Whether you’re in a monogamous relationship, engaging in sex with multiple partners, or choosing to abstain, you will make decisions that affect your sexual health. Therefore, it’s important to understand what steps you can take to enjoy a healthy and positive sex life. This page firstly covers commonly transmitted STIs, outlining level of risk and symptoms.
Information about access to and availability of testing and treatment options in Japan is then provided. Next, a more in-depth look at HIV is offered. The testing process, treatment and support systems, as well as preventative measures—PEP and PrEP—are discussed. Please consider this a non-judgmental and sex-positive introductory resource page for individuals living in Japan. There are links to more detailed information throughout.
Sexually Transmitted Infection (STIs)
Assessing Level of Risk
Having sex comes with risk. Some decisions may increase risk (e.g. using drugs that alter perception), while others may decrease risk (e.g. using a condom). Risk of transmission can depend on the sexual act performed and whether or not a condom is used. However, safer sex is much more than just condom use. Before engaging in sex, it can be a good idea to talk about practices that will help you feel safe and comfortable with your partner(s).
It is important to educate yourself about the signs and symptoms of potential STIs. It is also important to understand that you may not experience any symptoms, or that it might take time for symptoms to appear. If you do receive a positive diagnosis for any STI, it is advised to take care of your health and follow the advice of health care providers. Another consideration is to inform recent sexual partners, so they know to get tested too. Contracting an STI can be scary, painful, or embarrassing, but it is also a normal part of an active, healthy sex life. It can happen to someone who enjoys sex with multiple partners, or to someone who’s in a monogamous relationship. Emotions such as betrayal, anger, or guilt may come up for you or your partner(s). Remember, an STI isn’t something that someone does to someone else: it’s just something that happens.
Deciding how often to get tested for STIs can depend on a number of factors (e.g. frequency of sex, number of sexual partners, safer sex practices, etc.). Keeping in mind window periods, you may choose to get tested at regular intervals, such as every 3 months. Many public health centers in Japan provide free and anonymous testing for the following four STIs:
- HIV (Blood test)
- Syphilis—梅毒 [BAI-DOKU] (Blood test)
- Gonorrhea—淋病 [RIN-BYO] (Urine test)
- Chlamydia—クラミジア [KU-RA-MI-JIA] (Urine test)
The procedure and services provided can vary from site to site. Some centres require an appointment; they may or may not have non-Japanese language support; and they may not test for all of the STIs listed above. Typically, you will have to return to the centre for the results a week after testing. Depending on your results, you may receive counseling and treatment.
Urologists (for men), OB/GYNs (for women) and general private practitioners may offer STI testing and treatment at a cost. This generally includes tests for HIV, gonorrhea, chlamydia and syphilis, but may also include testing for hepatitis B and C as well as herpes simplex.The fees involved will depend on whether or not the patient is presenting symptoms. National Health Insurance will cover the tests, treatments and medications only when you have symptoms. This means that STI screenings as part of a regular check-up routine are not covered. Compared with free services, results will generally be available sooner, and may be received via email or phone. Again, follow-up appointments and treatment, as well as their associated fees, will depend on test results. You may be referred to a dermatologist (皮ふ科; HI-FU-KA) for diagnosis or treatment of the following STIs:
- Genital warts—尖圭コンジローマ [SEI-KEI-KON-JI-RO-MA]
- Herpes—性器ヘルペス [SEI-KI HE-RU-PE-SU]
- Pubic Lice—毛じらみ [KE-JI-RA-MI]
- Scabies—疥癬 [KAI-SEN]
Also keep in mind that non-Japanese language support may be limited in the case of all the health providers mentioned above. While you may be able to navigate these scenarios with limited Japanese ability, it’s important to consider that you may need an interpreter (e.g. a Japanese-speaking friend) to accompany you.
Human Immunodeficiency Virus (HIV)
HIV is a manageable disease with ongoing treatment options. Without treatment, HIV will eventually progress to AIDS (Acquired Immunodeficiency Syndrome) which leaves the individual susceptible to a variety of infectious diseases. With antiretroviral treatment, it is possible to continue to lead a normal, healthy life after being diagnosed as HIV-positive.
