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Tanabata festival. I'm interested in examples mostly for large-scale applications like skyscrapers, but other buildings with exceptional glazing systems are welcome too. Japanese Tsunami Over the sea wall inundation. Death toll from Sendai earthquakes and tsunami varies according to who you ask. The National Police Agency of Japan reported a total of 15, deaths, 6, injured, and 2, people missing. The USGS reports 20, fatalities for this disaster. This surpasses the death toll for the Great Hanshin Earthquake. The largest number of deaths was in the Miyagi, Iwate, and Fukushima districts.

If you've ever wished that there was a place where you could freely mingle with a bunch of adorable friendly foxes, your heaven on earth exists. Analysis revealed the emergence of three broad themes as follows including: facilitating and prohibiting factors to implementing Everywhere in Japan e. Data revealed a number of facilitating factors regarding the acceptability and feasibility of implementing Everywhere in Japan.

Perhaps most importantly was the strong expression of interest from the communities represented in the workshops, namely, MSM, business owners gay saunas and gay NGOs. There was broad agreement across the three workshops that many NGOs across Japan already have a firm foundation for conducting outreach activities with businesses e. Everywhere partner countries in Europe. Furthermore, and linking closely with the following theme, the transferability of the project e.

However, there were considerable cultural differences identified in the workshops that indicate some adaptability is required in transferring Everywhere to the Japanese context. During the Osaka workshop, important discussions occurred regarding the availability and provision of lubricants. In Europe, condom wallets are given out by the NGOs implementing Everywhere which contain both a condom and sachet of lubricant.

There is strong feeling amongst European NGOs that to not give out lubricants with condoms is irresponsible; partly because if it is not available, MSM may use other unsafe means such as oil based lubricants e. In practice, therefore, condoms and lubricants are generally not available or distributed together as they are in the UK and Europe. To circumvent this, some Japanese MSM carry their own water-based lubricants with them to venues but some still use other inappropriate substances such as oil-based lubricants.

In terms of inhibiting factors regarding the acceptability and feasibility of implementing Everywhere in Japan, an issue raised by participants across all three workshops was the issue of strong cultural values and related stigma and discrimination. This manifests itself more broadly, to a lack of community capacity locally and nationally across Japan.

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Stigmatization of sexual minorities historically resulted in a slow response to the epidemic compared to many Western European cultures, and continues currently to result in very low levels of financial support from Japanese local and national governments for HIV prevention activities conducted by gay NGOs. It is therefore likely that significant political lobbying for financial support as well as capacity building work with local Japanese NGOs and community centres will be required prior to any attempt to implement the Everywhere framework.

Workshop discussions revealed that participants felt the international dimension of the Everywhere project was important not just in Japan itself e. For example, participants reported that in Okinawa MSM tourists are often from Shanghai and Beijing China , in Osaka there are many Korean-Japanese but only a handful of bars targeting foreign nationals, whilst in Kyoto there are a greater number of foreign targeted bars which is relatively unusual in Japan. In other words, an Everywhere certified business and its customers in Tohoku would still potentially benefit because the standards upheld by the business would be compatible with other certified businesses both locally and across Japan.

With appropriate marketing, this would allow MSM from the region to know which businesses have prevention materials and information available both in Tohoku and other cities. A key issue discussed across all three workshops concerned the practicalities of how, where, and when Everywhere or its Japanese variant could be implemented and sustainably managed. For example, consistent across the workshops, discussions centred on the different types of gay businesses in Japan and Europe such as bars, discos, shops, cinemas, cafes, saunas and so on and the potential implications for NGOs commencing Everywhere activities.

In Japan, workshop participants reported that although most venues with saunas as the exception did not have dedicated sex spaces such as dark rooms mostly due to size , they were nonetheless places for MSM to meet and go elsewhere for sex. In the Osaka workshop, participants felt that given there were many gay bars and shops where sex on site is not possible but relatively fewer sex venues such as gay saunas where sex on site is possible , the former might be the best place to start Everywhere activities and then move on to the latter once the scheme becomes more established.

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However, this view was not unanimous; in Sendai Miyagi prefecture , for example, the NGO representative felt that given their existing positive relationship with the two gay saunas, these venues would be the best place for them to begin Everywhere. There was broad agreement across the three workshops that the benefits of adopting the Everywhere framework would be maximized if all major cities in Japan participated and collaborated nationally at the same time.

One way discussed that might be able to achieve this would be to develop one central coordinating centre that would be responsible for domestic and international Everywhere activities including coordinated branding, marketing, research, evaluation, monitoring, training, quality control and so on. However, given the lack of financial resourcing and sustainability in Japan for HIV prevention for MSM, this may in practice be a considerable challenge to overcome. In response, HIV outreach programmes across Japan have increased dramatically since despite considerable challenges Ichikawa, Such challenges are numerous and include: low levels of community capacity and sustainable financing for MSM-related HIV prevention programmes; high social stigma and discrimination; underdeveloped intersectoral partnerships e.

The success of settings-based outreach work in Japan evaluated by gay community surveys is attributable in part to the efficacious intersectoral collaborations between gay NGOs and MSM community members along with commercial gay venues or businesses. Given that 1. By conducting a small and qualitative feasibility study, we wanted to scope the potential for the adaptation of the Everywhere HIV prevention framework to Japanese contexts.

INTRODUCTION

Moreover, given the high degree of sexual mobility between countries in Asia as in the European Union , data from the workshops suggested that there is also potential for the Everywhere Project or its Japanese variant to be expanded and adapted to other countries within the Asia-Pacific region. The current study identified a number of factors likely to impact on the success of a Japanese variant of Everywhere e.

