Claes Herlitz

A decade of HIV/AIDS prevention in Sweden: changes in attitudes associated with HIV and sexual risk behaviour from 1987 to 1997.

ObjectiveThe objective of the present study was to monitor the changes in determinants of HIV-related attitudes and behaviour over a 10 year period. Design/methodsIn the past decade, over 11 000 individuals in Sweden participated in this repeated cross-sectional study to assess the changes in attitudes and behaviour associated with HIV. Changes in the fear of persons who are HIV seropositive, optimism that scientists will find a cure or vaccine for HIV/AIDS, engagement in discussions concerning HIV/AIDS as well as condom use, the number of sexual partners, and frequency of unprotected casual sex were assessed during four study years, 1987, 1989, 1994, and 1997. ResultsThe findings of this study suggest that changes in attitudes regarding HIV were more robust whereas only modest changes in sexual behaviour were observed. The fear of HIV-seropositive persons, optimism that a cure or vaccine would be developed, and engagement in discussions concerning HIV all decreased over the 10 year period. A trend in increased condom use was observed, particularly in younger participants, but little change in sex with multiple partners and unprotected casual sex was observed between 1987 and 1997. ConclusionChanges in attitudes regarding HIV are usually more often observed than changes in sexual behaviour. However, increased condom use in younger participants may be reflective of secular changes in sexual behaviour that may facilitate the prevention of HIV in Sweden.

AIDS in the minds of Swedish people: 1986-1989.

In order to assess changes in knowledge, attitudes and behaviour related to AIDS, annual mail surveys (1986-1989) were sent to random samples of the general public, aged 16-44 years. In total, 16,900 individuals were sampled, with an average response rate of 71%. Knowledge about the major routes of infection was generally good during the entire study period. The fear of unverified infection risks and of contact with HIV-infected people decreased during the period studied, but still remained high in 1989. Over the entire period, respondents expressed a strong fear concerning the spread of HIV in the population. Although an increasing percentage of respondents reported altered sexual habits as a result of fear of AIDS, overall sexual behaviour did not change sufficiently to reduce the risk of spread of any sexually transmissible disease. Progress toward knowledge, attitudes, and behaviour aimed at prevention of transmission of infection and unnecessary fear and counteraction of prejudice was most rapid during the middle of the study period when public debate concerning AIDS was at its peak. Knowledge and attitudes did not change during the last year of the study, but, in some respects, reverted to previous levels.

Sexual behaviour in the general population of Sweden

The AIDS issue was a focus of interest in Sweden during the latter part of the 1980s. To assess changes in sexual behaviour we carried out annual mail surveys in random samples of the general population during this period. Each sample comprised 4000 individuals in the age range 16-44 years. The response rate was 71%. Throughout the study, 32% of the males and 20% of the females reported being single, with no regular partner. The corresponding figures for male and female teenagers were 78% and 54%, respectively. A multiple logistic regression analysis indicated that the odds ratios for having several sequential sexual partners were 29.9 for singles with no regular partner, 8.8 for singles with one regular partner (married/cohabiting = 1.0), 1.7 in the 16-17-year group, 1.6 in the 20-24-year group (34-44-year-group = 1.0) and 2.5 for big-city-dwellers (rural areas = 1.0). These differences were statistically significant. Of all respondents, 2% reported having had five sexual partners or more during the past year. Most of the respondents with a large number of sexual partners had not used a condom during the past month. The use of condoms increased during the study period, but still by the end of the period most of the casual sexual contacts took place without the use of a condom.

Facing AIDS: Reactions among police officers, nurses and the general public in Sweden

This study compares police officers and registered nurses and the general public concerning their perceptions of the risk of HIV infection, attitudes toward HIV-infected individuals, and attitudes toward measures used to fight the AIDS epidemic. Information was obtained through mail questionnaires sent to random samples of individuals, aged 25-44 years, from the 3 groups. The samples included 525, 501 and 1600 individuals respectively. Response rates were 85, 93 and 74%. The study showed good knowledge concerning verified carriers of HIV infection (blood, sperm, vaginal secretion, etc.). A widespread fear of unverified carriers of infection (public toilets, kissing on the mouth) existed particularly among the public and police officers. Negative attitudes toward HIV-infected individuals and demands for compulsory measures were common among all groups, although least common among nurses and most common among the police. Positive relationships were established between the fear of unverified carriers of infection, repulsive attitudes toward individuals infected by HIV, and demands for compulsory measures.

The AIDS Epidemic in Sweden: Changes in Awareness, Attitudes and Behavior

Questionnaire surveys concerning awareness, attitudes and beliefs about HIV virus and AIDS in Sweden were conducted in March/April of 1986, February/March of 1987, and May 1987. The number of individuals compared in the three surveys were 2622, 1805 and 707 respectively. The surveys indicate that the general public views the AIDS epidemic with growing concern. They feel that researchers and public officials cannot effectively combat the problem. To a growing extent they feel that it is up to individuals to appropriately adapt their behavior if we are to slow the spread of the disease, and to a certain extent changes in sexual practices also seem to have happened. Changes in awareness, attitudes and beliefs have accelerated since the start in March, 1987 of the Swedish AIDS information campaign.

