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

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