Sexual and Reproductive Healthcare Guide
for LGBTQ+ people who are not yet familiar
with living in Japan

Ver. 1This is a guide for LGBTQ+ people who are new to Japan.
Please use this guide if and when you think you might have been exposed to
STIs (Sexually Transmitted Infections), when you want to know about healthcare
system, where to buy materials for safer sex, or how to go see a doctor in Japan.
Copyright © 2023 Wellness Support Team, Pride House Tokyo

1：The Current Status of HIV and Sexually Transmitted
Infections in Japan
In Japan, many people are hesitant to discuss their sexuality openly. This breeds a general lack of awareness about sexuallytransmitted infections (STIs), with some people unaware of being infected, and others engaging in sexual activities without
telling their partners of their infections. Because of this, it is crucial to prioritize prevention and safeguard your well-being
and that of your partners. To start, the basics of STI prevention remain the same worldwide: use condoms, practice good handhygiene, and gargle regularly.

Syphilis
he number of syphilis cases in Japan has been on the rise recently. However,thanks to a globally recognized standard treatment that was approved herein 2021, you are ensured world standard treatment at medical facilities inJapan if properly consulted. Nevertheless, reports indicate that reinfection
is possible even after an initial successful treatment. Therefore, regulartesting and vigilant prevention are vital for a healthy sex life in Japan.

HIV/AIDS
Although the number of newly infected individuals with HIV in Japan isdecreasing, cases where infection is detected after the onset of AIDS are
rising. This mostly due to a decline in testing caused fallout from the
COVID-19 pandemic. While testing used to be widely available, it has become
more challenging to secure appointments, with some institutions limiting thenumber of tests available to the general public. While mail-in testing is being
developed, it has proved to be insufficient at this point. Regular testingremains crucial.

Hepatitis B/CApproximately 3-4 million people in Japan are infected with hepatitis B
virus, with most unaware of their condition. While hepatitis B is most oftentransmitted sexually, hepatitis C is mostly transmitted by the sharing ofsyringes. Condom use remains the fundamental preventive measure against
hepatitis B transmissions, and for hepatitis C avoiding the use and sharingof needles and syringes.

Gonorrhea
Among Japanese youth in their 20s, gonorrhea cases have been increasing inrecent years, often occurring alongside chlamydia. Many cases of gonorrhea
are asymptomatic, and pharyngeal gonorrhea can be contracted through oral
sex. Seek proper treatment and take preventive measures to protect
yourself.

Chlamydia
Chlamydia infections in Japan are on the rise, surpassing the increase ingonorrhea cases. As with gonorrhea, chlamydia can spread unknowingly due
to asymptomatic cases. It can also be transmitted through the pharynx,
emphasizing the need for extra caution.

If you suspect you have an STD in Japan, visit a "urologist,""gynecologist," "infectious disease specialist," or an "ENT (Ear,Nose, Throat)” doctor. Be open about your symptoms andprogress to aid in accurate diagnosis. In Japan, you will receive thenecessary and appropriate medical care for infectious diseases, so
feel free to consult any doctor with confidence.

For foreigners｜HIV Testing and Consultation Map
hivkensa.com
HIV Testing and Consultation Map Foreign Language Page Links(Available in nine languages)

Availability of PrEP in Japan
PrEP has gained recognition in Japan, but the drugs used for PrEP have not been
approved for prophylactic use and are only available at one's own expense. Misuse of the
drug has been reported due to a lack of information about PrEP. Those interested in PrEP
should ensure proper usage. If you were using PrEP before coming to Japan and plan tocontinue, confirm if you can access it consistently before your trip.

● Continuing PrEP in Japan is not easy
There is no free distribution program in Japan, and PrEP medications are not covered byinsurance, requiring out-of-pocket expenses. It is also essential that you go to specificclinics for regular testing for STDs and HIV, and a PrEP follow-up. Even if you have prior
PrEP experience, your experience with PrEP in Japan may leave you nonplussed.

● Lack of quality clinics in regional cities
The reality is that the number of high quality medical institutions that prescribe PrEP isvery small and concentrated in large cities such as Tokyo and Osaka. Online clinics andprescribing services can be effective alternatives, particularly for those in regional cities.
You can find these self-prescribing clinics available in Tokyo through a quick search online.

● Purchasing PrEP through private importation
Importing PrEP privately will mean that you will be using PrEP without being tested for
STDs or HIV. That can lead to worsening symptoms of hepatitis B or result in drug
resistance if you are infected with HIV. You may also inadvertently be infected because
you ran out of PrEP due to an import delay or postal issue. Moreover, private imports canbe costly. Remember that continuing PrEP without knowing your HIV status limits yourtreatment options.

