS.

Africa Japan Forum (AJF)
A network group created in 1994 to support efforts in self-reliant development of the African people, AJF is involved in policy advocacy by Africanand Japanese civil societies and research projects to enhance understanding about Africa in Japanese society. Since 2001, it has launched programson HIV/AIDS issues in Africa, given the seriousness of the situation. The
main activities are networking of people with HIV/AIDS groups and NGOs
between Africa and Japan, policy advocacy to incorporate their needs inJapanese support programs on HIV/AIDS, capacity building of Japanese
NGO staff and volunteers involved in HIV/AIDS issues in Africa, andcooperation with counterpart NGOs in Europe and the United States topromote international efforts in ﬁghting the epidemic.

NGOs in Overseas HIV/AIDS Activities
The following organizations have been identiﬁed as pursuing HIV/AIDS
activities overseas, but as they do not specialize exclusively to HIV/AIDS
issues, the extent of their involvement is still in the process of being investigated.
ADRA Japan (Adventist Development and Relief Agency)
Africa Japan Forum (AJF)*
AMDA (Association of Medical Doctors of Asia)
Amis d’Afrique
Association for Aid and Relief, Japan (AAR Japan)
CARE JapanHANDS (Health and Development Service)77

JOICFP (Japanese Organization for International Cooperation in Family
Planning)
Kokkyo naki Kodomotachi (Children without borders) (KnK)
Medecins Sans Frontieres (MSF)
Project HOPE Japan (Health Opportunities for People Everywhere)
SHARE (Services for the Health in Asian & African Regions)*
World Vision Japan* See description given in the above list of NGOs in domestic HIV/AIDS activities.

The Japan Center for International Exchange

Founded in 1970, the Japan Center for International Exchange (JCIE)
is an independent, nonproﬁt, and nonpartisan organization dedicated tostrengthening Japan’s role in international affairs. JCIE believes that Japan
faces a major challenge in augmenting its positive contributions to theinternational community, in keeping with its position as one of the world’s
largest industrial democracies. Operating in a country where policy making
has traditionally been dominated by the government bureaucracy, JCIE has
played an important role in broadening debate on Japan’s international
responsibilities by conducting international and cross-sectional programsof exchange, research, and discussion.
JCIE creates opportunities for informed policy discussions; it does nottake policy positions. JCIE programs are carried out with the collaborationand cosponsorship of many organizations. The contacts developed throughthese working relationships are crucial to JCIE’s efforts to increase thenumber of Japanese from the private sector engaged in meaningful policy
research and dialogue with overseas counterparts.
JCIE receives no government subsidies; rather, funding comes fromprivate foundation grants, corporate contributions, and contracts.