Whilst in some cases, similar issues emerged and were addressed during the European pilot of Everywhere see Sherriff, ; Sherriff et al.

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In terms of the former, although homosexuality in Japan is not illegal, the strong stigma and discrimination towards sexual minorities including gay and bisexual men is likely to be problematic in working with gay businesses Taniguchi, Consistent with many Asian societies where social and cultural norms privilege heteronormativity, homosexuality in Japan remains taboo and stigmatized which renders sexual minorities such as MSM less than visible Laurent, Consequently, Japanese MSM often face strong social pressures to conform to a heteronormative lifestyle Hidaka, ; Hidaka and Operario, This in turn means that there are few positive portrayals of sexual minorities which results in difficulties in advocating for community-based activities e.

HIV prevention via settings such as gay businesses that acknowledge and promote positive sexual health among MSM. Moreover, it also means that knowledge and understandings of MSM's sexual health needs as well as social, mental and emotional health needs among medical staff, public health workers and public health officials as well as the general public is limited.

Thus, for Everywhere in Japan to move forward, it will be important to conduct comprehensive formative research with MSM and businesses across Japan to explore their willingness to engage in a Japanese version of Everywhere c. Together, this formative research will help form a knowledge-base on which to develop culturally relevant and appropriate Everywhere style HIV standards for different types of gay business, as well as potentially identify strategies and opportunities to counter stigmatization of sexual minorities and HIV.

In terms of financial resourcing for sustainable HIV prevention activities in Japan, this was raised as a potentially crucial barrier by workshop participants to carrying out settings-based health promotion initiatives such as Everywhere. Without long-term assurances regarding sustainability of HIV prevention actions, experience from Europe indicates that many gay NGOs and businesses may be unwilling to engage for fear of jeopardizing their existing and often fragile relationships that may have taken many years to forge Sherriff and Gugglberger, Consequently, for Everywhere in Japan it may be necessary to work with relevant Japanese PHAs early in the planning stages to secure financial sustainable and policy support to allow central coordination and monitoring of Everywhere activities to maximize the potential of implementation fidelity and ultimately, effectiveness.

Although the findings of this study are promising, it is important to acknowledge a key limitation. In addition, the quality of data obtained from the workshops and additional meetings may be lower due to translation given that a method to evaluate or enhance the quality of translations was not employed. However, steps were taken to mitigate this by utilizing multiple note takers during the workshops, combining drafts until consensus was reached, and engaging in pre- and-post-workshop discussions to further provide contextualization, clarification and additional detail where required.

Consequently, it is possible that the final quality of data achieved may actually be richer than had the workshops been recorded and discussions potentially muted. However, the authors also argue that there is a significant risk that the epidemic will grow out of control in the near future and propose that a greater focus is required on identifying the key behavioural factors driving the epidemic and to then facilitate change in these behaviours. Sherriff et al. Yet, few countries implement coordinated, coherent and sustainable health promotion actions in collaboration with such businesses.

Given the degree of enthusiasm from workshop participants in this present study combined with the results from the European pilot implementation, it is possible that Everywhere in Japan can offer an important contribution to the health promotion field in the form of a practical, policy-relevant, settings-based HIV prevention framework for gay businesses that could facilitate the scale up prevention responses among MSM in Japan.

However, in order to do so, issues such as stigma and financial security in Japan for HIV prevention actions, will need to be addressed. This work was supported by the Daiwa Foundation Grant No. Finally, the authors extend their thanks to the three reviewers who provided helpful and constructive comments on an earlier version of this manuscript. Akino K. Journal of the National Institute of Public Health , 56 , — Google Scholar. Arumainayagam J. Bayarsaikhan D. Bulletin of the World Health Organization , 86 , — Dodds J.

Sexually Transmitted Infections , 83 , — Dudareva-Vizule S. Robert Koch Institut , Berlin. Google Preview.

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European Commission. COM Final. Commission of the European Communities , Brussels. Gilmour S. Godin G. Health Education Research , 23 , — Hallin S. Hernandez T. Hidaka Y. Shishunkigaku [Adolescentology] , 18 , — Journal of Epidemiology and Community Health , 60 , — Ichikawa S. Institute of Tropical Medicine. Interim Report to the European Commission. Institute of Tropical Medicine , Antwerp.

Koerner J. Laurent E. Journal of Homosexuality , 48 , — Liamputtong P. Sage , London. McLelland M. Culture, Health and Sexuality , 2 , — Mirandola M. Euro Surveillance , 14 , pii Final Report to the European Commission. Pedrana A. Journal of Acquired Immune Deficiency Syndrome , 59 , 94 — Pekkanen R. In Schwartz F. Cambridge University Press , Cambridge.

Phillips-Guzman C. Health Promotion Practice , 12 , — Platt L. Directions in Development. World Bank , Washington, DC. Pottinger E. University of Brighton , Brighton.

Prost A. Sexually Transmitted Infection , 83 , — Sherriff N. The Everywhere Project. Final report to the European Commission.

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University of Brighton , Brighton, UK. Health Education Journal , 72 , 13 — Perspectives in Public Health , , — Spencer R. In Huberman A. Sage , London , pp. Taniguchi H. Intersections: Gender and Sexuality in Asia and the Pacific , Vanden Berghe W. Euro Surveillance , 16 , pii WHO , Geneva. WHO , Sundvall. WHO , Jakarta.

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