HIV Testing Window Period
The HIV antibody test is a blood test that detects the presence of HIV antibodies. It takes the body time to build up antibodies to the virus in numbers sufficient enough to show up on a test. It has been recommended that initial testing take place at least two weeks after potential exposure, however the most accurate results will be after three months. This waiting period is known as the “window period”. More recently, rapid combined testing for HIV-1 p24 antigen and HIV-1 and HIV-2 antibodies has become available. For this method, results can be available within an hour of testing. In Japan, rapid testing is available at some free clinics and general practitioners clinics, but again, you will have to wait some time after the potential exposure event. The rapid test can detect infection as early as two weeks after potential exposure, but repeat testing at three months is recommended even if the initial test is negative.
What it means to test positive
For HIV, if the screening test is positive, a confirmatory test is recommended. Once a positive status has been confirmed, referral to a specialist can be made for further evaluation and treatment. Throughout this process, you may be feeling a lot of different emotions from fear to guilt, and it is important for you to know that you don’t have to go through this alone. There are different avenues for finding support. If you do not feel comfortable reaching out to friends or family, there are active online communities that can provide information and support. Please also consider reaching out to TELL Lifeline: we are here to listen.
Below are some other considerations following confirmation of positive status:
- Avoidance of re-infection—It is important to understand that there are different strains of HIV. It is possible to contract multiple strains. If you get infected with two or more strains of HIV, the effectiveness of treatment could be impacted.
- Plans for notifying others—Disclosing your HIV status is a personal choice. Stigma around HIV still exists and the fear of being judged is valid. You may want to consider how you approach disclosing your HIV status to the following people:
- Former and current sexual partners
- Friends and family
- Health service providers (therapists, fertility treatment, etc.)
- Service providers (tattooists, etc.)
- Employers and colleagues
- Education—Sometimes, it is helpful to provide those you notify of your diagnosis with resources. The following links can help answer questions about risks of transmission, treatment options, and how to support people living with HIV:
Treatment in Japan
There are various drugs available to treat HIV in Japan. Depending on your circumstances, you may take a combination of pills or a single pill orally once a day. These days, side-effects are minimal. However it is important to consult your health-care provider should adverse effects persist; you may need to be put on an alternative drug regime. Normally, you will be prescribed 3 months worth of pills, and you will need to visit your health-care provider to renew the prescription and receive counseling and blood tests. Social welfare is available to cover part of the prescription cost as well as doctor fees. The welfare system can be challenging to navigate, especially if you have limited Japanese language ability. It may be frustrating and disheartening, but please know that it is possible to continue to live in Japan and have access to affordable treatment options.
Prevention Measures in Japan
Antiretrovirals (ARVs) have been used to prevent infection in case of exposure to HIV for many years. This intervention is called post-exposure prophylaxis (PEP) and involves taking a 28-day course of ARVs. These drugs work to stop the spread of HIV throughout the body. Use of PEP may be considered in those who are currently HIV negative and may have been exposed to HIV within the past 72 hours. Another ARV treatment is called pre-exposure prophylaxis (PrEP). PrEP is a daily pill for people who don’t have HIV, and who want to reduce the risk of getting it. For more information on PEP and PrEP, please see the following videos:
In Japan it is possible to acquire nPEP (non-occupational post-exposure prophylaxis) treatment, however, PrEP is not available. Although the recommended medication for PrEP, Truvada (tenofovir / emtricitabine), is available and approved for treatment of HIV infection, it is not approved for use as PrEP.
Please note the following regarding nPEP:
- nPEP is not a standard prescription, and you may have to ask for it
- nPEP is not 100% effective in preventing infection
- nPEP is not covered by Japanese National Health Insurance and is expensive (initial cost of ¥220,000~240,000)
- Payment in full will be required prior to dispensing of medications
- Medication needs to be taken daily for 28 days
The majority (65%) of people who take PrEP in Japan acquire it online and have it shipped internationally. However, individuals are only permitted to import one month’s worth of PrEP at a time, per law. In 2018, London-based PrEPster conducted a study that tested the quality of 6 major online stores that sell PrEP and found that all were genuine.
Of the 6, the 4 online stores that ship to Japan are: