title: [Evaluation of the law of communicable disease control: compulsory isolation can reduce the high-risk behavior of HIV-positive individuals].
abstract: The Swedish approach to HIV is based on HIV-positive individuals' fulfilling their societal obligation to prevent further spread of the disease. Under section 38 of the Communicable Disease Act of 1989, compulsory admission to hospital may be resorted to in cases where voluntary efforts have failed to bring about modification of high-risk behaviour. The article consists in a report of a retrospective study of the effects of such enforced isolation in the HIV-positive subgroup committed under the Act within an eight-year period. Relevant information was obtained from the records of medical and psychiatric hospitals, the social services and correctional care authorities. Modification of high-risk behaviour was assessed by enquiries involving attending physicians, the social services, and prison and police authorities, and by interviews with the patients. During the 8-year period, 1.5 per cent (44/2982) of registered HIV-positive patients in Stockholm County were committed by the county administrative court to compulsory admission. Of the 44 patients, 25 (57%) were born in Sweden, and 19 (43%) elsewhere (mostly sub-Saharan African countries where HIV is highly endemic). Intravenous drug abuse was very common in the subgroup, and 34 per cent of them were diagnosed as having a psychiatric disorder or intellectual handicap. Thirty-four (77%) of the subgroup were released after varying periods of isolation. Follow-up at 6, 18 and 36 months showed the overwhelming majority to be capable of maintaining a low-risk profile, and only 20 per cent to be characterised by continued high-risk behaviour (suspected or verified). The results thus suggest that individuals with the intellectual and psychiatric capacity to comprehend the serious nature of HIV infection and its modes of transmission can successfully modify risk behaviour by undergoing intensified individualised programmes, provided the duration of isolation is sufficiently long.
authors.affiliation: Karolinska sjukhuset, Stockholm. staffan.sylvan@sme.sll.se
authors.forename: S
authors.initials: S
authors.lastname: Sylvan
authors.forename: M
authors.initials: M
authors.lastname: Gustavsson
authors.forename: B
authors.initials: B
authors.lastname: Christenson
mesh_terms: D000328:Adult; D003140:Communicable Disease Control / Q000331:legislation & jurisprudence*; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000523:psychology / Q000635:transmission*; D006801:Humans; D008297:Male; D010356:Patient Isolation / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies; D012309:Risk-Taking; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous; D013548:Sweden / Q000208:ethnology
vernacular_title: Utvärdering av smittskyddslagen: tvångsisolering kan minska HIV-smittades högriskbeteende.