Sexual behaviour and risk assessment in different age cohorts in the general population of Sweden (1989-2007).

AIM: The aim of this investigation was to study the development of sexual attitudes, behaviour and risk assessment in adolescents and young adults, 16-24 years, compared with older adults, 25-44 years, between 1989 and 2007. METHODS: We conducted mailed questionnaire surveys in random samples of the Swedish general population in 1989, 1994, 1997, 2000, 2003, and 2007 (total n = 16,773). Each sample consisted of 4,000-6,000 participants, stratified by age. The overall participation rate for men was 54% and for women was 70%. RESULTS: The likelihood of holding a restrained attitude to sexual intercourse outside of a stable relationship decreased significantly throughout the period of study, particularly for the 16-24 year olds. The odds ratio for more than two sexual partners and casual sexual intercourse without using a condom during the preceding 12 months increased significantly in the younger age group, particularly for young women. For women aged 16-24 years, the prevalence of several sexual partners and casual sexual intercourse without the use of a condom doubled between 1989 and 2007. In 2007 there was no difference in this respect between young men and young women. There were small changes in risk assessment associated with HIV infection during the study period. CONCLUSIONS: Sexual risk behaviour increased significantly for 16-24 year olds, and particularly young women, during the study period. To reduce the risk of uncontrollable spread of sexually transmitted infections in this age group, it is imperative that condom use in risky sexual contact is encouraged.

Sexual risk-taking in the general population of Sweden (1989-2007).

BACKGROUND: The aim of the study was to assess changes in sexual attitudes and sexual behaviour related to HIV/sexually transmissible infections (STI) during a long period of intensive efforts by the Swedish authorities to curb the spread of HIV. METHODS: We conducted mailed questionnaire surveys in random samples of the Swedish general population in 1989, 1994, 1997, 2000, 2003 and 2007 (total n = 16773). Each sample consisted of some 4000-6000 participants aged 16-44 years, stratified by age: 16-17, 18-19, 20-24, 25-34 and 35-44 years. The overall participation rate was 61.6% (for men, 53.5%; for women, 69.9%). RESULTS: Between 1989 and 1994, the proportion of participants holding a restrictive view on sexual intercourse outside a stable relationship decreased significantly. The surveys since 1994 do not show any change in that respect. The prevalence of several sexual partners increased significantly throughout the period of study. The prevalence of casual sexual intercourse without the use of a condom also increased significantly from 1989 until 2003, but decreased slightly between 2003 and 2007. This change in sexual behaviour was more prominent in women than among men. The prevalence of several sexual partners and casual sexual intercourse without the use of a condom was significantly higher for the younger than for the older age cohorts. CONCLUSIONS: The study demonstrates the need for a continuous preventive campaign against HIV/STI in the general population in Sweden, particularly among young people.

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.

The association between childhood and adolescent sexual abuse and proxies for sexual risk behavior: a random sample of the general population of Sweden.

OBJECTIVE: Several studies with small and "high risk" samples have demonstrated that a history of childhood or adolescent sexual abuse (CASA) is associated with sexual risk behaviors (SRBs). However, few studies with large random samples from the general population have specifically examined the relationship between CASA and SRBs with a comprehensive set of measures. DESIGN: The study was a cross-sectional retrospective survey of past and current sexual health and behavior. METHODS: A random sample of 4781 persons from the Swedish Post Address Register was obtained, which included 6,119,000 Swedish citizens in 1996. Of those persons, 2810 participants agreed to participate in the study. Participants were interviewed as well as administered a questionnaire regarding their sexual health and behavior. RESULTS: Using Mann-Whitney U tests, a history of CASA was found to be associated with younger age at first intercourse; younger age at diagnosis of first sexually transmitted infection (STI); greater frequency of unintended pregnancy; greater likelihood of participation in group sex; higher likelihood of not interrupting sexual intercourse despite the risk of pregnancy or risk of an STI; greater likelihood of exchanging sex for money or other necessities/drugs; more frequent substance use in the last 48 hours; and higher likelihood of adult sexual and physical assault. CONCLUSIONS: The findings of this study confirm previous research, which has reported an association between CASA and SRBs in smaller and high-risk samples. Clinicians working with adults with a history of CASA should be aware of the relationship between CASA and SRBs and be prepared to address such issues during therapy.

Assessment of sexual behavior, sexual attitudes, and sexual risk in Sweden (1989-2003).

To assess changes in sexual behavior, sexual attitudes, and sexual risk related to HIV, we conducted mailed questionnaire surveys in random samples of the Swedish general population in 1989, 1994, 1997, 2000, and 2003 (total N = 13,762). Each sample consisted of 4,000-6,000 subjects aged 16-44 years, stratified by age: 16-17, 18-19, 20-24, 25-34, and 35-44 years. The overall participation rate was 63.8% (for men, 55.9%; for women, 71.9%). The prevalence of three or more sexual partners and casual sexual contacts without the use of a condom was comparatively high for men, for persons aged 16-24 years, single persons with and without a regular partner, and persons living in towns and urban areas. The prevalence of multiple sexual partners and casual sexual contacts increased significantly over time. There was a significant decrease in the proportion of participants who agreed with the statement "Sexual intercourse should only take place in a stable relationship." Personal risk assessments related to HIV did not change significantly over time. The study shows that risky sexual behavior related to HIV/AIDS increased in the Swedish population between 1989 and 2003, and that attitudes concerning casual sexual relations became more permissive.

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 individual's 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.