Factors associated with access to HIV testing among international students in Japanese language schools in Tokyo

Barriers and facilitators for healthcare access among immigrants in Japan: a mixed methods systematic review and meta-synthesis

Background

While Japan provides universal healthcare, immigrants may experience hampered access to healthcare. A comprehensive review of immigrant healthcare access is also lacking. This systematic review aims to examine barriers and facilitators of healthcare access among immigrants in Japan.

Methods

We searched for literature published in English and Japanese until January 9, 2024. Studies were included if they assessed factors influencing any stage of immigrants' healthcare access, such as perceiving needs, seeking, reaching, utilizing healthcare and the consequences of healthcare, as defined by the Levesque framework. We performed a thematic analysis to further identify categories (PROSPERO: CRD42023418554).

Findings

After screening 2791 articles, we identified 67 studies (40 quantitative, 23 qualitative, 4 mixed methods) meeting eligibility criteria. Limited healthcare information led immigrants to seek alternative information sources and affected immigrants' perceived healthcare needs. Longer duration of stay improved access to healthcare information. Cultural and healthcare system differences affected healthcare seeking. Reaching and utilizing healthcare were hindered by heavy workloads, undocumented status, financial hardship, and limited insurance but were facilitated by support from family and friends. The healthcare system was often insufficient to support immigrants' language and cultural needs leading to dissatisfaction and poor compliance.

Interpretation

Findings highlight the critical importance of a multidimensional approach to support immigrants in Japan, ranging from improving healthcare information access to creating immigrant-friendly health systems. More research is needed on the healthcare access among vulnerable immigrants, such as undocumented and low-skilled labor immigrants and children.

Funding

No specific funding source supported this study.

Interventions to ensure access to and continuity of HIV care for international migrants: an evidence synthesis

International migrants, especially those belonging to key populations, face a considerable HIV burden. However, continuity of HIV care for this group is often challenged along the migration route. We assess the available evidence on the existing interventions that aim to strengthen community and health systems to ensure the continuity of HIV care for international migrants. We did a systematic search of PubMed for publications from 1989 until 2023 focused on different stages of the HIV care continuum regardless of the geographical region. The literature was reviewed with a thematic approach. Globally, legal regulations can restrict access to HIV care and fuel fear of deportation among undocumented migrants. The intersection of HIV-related and migration-related stigma creates further challenges for uninterrupted access to HIV care along the migration route, with negative clinical and public health consequences. Different potential interventions were identified including: provision of HIV care regardless of migration status; utilisation of mobile health, mobile units, and community-led initiatives to bring HIV care to migrants; and utilisation of participatory and co-creation methods to develop tailored and sustainable HIV-related interventions with migrant communities. Improving access to the continuity of care for migrants requires a shift towards intersectional policies rooted in co-creation approaches to address the underlying multiple and mutually reinforcing inequalities.

Factors impacting HIV testing among young sexually active women migrant workers in Vietnamese industrial zones

BACKGROUND

Young migrant workers living in low- and middle-income countries often experience barriers and inadequate access to HIV prevention and treatment services. This study examines the prevalence of HIV testing, associated factors, and reasons for obtaining and not obtaining HIV testing among young sexually active women migrant workers in an industrial zone in Hanoi, Vietnam.

METHODS

A cross-sectional study was conducted among 512 sexually active young women migrant workers (aged 18 to 29) working in the Thang Long industrial zone in Hanoi, Vietnam. Data was collected via a face-to-face interview from January 2020 to June 2021. Multivariable logistic regression analysis was used to explore factors associated with ever-testing for HIV among sexually active participants.

RESULTS

The study found a low level of HIV testing and high rates of unprotected sex. Among those who reported being sexually active, only 23.7% of participants (n = 126) reported having ever been tested for HIV. Among those who reported never having tested for HIV, 38.2% reported not using condoms during their most recent sexual encounter. Factors associated with engaging in HIV testing included being older (25-29 years), having greater knowledge about HIV, past use of sexual and reproductive health and HIV services, and familiarity with HIV testing locations.

CONCLUSIONS

Overall, a low level of HIV testing, high rates of unprotected sex, and low perceived risks regarding HIV among the study participants point to a need to implement targeted HIV interventions that can improve both safe sex practices and perceptions of and knowledge about risky sexual behaviors. Such interventions should use insights from this study to address factors facilitating HIV testing among industrial zones' women migrant workers.

