July 30, 2008

To:       His Excellency the Prime Minister of Japan, Mr Yasuo Fukuda,

cc:        Mr Jin Murai, Governor of Nagano Prefecture

            Mr Masaru Hashimoto, Governor of Ibaraki Prefecture

On behalf of people living with HIV/AIDS of Thailand and non-governmental organizations working on AIDS in Thailand, we would like to congratulate Japan on her advanced public health system and in particular its excellent care of HIV positives. The Japanese government has also shown concern for HIV positives in other countries by its generous financial support to the Global Fund, as the world"s third biggest donor. However, we are seriously concerned about the fact that HIV-positive migrants from Thailand in Japan were not treated properly by the Japanese health system, even though they were critically ill with life- threatening conditions.

Last year, two Thai migrants developed brain abscess as a opportunistic infection of AIDS, while staying in Japan. The condition of both became life-threatening because they were not able to access urgent medical treatment. Due to other factors, both overstayed their visas. When they realized that their health problems were critical, they wanted to return to Thailand.

But by that time, they had developed central nervous system dysfunctions, resulting in drowsiness and paralysis, so that they could not leave Japan without first receiving appropriate treatment.

One visited a clinic and was found to be HIV positive. She then lost consciousness and, because of her brain abscess and drowsiness, could not be informed of where to seek medical treatment. Her friends suggested she return to Thailand, as they were sure no clinic in the neighbourhood would accept a Thai AIDS patient without health insurance.

Finally, on her way to the Immigration Office to give herself up, she was arrested for overstaying her visa. She was locked up for an entire week by the police, who did not allow her to see a doctor until after repeated calls from her friends to the police via the Embassy for her to be sent to hospital for medical treatment. Once hospitalized, she was immediately found to have a brain abscess and could have lost her life had she been further detained even for a few days.

Another person went from one well-equipped hospital to another in the neighbourhood before being found to have developed a number of brain abscesses as a result of AIDS. Without doubt, any doctor would recommend a patient in such a critical condition to be admitted to hospital for immediate treatment. But one doctor merely advised the patient to return to Thailand. No treatment was given to the patient because of a lack of health insurance coverage, which had been too expensive for this patient.

After several days the patient became semi-comatose, but was still denied medical treatment by the hospital. Finally, through the coordination of a Japanese NGO and the Thai Embassy, the patient was given medical treatment at a hospital located in a remote area.

We have in the past heard repeated reports of Thai migrants in Japan developed AIDS who died without proper treatment. Many cases occurred in the areas where proper treatment of foreign patients was lacking, such as Nagano and Ibaraki Prefectures. Doctors in those areas often suggested that the patients return to Thailand without providing any prescription medicines or treatment of opportunistic infections. AIDS is a progressive illness and patients" lives can be at risk without immediate treatment.

Currently, Thailand has an efficient system of AIDS treatment. If medical services in Japan provided proper treatment for opportunistic infections before referring the patients to Thailand, the lives of HIV-infected Thais could be saved.

It took several weeks for the abovementioned patients to recuperate to the point where they were fit enough to travel back to Thailand, where free medical treatment is available in government hospitals. One recovered after being treated with antiretroviral drugs but was disabled as a result of delayed treatment of the brain abscess. The other person"s brain abscesses became already too advanced, and it made doctors very difficult to improve her general condition enough to start antiretroviral drug treatment, and she died after arriving in Thailand.  

In Thailand, both civil society and the government have a strong commitment to fighting any discrimination against HIV-infected people. We are saddened to hear that HIV-infected Thais in a rich country like Japan have been discriminated against and denied appropriate medical treatment, which is a basic human right. As long as certain groups of people in Japan are denied access to prompt medical treatment, it will be difficult to ensure a reduction in new AIDS cases and an effective solution to AIDS problems in Japan.

We strongly recommend that the Japanese public health authorities and concerned government agencies should lead other medical facilities in giving appropriate and prompt treatment to patients, regardless of their nationality or visa status. Please do not refuse to treat them. Any such refusal may be the equivalent of a death sentence and may worsen Japan"s own AIDS problems. In the case of the Thai HIV-infected migrants, we request that they receive treatment until they are in a condition to return safely to Thailand where they can be further treated with antiretroviral drugs at Thai government hospitals. We further urge the Immigration Office and police agencies to allow undocumented migrants to receive essential treatment for their health problems.

It is recommended that the Japanese government and local administrations should allocate an adequate budget to finance the urgent treatment of foreign patients.  Japan"s reputation as a large donor to AIDS treatment through the Global Fund will otherwise be discredited by the failure to provide adequate medical treatment for foreigners residing in Japan to the point where their lives are at risk.

We hope this letter will prompt the relevant agencies and organizations to change their attitudes towards HIV-infected migrants in Japan to show the country"s respect for the basic human rights of all persons. Such a change will promote Japan"s contribution to the Millennium Development Goal of providing HIV/AIDS treatment for all by the year 2010. We believe that this will bring about mutual trust and solidarity between the Thai and Japanese people and help improve the public heath systems in Thailand and Japan.  

Sincerely yours,

Mr. Boripat Donmon

Chairperson of the Thai Network of People Living with HIV/AIDS

Ms. Supatra Nacapew

Chairperson of the Thai NGO Coalition on AIDS

Director of the Foundation for AIDS Rights

Mr. Nimit Tien U-dom

Director of the AIDS Access Foundation