● What should you do?
Connect with the few medical facilities in Japan that allow continued PrEP usage while
conducting regular testing. Some clinics offer online medical services in English. If you
don't have a nearby medical institution, consider private procurement of PrEP while
ensuring regular checkups. If you have any doubts, consult an institution experienced with
PrEP. Remember, it is crucial not to face these challenges alone. Seek assistance fromthose who can support your PrEP journey.
Note: The method of taking PrEP medications varies depending on individual cases, such as one's
sex assigned at birth, and whether or not one is receiving hormone replacement therapy.

PrEP in JAPAN - This site provides information about PrEP and support for sexual
health. (ptokyo.org)（Use your browser’s translation function if you can not find English or non-Japanese references
online）

Pre-Exposure Prophylaxis (PrEP) for HIV Prevention in Japan - User's Guide(This is in PDF form and in Japanese only. It may be harder to translate using online resources)

Pocket-Guide https://prep.ptokyo.org/eBook/prep_pocket_guide/2：Medical Insurance Situation for Visitorsfrom Outside JapanThe medical insurance situation for foreign visitors to Japan varies depending on factors such as citizenshipand the length of stay. According to a survey conducted by the Japan Tourism Agency in 2019, about 30% of
people who visit Japan on vacation do not have insurance. Including those who are unaware that they areautomatically insured through a specific travel or financial service, half of them are not adequately preparedin advance. It is important to confirm in advance that you have "insurance to cover medical expenses” in theevent of unforeseen injury or illness!

Short-term stay,
3 months or lessStaying longer than
3 months in Japan

About Foreigners and Health
Insurance in Japan:(regardless of purpose or visa status)

Fundamentally you should becovered by Japan's Public Health
Insurance system, but private travel
insurance is still an option.

- Foreigners staying in Japan for more than 3months with a residence permit are covered by
the National Health Insurance under the Basic
Resident Registration Act.
- Even those not covered by the Basic Resident
Registration Act but staying in Japan for morethan 3 months with authorized documentation
are also eligible for National Health Insurance
coverage.
- Employees are required to have healthinsurance regardless of their length of stay.

Fundamentally you should becovered by private travel insurance- Apply for insurance from an international
insurance company before departing for Japan.
Review the coverage details carefully.
- Purchasing insurance from a Japanese
insurance company requires someone in Japan(a Japanese company, relative, or friend) tocomplete the necessary procedures. It cannot
be done remotely.
- For stays less than 31 days, you can purchase
travel medical insurance at the airport or
through an app after entering Japan.
- Employees of companies may be eligible forpublic health insurance regardless of the lengthof stay. Check with your employer in advance.

- If you are employed, consult your employer toenroll in the public health insurance program.
- If you do not work, or if you work but are notcovered by your employer, take the Residency
Card issued to all long-term visa holders to themunicipal office of the municipality where you
are staying to register and join the National
Health Insurance System (note that certain
medical treatments not covered by the publichealth insurance system such as cosmetic
surgery/check when registering).
- Besides this public health insurance, you canalso purchase travel insurance to cover 30% of
your medical expenses (apply through aJapanese insurance company after entering
Japan).
- Private injury (accident) insurance andmedical insurance may also be available options.

Important Points to Consider:- Private travel insurance may provide accessto multilingual call centers and referrals to
medical facilities. Some major insurancecompanies offer services in over 30 languages.
- Many medical facilities in Japan do not
accept credit cards.
- Without Japanese health insurance or travel
insurance, full payment may be required for
injuries sustained at work or by third parties.

For visitors to Japan ／ © Tokyo Sexual Health Project. https://www.tsh.ncgm.go.jp/en/support/japan.html

SAFER SEX
Condoms

3：Where can I buy
safer sex supplies?
Japan has a well-established retail distribution network, making it
convenient to purchase goods through various e-commerce websites.
For items bought within Japan, delivery usually takes only a few days.
If purchasing from outside Japan, personal importation may take 1-2
weeks by air or 3-4 months by sea, so it is advisable to plan ahead
and stock up on supplies that you need when overseas.
Because discussions related to sexuality are not often part of normalinterpersonal communication, many people in Japan feel hesitant tobuy sexual health items from in-person retailers like pharmacies orvariety stores*. Therefore, e-commerce is a popular option for
discreet purchasing. Note that safer sex supplies may be listed underthe "adult products" category on e-commerce platforms. If you can't
find the desired item immediately, try the suggestions below.

* Note: Variety stores in Japan often refer to stores that sell sex-related
goods, sometimes called sex shops or adult stores.

● Condoms can be purchased at convenience stores, supermarkets,
drugstores, and e-commerce.
● Convenience stores and supermarkets offer a basic selection.
● Drugstores and e-commerce sell a wider variety.
● Some sex establishments, such as love hotels, may provide
condoms in each room, but it is advisable to prepare your own
condoms in advance if you are concerned about the quality andexpiration date, as it is difficult to check in advance.

Femidoms or internal condoms
for people with vaginas
Currently, internal condoms may not be readily available in Japan.
Those interested in using internal condoms may need to rely oninternational mail order options.

Continue to next page

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4：Hospital Visits in Japan:Your Guide to Healthcare
If you stay in Japan for more than 90 days, you are eligible for national healthinsurance coverage. Under this coverage, you are responsible for 30% of
hospital treatment and other expenses, while the remaining 70% is covered bypublic health insurance. It is important to note that any treatment not coveredby health insurance will be your full responsibility.

Lubricants/Lotions
Lubricants and lotions can be found at drugstores, variety
stores, and on e-commerce platforms. A wide range ofoptions is available, but be cautious when using them withcondoms, as some water-based and oil-based products may
not be compatible. In pharmacies, lubricants are often foundin the same section as condoms, while e-commerce
platforms may list them under the adult products category.

Finger Condoms
Primarily available through e-commerce, finger condoms
may be harder to find in physical stores. They may be listed
under the adult products category.

Dental Dams
Dental dams are primarily available through e-commerce,with limited availability in physical stores. They may also belabeled as dental hygiene products, requiring extra effort tofind them in the adult category.

Tongue condoms
Primarily available through e-commerce, tongue condoms
may be harder to find in physical stores.

Latex Gloves
Due to the COVID-19 pandemic, latex gloves are relatively
easy to obtain as a hygiene product. They can be found inpharmacies and well-stocked supermarkets, as well as
through e-commerce platforms.

Where to Buy Sex Toys
Sex toys can be purchased at variety stores andthrough e-commerce. However, most variety
stores cater to heterosexual cisgender men, so if
you cannot find what you're looking for in aphysical store, exploring e-commerce platforms
may offer a wider selection.
* Note: Variety stores in Japan often refer to storesthat sell sex-related goods, sometimes called sex
shops or adult stores.

● For general illnesses, injuries, or concerns about sexually transmitted infections(STIs), you can visit hospitals or clinics without an appointment in most cases● In general, it is up to you to decide which department/specialty care you need tovisit and proceed accordingly● Large general hospitals may require appointments, so it is advisable to check theirwebsites or call ahead. Some facilities offer services in languages other than Japanese● Online medical services may also be available, providing convenient healthcare
options

Getting Tested for STIs:
If you suspect or want to confirm an STI or HIV status,
you can visit the following places:● Public Health Centers● Sexually Transmitted Infections Medicine/STIs clinics● Obstetrics and gynecology clinics● Urology clinics● Dermatology clinics● Otolaryngology (ENT) clinics

Continuing HIV Treatment:
Note that HIV treatment in Japan can be costly,
and it is often more affordable to bring aprescription from your home country before
arriving. While limited hospitals and clinics
provide HIV treatment, the following options areavailable:● Hospitals and clinics specializing in STIs
You might find this map helpful: https://www.hivkensa.com/language● Core HIV/AIDS treatment hospitals or core HIV/AIDS treatment centers
You can find them on the website: https://hiv-hospital.jp/ (Please use a translation
function on your browser as needed)● For long-term stays in Japan, visit: https://ptokyo.org/en/faq

Birth Control and Pregnancy:
For birth control or pregnancy-related inquiries,
consider the following options:● Obstetrics and gynecology clinics (for matters related to ovaries and uterus)● Urology clinics (for matters related to testicles)● Pregnancy tests are available at pharmacies● The morning-after pill (known and pronounced as the "afutah piru" in Japan) is
usually prescribed by obstetricians/gynecologists● Online medical services can provide prescriptions as well.

Using PrEP (Pre-Exposure Prophylaxis):
Please note that health insurance in Japan does not cover PrEP, making it aself-pay medical treatment. If you plan to use PrEP, it is often morecost-effective to obtain a prescription from your home country before coming
to Japan.
● In Japan, general practitioners, family doctors, or physicians can assist you● For a list of clinics offering PrEP consultations, visit the website
https://prep.ptokyo.org/facilities(Please use a translation function on your browser as needed)