By Ibi Fakoya

In December 2004 I spent a week in Japan as the guest of Masaki Inaba, HIV/AIDS coordinator of the African Japan Forum (AJF). Founded in 1994 this Japan-based NGO has been working to build solidarity between African and Japanese civil society through networking, advocacy and information provision. The main purpose of my visit to Tokyo was to speak at a two day International Symposium organised by AJF in conjuction with Share (Services for Asian and African Regions), ayus: Network of Buddhist Volunteers and Criativos – Centre for reference and Support on HIV/STD.

Japan is a relatively homogenous society with just 2% of its population coming from a non-Japanese background. Migrants are disproportionately represented in the Japanese HIV/AIDS epidemic (25% of the 20,000 reported cases). The bulk of migrants living with HIV are undocumented and therefore not entitled to the health insurance systems used to pay for HIV treatment and care.

There are an estimated 30,000 Africans living in Japan, mainly Nigerians (6-8000), Ghanaians (5-7000), Ugandans (3000) and Guineans (2000). Africans from other countries such as Senegal, South Africa Tanzania and Ethiopia are represented in smaller numbers. The majority of Africans in Japan are undocumented male migrant workers employed in the car industry and other factories. Although Africans in Japan live in established communities those who are undocumented are often isolated, choosing to stay away from community groups and events for fear of deportation by immigration authorities.

Africans make up around a third of the numbers of migrants living with HIV. As is the case in the UK, a large number of those who test HIV positive do so having been admitted to hospital after presenting with an AIDS defining illness. Because the overall prevalence in Japan is low, HIV prevention activities are few and far between, especially for migrants. Language barriers and cultural differences of make it very hard for migrants to access the few voluntary counselling and testing centres.

Once diagnosed migrants also find it very difficult to access healthcare. In addition to language barriers and cultural differences, the cost of treatment for migrants without insurance is prohibitive, more than US$16,000 compared with US$200-300 for the insured. HIV is seen as a disease that affects people living in other countries and very little exists in the way of charitable aid for those who cannot find the money for treatment. HIV positive Africans also find it difficult to find secure income and housing, since illness might prevent them from working regularly. The lack of input from Japanese civil society means that social support in the form of community groups, patient groups and charitable social care is unavailable to a lot of people living with HIV.

When immigration authorities eventually catch up with undocumented Africans, the outcome of such an encounter can be catastrophic for those living with HIV, as Margaret Mawanda from the Mildmay Hospital in Uganda told delegates at the Immigrants and HIV/AIDS in Japan international symposium. Generally, Japanese authorities do not prosecute undocumented migrants, but will hold them in detention while they await deportation. Mrs Mawanda told the story of a Ugandan woman living in Japan who, having overstayed her visa, eventually came across the immigration authorities who detained her. While awaiting deportation she fell ill and was diagnosed with tuberculosis and HIV, but was treated for neither infection. She was deported shortly afterwards even though she was gravely ill and arrived in Uganda on the point of death. She collapsed at the airport, but fortunately, was rushed to Mildmay hospital where she had her TB successfully treated and was started on anti-retroviral therapy. Clearly, the cost to both public and individual health far outweighed any potential financial cost of emergency treatment in such a case. Yet this case is not unique; indeed another panellist at the symposium Payap Ranarathorn, a social worker from Thailand, said that he had come across a number of Thai people that had similar experiences with Japanese immigration authorities, as emergency treatment for HIV is not guaranteed for those without insurance.

At the end of the two-day symposium panellists and delegates were invited to review draft recommendations for a new Japanese national policy on HIV/AIDS and immigrants. In addition to asking that the government consider universal access to HIV treatment the symposium recommended that: culturally appropriate VCT services be established; medical treatment be carried out with interpreters and with informed consent; emergency care is a human right and the health case system must be modified to accommodate this and HIV prevention activities must be improved.

I have yet to hear how the Japanese government has responded to these recommendations but the symposium itself was a great success. In a country like Japan, where both awareness and prevalence of HIV is low, symposia such as this are an excellent way to improve civil society mobilisation. It is imperative that this mobilisation continues and NGOs formulate strategic networks that actively seek to involve members of migrant communities. Three African people, from the Ugandan Association in Japan, were the only non-Japanese delegates at the symposium, illustrating how far Japanese NGOs have to go to get community participation in research and health promotion. Although there may not be many professional Africans living in Japan there is the potential to capacity build through Embassy and home country patronage. There is a need to involve not only Japanese students interested in African issues, (who were amply represented at the symposium), but also African students studying in Japan.

Japanese NGOs are now building networks with organisations in other developed countries making it harder for the government to continue to underestimate the importance of HIV. I look forward to plenty of collaboration between UK and Japanese organisations and hope that shared knowledge will go a long way to improving the lives of migrants in both counties.