A Study on the Health-Related Issues and Behavior of Vietnamese Migrants Living in Japan: Developing Risk Communication in the Tuberculosis Response

Ensuring a healthy lifestyle for the increasing number of Vietnamese migrants living in Japan is a key public health issue, including infectious disease responses such as tuberculosis (TB). To develop risk communication in relation to the TB response, this study aimed to explore the health issues and health-related behaviors of Vietnamese migrants living in Japan using a mixed method. A survey was conducted on Vietnam-born migrants, aged 18 years and over, in Tokyo. The survey consisted of questions on the following components: (1) demographics; (2) health-related issues and behavior; and (3) health-seeking behavior, information, and communication. A total 165 participants participated in the survey. The majority of the participants were young adults. 13% of the participants responded that they were concerned about their health. Moreover, 22% and 7% of the participants reported weight loss and respiratory symptoms, respectively. 44% of the participants answered they had no one to consult about their health in Japan when they needed it, and 58% answered they had no awareness of any Vietnamese-language health consultation services. Logistic regression analysis revealed that people who contact family members living in Vietnam or overseas using social networking services (SNSs) when they needed to consult someone about their health (adjusted odds ratio (AOR) = 6.09, 95% confidence interval (CI) 1.52-24.43) were more likely to present with one or more of the typical TB symptoms, compared to those who did not consult someone in this manner. Current smokers (OR = 3.08, 95% CI 1.15-8.23) were more likely to have health problems compared to non-smokers. The key informant interviews revealed that individual factors, the health system, and socio-environmental factors may hinder Vietnamese migrants' health-seeking and health-information-seeking behaviors in Japan. TB risk communication approaches for migrants need to be developed considering their health-related behaviors while addressing their health needs.

Associations between social support and access to healthcare among Filipino women living in Japan

This study investigated associations between social support and access to healthcare among Filipino women living in Aichi Prefecture, Japan. A cross-sectional design was used. Self-administered questionnaires were distributed to Filipino women and collected 342 valid responses. Each participant was asked about her access to healthcare for her own health and for her youngest child's health, and social support, as well as her socio-demographic characteristics. Of these respondents, 114 women (33%) did not have a usual source of care for themselves. Participants in our study had higher Medical Outcome Study Social Support Survey scores than people living in other Southeast Asian countries. However, distribution of the score showed that there were outliers with low scores which were very different from the others. Women with the highest emotional/informational and tangible support score showed better access to healthcare (adjusted odds ratio=0.22, 95% confidence interval 0.10-0.50, and adjusted odds ratio=0.38, 95% confidence interval 0.17-0.85 respectively). Women with a Japanese husband also showed lower odds of no usual source of care (adjusted odds ratio=0.44, 95% confidence interval 0.20-0.95). On the other hand, there was no factors significantly associated with access to healthcare for their youngest child including social support. Emotional/informational and tangible support were crucial factors associated with access to healthcare among Filipino women in Aichi Prefecture.

Evaluating Local Multilingual Health Care Information Environments on the Internet: A Pilot Study

For foreign-born populations, difficulty in finding health care information in their primary language is a structural barrier to accessing timely health care. While such information may be available at a national level, it may not always be relevant or appropriate to the living situations of these people. Our objective was to explore the quality of online multilingual health information environments by pilot-testing a framework for assessing such information at the prefectural level in Japan. The framework consisted of five health care domains (health system, hospitals, emergency services, medical interpreters, and health insurance). Framework scores varied considerably among prefectures; many resources were machine-translated. These scores were significantly associated with foreign population proportion and the number of hospitals in each prefecture. Our multilingual health care information environment (MHCIE) framework provides a measure of health access inclusivity, which has not been quantified before. It is adaptable to other international contexts, but further validation is required.

Factors associated with access to health care among foreign residents living in Aichi Prefecture, Japan: secondary data analysis

BACKGROUND

In Japan, foreign residents, and particularly new arrivals in the country, experience barriers to health care and show poorer health outcomes when compared to Japanese nationals. The health-care-related situation for foreign residents in Japan has been characterized by drastic changes over time; thus, there is difficulty identifying individuals who are "left behind" by the system. In this study, we aimed to identify, among foreign residents who attended informal free medical consultations, factors associated with "being advised to visit a medical facility" and "being referred to a medical facility," which represented hypothetical proxy indicators of barriers to health care.

METHODS

Secondary data analyses were conducted using the activity records of a non-governmental organization that provides free consultations targeting foreign residents in various locations in Aichi Prefecture, Japan. Participant characteristics, including insurance coverage, were determined. Bivariate and multi-variate analyses were performed to identify factors associated with having barriers to health care.

RESULTS

Among 608 extracted cases, 164 (27.5%) cases were advised to visit a medical facility, and 72 (11.8%) were referred to a medical facility during the consultations. Those who were not covered by public insurance showed a 1.56-time (95% confidence interval [CI]: 1.19-2.05) higher prevalence of being advised to visit a medical facility when compared to those who were covered by public insurance. Unemployed people and students were more likely to be referred to a medical facility than were professional workers; the prevalence ratios were 3.28 (95% CI: 1.64-6.57) and 2.77 (95% CI: 1.18-6.46), respectively.

CONCLUSIONS

Although the majority were insured, almost 30% were advised to visit a medical facility, which implied that they had had limited access to the formal health-care system before availing of the free consultations. The findings highlight those uninsured, unemployed people and students, who are considered vulnerable to access to health care. It is vital to provide those who are vulnerable with the necessary support while updatinge evidence, so that no one is "left behind."