Education And Debate

HIV testing and HIV prevention in Sweden

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7127.293 (Published 24 January 1998) Cite this as: BMJ 1998;316:293
  1. Renée Danziger, lecturer in health policy ([email protected])a
  1. a Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  • Accepted 27 November 1997

Introduction

HIV testing is central to Sweden's programme of preventing the spread of HIV infection. It has been widely promoted and encouraged on the grounds that once HIV infected people are aware of their serostatus and receive appropriate counselling, they will take the necessary steps to protect their partners.1 This faith in the inclination of citizens to protect one another is underpinned by a legal structure which bestows great powers of control on public health authorities. Many Swedes argue that the Communicable Diseases Act is superfluous and even harmful to HIV prevention efforts, but others regard it as essential to the country's HIV prevention and control programme.

HIV and AIDS in Sweden

That the promotion of HIV testing in Sweden is effective is reflected in the fact that the country has one of the highest rates of HIV testing per capita in Europe. By 1996, 9.5 million tests had been carried out among Sweden's population of 8.5 million (Swedish Institute for Infectious Disease Control, unpublished data). As of 1992, 1 in 100 000 blood donors had tested positive, compared with 1 in 10 000 pregnant women, 1–2 per 1000 patients with sexually transmitted diseases, and 1 in 1000 among the remaining population.2

By December 1996 Sweden had reported 1477 cases of AIDS and 4407 cases of HIV infection. Approximately 60% of the cases of HIV infection had been reported in Stockholm county, where the main route of transmission has been homosexual sex (1). Most cases of HIV infection that have been transmitted through homosexual sex and through intravenous drug use have been in Swedes, but most cases of heterosexually transmitted HIV infection have been reported among people born outside Sweden.3

View this table:

Route of transmission of all cases of HIV infection and AIDS reported in Stockholm county, Sweden, to December 1996

Role of HIV testing in HIV prevention

In Britain the HIV …

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