Pre-Migration Trauma and HIV-Risk Behavior:

This study examined the relationship between pre-migration trauma and HIV-risk behavior in refugees from sub-Saharan Africa. The sample comprised 122 persons who had emigrated from sub-Saharan Africa and were currently residing in Sweden. Qualitative methods including individual interviews, focus groups, and interviews with key informants addressed questions regarding trauma experience and HIV-risk behavior. A history of pre-migration trauma was found to be associated with HIV-risk behavior. According to the participants, symptoms associated with post-traumatic stress disorder, depression, adjustment disorder, and substance use mediated the relationship between pre-migration trauma and sexual risk behavior. In contrast, a minority of the participants who reported pre-migration trauma but not psychological sequelae, or experienced post-traumatic growth, reported safer sexual practices. It appears that for some individuals, pre-migration trauma resulted in psychiatric sequelae, which may increase an individuals risk to be infected with HIV. Interventions targeted at individuals at increased risk (i.e. pre-migration trauma with unresolved psychiatric symptomatology) may facilitate the prevention of HIV and other sexually transmitted diseases in this population. Integration of multiple psychosocial and health issues is recommended for comprehensive treatment and prevention programs.

Condom use due to the risk of AIDS. Trends in the general population of Sweden.

Condom use due to the risk of AIDS: Trends in the general population of Sweden. Claes Herlitz. Department of Social Medicine, University of Uppsala, Uppsala, Sweden. This study examines the use of condoms due to the risk of AIDS in the general population of Sweden during 1986–1989. The study is based on annual mail surveys (1986–1989) of random population samples aged 16–44 years -4000 individuals in each sample. The response rate was 71%. The study indicates that the use of condoms increased significantly during the first years of the study period, particularly among 18–24-year-olds. Roughly the same tendency was observed regarding the perception of personal risk related to HIV infection. In 1988 a positive connection was established between condom use and personal risk perception. Between 1988 and 1989 (as the public interest in the AIDS issue declined) no further increase in condom use was observed but rather a tendency of reversal towards previous levels. Having several sexual partners was not significantly associated with a more frequent use of condoms, nor was the occurrence of casual sexual contacts. In most of the casual sexual contacts reported condoms were not used.

The AIDS Epidemic in Sweden Estimates of Costs, 1986, 1987 and 1990

This study calculates the cost of medical care during the different stages of HIV infection, from the asymptomatic period to a confirmed AIDS diagnosis. Also, we have estimated the total cost of taking specimens and performing tests related to HIV infection, and the cost of information, research, etc. Medical costs were based on estimates of the average cost per day and the total number of days at the various stages of HIV infection. The cost estimates for testing include costs related to taking specimens, analysing samples, managing test results, etc. The cost outlook until 1990 is discussed using different assumptions concerning incidence, survival and the level of preventive efforts. The total estimated costs for medical care, HIV tests, information, etc. doubled between 1986 and 1987. During 1987, costs totaled 313 million Swedish kronor (SEK). The costs for specimens and tests totaled SEK 124 million, medical costs for HIV positives who had not developed AIDS totaled SEK 31 million, and medical costs for AIDS patients totaled SEK 26 million. The costs discussed in this study will probably increase by at least 50% by 1990.

Risk of sexual dysfunction in a randomly selected nonclinical sample of the swedish population

OBJECTIVE: To investigate the risk of sexual dysfunction as a result of childhood sexual abuse or sexual assault in a randomly selected nonclinical sample of men and women. METHODS: In 1996, a randomly selected sample of 2,810 Swedish males and females completed a 322-item interview and questionnaire. Age-adjusted odds ratios (ORs) were calculated to assess risk of sexual dysfunction and analysis of variance was employed to test differences by gender and abuse or assault history in regard to seeking assistance for sexual dysfunction. RESULTS: For females with a history of childhood sexual abuse, an increased risk of anorgasmia for more than 12 months was found for women aged between 31 and 45 years (OR 1.21, P=.009). For females with a history of sexual assault; an increased risk for hypoactive sexual desire disorder was found for women who between the ages of 16 and 30 years (OR 1.51, P=.03), 31 and 45 years (OR 1.28; P=.02), 46 and 60 years (OR 1.21, P=.03), and 61 and 84 years (OR 1.62, P=.04); lubrication problems in the past year for women between 46 and 60 years (OR 1.28, P=.02) and for more than 12 months (OR 1.38, P=.02). No statistically significant increased risk of sexual dysfunction was found for males with a history of childhood sexual abuse. Males who reported a history of sexual assault as an adult had a significant increased risk of retarded ejaculation in the last 12 months if they were between the ages of 31 and 45 years (OR 2.00, P=.008) or 46 and 60 years (OR 2.11, P=.02). Women most often reported sexual dysfunction to their gynecologists (18%) or midwives (8.4%), whereas men reported their sexual dysfunction to their physicians (5.6%) or urologists (4.3%). CONCLUSION: Future research should focus on predictors of sexual dysfunction and resilience subsequent to childhood sexual abuse and sexual assault as an adult. LEVEL OF EVIDENCE: III

Functional Status of the Non-Institutionalized Elderly in Sweden

Abstract Functional ability was assessed in a randomly recruited population of elderly persons, totalling 553 individuals, living in their homes in four municipalities in central Sweden. These subjects were interviewed at home, using the Sickness Impact Profile. The response rate was 75%. No significant differences in functional ability were found among the municipalities. For those subjects 85 years old or more, average physical and overall functional ability was significantly worse than among the 81-84 year olds. Women had a significantly lower functional ability than men. Less well educated elderly persons had lower psychosocial and overall functional abilities than had the better educated. Physical dysfunctionbut not psychosocial dysfunctionwas significantly associated with formal and informal home help.Abstract Functional ability was assessed in a randomly recruited population of elderly persons, totalling 553 individuals, living in their homes in four municipalities in central Sweden. These subjects were interviewed at home, using the Sickness Impact Profile. The response rate was 75%. No significant differences in functional ability were found among the municipalities. For those subjects 85 years old or more, average physical and overall functional ability was significantly worse than among the 81-84 year olds. Women had a significantly lower functional ability than men. Less well educated elderly persons had lower psychosocial and overall functional abilities than had the better educated. Physical dysfunctionbut not psychosocial dysfunctionwas significantly associated with formal and informal home help.