The epidemiology of human immunodeficiency virus and other sexually transmitted diseases in the Stockholm area.
OBJECTIVE
In Sweden, human immunodeficiency virus has been almost exclusively spread in three subpopulations. These are homosexual men (47%), intravenous drug abusers (21%), and immigrants from highly endemic areas (22%). In contrast to human immunodeficiency virus, gonorrhea and syphilis have in the past affected the general population in Sweden. Today, gonorrhea and syphilis, like human immunodeficiency virus, are referred to the subpopulations. The only sexually transmitted disease that affects the general population is chlamydia.


OBJECTIVE
This is a descriptive analysis of the epidemiology of human immunodeficiency virus and the other STDs in the Stockholm area, and an inquiry regarding whether these diseases have been spread in the general population. The goal also was to evaluate the actual risk of exposure to human immunodeficiency virus and the other sexually transmitted diseases in the general population and in the subpopulations.


METHODS
The homosexual subpopulation in the Stockholm area has been estimated at 14,000, or 2.5% of the males. More than 95% of the human immunodeficiency virus-infected homosexual males have been found in the 15 to 64-year-old age group. There are 3,000 to 4,000 drug abusers in the Stockholm area, with about 3,000 known to social workers. The third subpopulation with a high prevalence of human immunodeficiency virus-infected individuals is immigrants from sub-Saharan Africa. It is estimated that in the Stockholm area about 9,000 of the individuals in this sub-population are in the sexually active age-group, 15-64 years old.


RESULTS
Through January 1995, 3,958 cases of human immunodeficiency virus have been reported in Sweden, of which 65% (2,543) were reported in the Stockholm area. Human immunodeficiency virus in the Stockholm area in 1994 was calculated as occurring among 6% of the homosexual men, 13% of the intravenous drug abusers, and 4% of the immigrants from sub-Saharan Africa. The relative increases (observed number of new cases in a particular year/number of known cases) were 10%, 4%, and 43%, respectively.


CONCLUSIONS
The Swedish strategy against sexually transmitted diseases, including human immunodeficiency virus, has been successful regarding the spread in the general population. The human immunodeficiency virus epidemic has remained confined to distinct risk groups. Gonorrhea and syphilis are being eradicated and the chlamydia trend is declining.
Christenson
B
B
Department of Environmental Health, Karolinska Hospital, Stockholm, Sweden.
Stillström
J
J
D000293:Adolescent; D000328:Adult; D000349:Africa; D004641:Emigration and Immigration; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology