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Earlier research reports lower sexual satisfaction among people living with HIV (PLHIV) compared to HIV-negative persons. A number of psychosocial factors directly associated with sexual dissatisfaction have been identified. Little is known about sexual satisfaction and their contributors among PLHIV in Sweden. The aim of this study was to examine direct and indirect effects of variables within sociodemographic, clinical HIV-related, psychological, and sexual domains on sexual (dis)satisfaction among PLHIV in Sweden. Data for this study were derived from a nationally representative, anonymous survey among PLHIV conducted in 2014 (n = 1096). Statistical analysis included four steps: descriptive analyses, identification of variables associated with sexual (dis)satisfaction, identification of variables associated with those contributors of sexual (dis)satisfaction, and a path model integrating all these analyses. A total of 49% of participants reported being sexually dissatisfied, and no significant differences were observed when non-heterosexual men, heterosexual men, and women were compared. Among women, a negative change in sex life after HIV diagnosis and distress with orgasmic difficulties was directly associated with sexual dissatisfaction. For men, hopelessness, high HIV stigma, sexual inactivity in the last 6 months, and a negative change in sex life after HIV diagnosis were directly associated with sexual dissatisfaction. Path analyses showed in both men and women significant indirect associations between not being involved in an intimate relationship, lower self-reported CD4 cell counts, and perceiving obligation to disclose HIV status to sexual partners as a barrier to look for a long-term partner and sexual dissatisfaction. Our results show that despite good treatment outcomes, the HIV diagnosis has a negative bearing on sexual satisfaction. The need for gender-tailored interventions and clinical implications of these findings are discussed.

Background: The purpose of the current study was to examine the characteristics of those who report fulfillment of sexual desires as a result of internet use for sexual purposes and which sexually related online activities contribute to the fulfillment of sexual desires., Methods: Data were collected through a questionnaire posted on Swedish-language websites in 2009. The sample comprised 1614 respondents who reported using the internet for sexual purposes, 62% women and 38% men., Results: The results showed that the majority of the respondents had their sexual desires fulfilled as a result of their sexually related activities on the internet; 21% to a great extent and 59% to a small extent, but 20% did not have their sexual desires fulfilled. Using a multinomial logistic regression analysis, respondents who had their sexual desires fulfilled to a small or great extent were each compared with those who did not have their sexual desires fulfilled at all. At the level of individual characteristics and sexual behaviours, those with no fulfillment of their sexual desires did not differ from those who had their sexual desires fulfilled, with the exceptions of age and masturbation. In comparison to fulfillment to a small extent, fulfillment of sexual desires to a great extent was predicted by a larger number of sexually related online activities that were based on interaction., Conclusion: The findings suggest that the internet may contribute to fulfillment of sexual desires among a large internet population, irrespective of sex or sexual identity.

The content and prevalence of problematic Internet sexual use was investigated in a sample of 1,913 Internet-recruited younger Swedish men and women. Five items as part of a larger Internet sexual use study addressed problems associated with it, control, dysphoria, feeling "addicted," and feeling the need for treatment. The resulting scale of Internet sexual problems indicated that 5% of women and 13% of men reported some problems, with 2% of women and 5% of men indicating serious problems across the five items. Of five predictors of problematic use, three were significant: religiosity, having negative experiences with Internet sexual use, and frequency of pornography viewing. The viewing and sharing of pornography was most closely associated with reported problems. Data also suggested that having some very specific pornographic content interests were associated with an increase in reported problems. While these data were limited by the non-random nature of the sample, they suggest that Internet sexual problems are measurable, are a subset of Internet addiction with sexual content, and affect a small but significant proportion of the Internet-using population.

This study aimed to understand how person, health and sexual behavior, HIV-risk cognitions, and gay community involvement relate to barebacking among 3634 men who have sex with men (MSM) recruited by way of the Swedish website QX.se. In this sample, 10% reported that they had engaged in barebacking in the past year. Variables found to be statistically significant in the bivariate analyses were incorporated into a logistic regression domain-specific model. Variables that remained significantly associated with barebacking in domain 1 were being HIV-positive and having had a sexually transmitted infection (STI) in the past year. The variable talked with someone in HIV services remained significant in domain 2, and for domain 3, the variable used the Internet to look for a bareback partner remained significant. Two variables, believing taking semen in one's mouth involves no or low risk of HIV transmission and believing that engaging in insertive unprotected anal intercourse (IUAI) involves no or low risk of HIV transmission, remained significant in domain 4. The final multivariate regression analysis included six variables (from domains 1 to 4) and had a significant fit (χ (2)(6) = 2.571, p=0.958). The likelihood of engaging in barebacking was higher for those men who reported being HIV-positive (odds ratio [OR] = 2.77), having had an STI in the past year (OR = 1.67), and having used the Internet to look for a bareback partner (OR = 12.59). This first study to explore the predictors of bareback sex among a Nordic MSM sample suggests that bareback sex among northern European MSM is less common than among other samples. The findings reconfirm that MSM who engage in bareback sex may represent a unique subset of MSM with distinct HIV prevention needs.

Although the Internet has become a forum for making sexual contacts, and has been associated with increased sexually transmitted infection (STI) transmission, we have little information of history of STIs in Internet-based samples. The Internet behaviours that are associated with STI acquisition are poorly understood. We analysed STI histories reported by 904 Swedish men and 931 Swedish women who responded to an Internet-based survey on sexual behaviour in 2002: 16.6% of men and 22.5% of women reported a lifetime history of STIs, with Chlamydia being the most common for both genders. 3% of men and 5% of women who reported an STI, indicated that they had had more than one. Sources of the STI, where known, were Internet-acquired partners in only 3% of cases. There were no differences between men and women with or without an STI history regarding the kind of online sexual activities they engaged in, how they found sexual material online, and the reasons they engage in sexual activities. These rates are similar to those reported in a national random study of sexuality in Sweden. Contrary to prior research, these results suggest no relationship between STI and specific Internet characteristics usage patterns. These data suggest that the Internet is not yet a major source of STIs in Swedish men and women. Given these STI histories, the Internet may be a useful medium to include in STI prevention efforts.

The purposes of the study were to measure adherence with antiretroviral therapy to dose, schedule, and dietary instructions in a sample of patients with HIV infection in Stockholm, Sweden, over a 2-year period and identify baseline predictors of the three types of adherence. The study cohort consists of 144 patients who completed at least six out of seven follow-up self-reported adherence questionnaires. Baseline self-administrated questionnaire examined socio-demographics, medication-related, psychological, cognitive, and social context factors and self-reported adherence. Biomedical data were obtained through patients' medical records. Summary dose, schedule, and dietary instructions adherence scores provided outcome measures reflecting 100% adherence across all time points or not 100% adherence during at least one measurement period. A total of 61% maintained consistent full-dose adherence throughout baseline and all follow-up visits and equivalent proportion of 100% schedule adherence was 39%. Among patients with dietary instructions, 37% retained consistent adherence at all visits. Only schedule adherence was predicted by baseline data; perceived pressures from medical staff to take HIV medications (OR 0.51, p < .05), life stress (OR 0.13, p < .01), ART health concerns (OR 0.19, p < .01), and ART prolongs one's life (OR 0.39, p < .05) predicted reduced schedule adherence over time. Perceived medication pressures from those close to the patient (OR 1.76, p < .05), post-traumatic stress disorder symptoms (OR 1.07 p<.01), and adherence self-efficacy (OR 3.50, p < .05) predicted positive schedule adherence over time. These results clearly illustrate difficulties in sustaining ART adherent behaviour, in particular schedule and dietary restrictions, over time and thus emphasizes the importance of multiple periodic assessments of all three types of adherence. Interventions aimed at improving schedule adherence should in particular focus on psychological and cognitive factors.

The purposes of the study were to measure adherence with antiretroviral therapy to dose, schedule, and dietary instructions in a sample of patients with HIV infection in Stockholm, Sweden, over a 2-year period and identify baseline predictors of the three types of adherence. The study cohort consists of 144 patients who completed at least six out of seven follow-up self-reported adherence questionnaires. Baseline self-administrated questionnaire examined socio-demographics, medication-related, psychological, cognitive, and social context factors and self-reported adherence. Biomedical data were obtained through patients' medical records. Summary dose, schedule, and dietary instructions adherence scores provided outcome measures reflecting 100% adherence across all time points or not 100% adherence during at least one measurement period. A total of 61% maintained consistent full-dose adherence throughout baseline and all follow-up visits and equivalent proportion of 100% schedule adherence was 39%. Among patients with dietary instructions, 37% retained consistent adherence at all visits. Only schedule adherence was predicted by baseline data; perceived pressures from those close to the patient to take HIV medications (OR 0.51, p<.05), life stress (OR 0.13, p 0.009), ART health concerns (OR 0.19, p 0.003), and ART prolongs one's life (OR 0.39, p 0.04) predicted reduced schedule adherence over time. Perceived medication pressures from medical staff (OR 1.76, p<.05), post-traumatic stress disorder symptoms (OR 1.07 p<.01), and adherence self-efficacy (OR 3.50, p<.05) predicted positive schedule adherence over time. These results clearly illustrate difficulties in sustaining ART adherent behaviour, in particular schedule and dietary restrictions, over time and thus emphasizes the importance of multiple periodic assessments of all three types of adherence. Interventions aimed at improving schedule adherence should in particular focus on psychological and cognitive factors.

The internet is becoming a favored technology for carrying out survey research, and particularly sexual health research. However, its utility is limited by unresolved sampling questions such as how biased internet samples may be. This paper addresses this issue through comparison of a 'gold standard' random selection population-based sexual survey (The Swedish Sexual Life Survey) with an internet-based survey in Sweden which used identical demographic, sexual and relationship questions, to ascertain the biases and degree of comparability between the recruitment methods. On the internet questionnaire, there were significant differences between males and females on all the measured indices. There were no significant differences in proportions of males and females, or nationality, between the two samples. However, the internet samples for both males and females were significantly more likely to be younger, originally from and currently living in a major city, better educated, and more likely to be students and less likely to be retired. Relationship variables were less likely to be significantly different between samples: there were no differences for males or females between the SSS and the internet samples on having been in a committed relationship, and how they met their present partner, nor for males in having discussed separation in the past year. However, there was a higher proportion of people attracted to the same sex, and higher numbers of sex partners (as well as a higher proportion of people reporting no sex) in the past year, in the internet sample. These data suggest that apart from the demographics of age, location, and education, currently being in a committed relationship, and the number of sex partners in the past year, internet samples are comparable for relationship characteristics and history with a national sexual life survey. Comparison of internet data with random survey data in other western countries should occur to determine if these patterns are replicated.

Several hypotheses with regard to the influence of societal factors including the rigidity of the society with regard to sex roles, sexual equality and homosexual behaviour were tested comparing prevalence, incidence and sex ratio of transsexualism between Sweden and Australia, two societies which differ with respect to these factors while otherwise remaining comparable as Western democratic societies of about the same size and level of technological development. Significant differences were found between the two countries in both frequency and sex ratio of transsexualism. These findings are discussed and it is concluded that societal influences seem to have an influence on the number of transsexuals presenting as patients. Further research is needed to assess whether these factors also influence aetiology and development of transsexualism.

The prevalence of venereal disease was studied in homosexuals in two countries, Sweden and Australia, which are similar apart from their different legal and social attitudes to homosexuality. Social attitudes were not generally associated with differences in the numbers of infections and reinfections in homosexual men with sexually transmitted diseases. Using a non-clinical sample there was some evidence that sexually transmitted diseases in homosexuals are grossly overestimated if cases rather than individuals are used as an index. Furthermore, the incidence of syphilis was related to the numbers of partners and the latency of symptoms in both societies.

Two possible levels of bias have been reported with regard to recall of human sexual behavior. A third level is postulated, that of bias in line with societal expectations. Looking at Australian and Swedish homosexual men, significant differences were found in recall of opposite-sex childhood play expectations independent of relationships with parents. It is concluded that sex-role rigidity and attitudes toward homosexuality may play an important part in these differences.

Young and older homosexual men in four countries (Sweden, Finland, Ireland, and Australia) were compared on a number of psychological, social, and psychometric indices to determine what differences existed between them, and the effect of culture on any such differences. Data show that there are greater differences between younger and older homosexual men as the culture appears more antihomosexual, and that younger homosexual men are less likely to accept their sexual orientation and more likely to accept myths surrounding homosexuality. Younger homosexual men were also more likely to have had gonorrhea (regardless of their number of sexual partners), to prefer receptive anal intercourse, and to have contacted partners by cruising. These data confirm that mental health consequences of antihomosexual environments are most negative where homosexuality is most severely stigmatized.

The prevalence of venereal disease among homosexual men was investigated by looking at non-clinic patients from Sweden, Australia, Finland, and the Republic of Ireland. Results showed significant differences between nationalities in the incidence of syphilis, gonorrhoea, other sexually transmitted diseases (STD), number of variables of presentation to STD clinics, and number of infections. Data were interpreted as indicating that social and cultural factors may influence incidence of STD in male homosexuals.

I investigated over 600 homosexual men in four countries (Sweden, Finland, Ireland, and Australia) regarding the number of times they had contracted a sexually transmitted disease (STD) and several psychological variables including masculinity and feminity, sex role conservatism, relationships with parents, number of sexual partners, attitudes towards homosexuality, and involvement in the homosexual subculture. Using multiple linear regression in each country, it was found that 19-42% of the variance of number of times infected could be accounted for by psychosocial factors, seven of which were common to all countries. The number of sexual partners was not a significant variable in any country. These data strongly suggest that numbers of infections in homosexual men are best predicted by psychological factors, and this has considerable implications for preventative and treatment programmes for homosexuals.

Six hundred four homosexual men in four countries (Sweden, Finland, Australia, and the Republic of Ireland) were investigated with regard to their number of sexual partners over the past year and a number of psychological variables including masculinity and femininity, number of infections with sexually transmitted agents, relationships with parents, attitudes toward homosexuality, degree of homosexuality, sex-role conservatism, and a number of demographic variables. By use of multiple linear regression on partner numbers for each sample, it was found that between 15% and 28% of the variance of number of partners was accounted for by psychosocial factors, and that the great majority of these were significant in more than one country. Predictors included masculine and feminine personality traits, relationships with mother, degree of homosexuality, perceived societal attitudes toward homosexuality, age, and education. The data strongly suggest that psychosocial factors are significant predictors of numbers of partners of homosexual men, and that psychological approaches to treatment and prevention of sexually transmitted diseases may be warranted.

Predominantly homosexual males from Australia (n = 163), Sweden (n = 176) and Finland (n = 149) were compared on the Bem Sex-Role Inventory and on various measures of partner preference in order to establish the relationship between degree of homosexuality in terms of Kinsey Scale position and gender identity. Results suggest that while there is no relationship between femininity and degree of homosexuality, masculinity is inversely related depending on the degree of sex role stereotyping and anti-homosexual attitudes of the society the subjects live in. Such findings suggest that deviant gender identity is a function not of homosexuality as such but of societal attitudes which may reinforce a homosexual role.

This study investigated the factors that predict nonadmission of homosexual orientation in public and private clinics for sexually transmitted diseases in Sweden, Finland, Ireland, and Australia. Results from 604 respondents indicate that nonadmitters in all four countries are likely to conceal their orientation from most people, to expect the most negative reaction to their homosexuality, to believe in more conservative sex roles for males and females, to report themselves as more bisexual, to have had no previous sexually transmitted infections, and to have had worse relationships with their mother during adolescence than admitters. Men who attend private clinics are usually older, more conservative, of higher social class, and have had more negative reactions to their homosexuality from others. These data suggest that nonadmitters are most likely to be reassured by empathy and, particularly, explicit discussion of and expressed acceptance of homosexuality and bisexuality, reiteration of confidentiality. and avoidance of questions that assume the sex of partner. Thus, manipulation of the clinic environment may help to decrease the number of individuals who do not admit to sexual contacts with members of the same sex.