Cristin-resultat-ID: 1061978
Sist endret: 28. oktober 2016, 16:37
Resultat
Doktorgradsavhandling
2003

Aspects of HIV disease development in Denmark, Norway and Sweden : Quantitative development of epidemics, effect of national prevention strategies and of highly active antiretroviral treatment

Bidragsytere:
  • Ellen Johanna Amundsen

Utgiver/serie

Utgiver

Unipub forlag
NVI-nivå 1

Serie

Series of dissertations submitted to the Faculty of Medicine, University of Oslo

Om resultatet

Doktorgradsavhandling
Publiseringsår: 2003
Hefte: 29
ISBN: 82-8072-050-2

Beskrivelse Beskrivelse

Tittel

Aspects of HIV disease development in Denmark, Norway and Sweden : Quantitative development of epidemics, effect of national prevention strategies and of highly active antiretroviral treatment

Sammendrag

The HIV/AIDS epidemic that evolved hidden until 1981 has since then challenged different disciplines in the medical and behavioural sciences. Surveillance of AIDS was started early in many countries. Studies of HIV disease development, prevention and treatment and also vaccine studies have been carried out. Statistical models have been widely used and new developments have appeared. In this study data from HIV and AIDS registers in Denmark, Norway and Sweden was used to estimate quantitative measures of the epidemics applying different types of statistical models. In addition data on HIV prevention policies and the reaction to the HIV threat among groups with risk activity was gathered from the three countries. A special study of the effectiveness of highly active antiretroviral treatment introduced in August 1996 in Norway was also conducted. A back calculation model is a tool to estimate new HIV infections (absolute rates) over time based on HIV and AIDS registry information. In this thesis a back calculation model was adjusted to fit the data from the HIV and AIDS registries in the Scandinavian countries. Results for men infected through sex with men and intravenous drug users showed that the epidemics developed differently within a frame of a common epidemic picture – increase, decrease and stabilisation of new cases. The HIV epidemics among men having sex with men started earlier in Denmark than in Norway and Sweden. Incidence rates were higher in Denmark than in the two other countries for a long period through the eighties. The prevalence was also higher in Denmark for the whole study period through 1995. HIV among intravenous drug users was introduced earlier in Denmark than in Norway and Sweden, but the peak of the epidemics occurred in 1985/86 in all three countries. From 1991 to 1996 Norway and Sweden had significantly lower incidence rates than Denmark. Prevalence was higher in Norway in the period 1984/85 to 1991/92 than in the two other countries. Countries have adopted different strategies to prevent the transmission of HIV among intravenous drug users. Legal access to needles and syringes/needle exchange programmes as part of such a strategy has been heavily debated. HIV counselling and testing has also been part of prevention strategies. Sweden and Norway, with higher levels of HIV counselling and testing than Denmark, had significantly lower incidence rates of HIV among intravenous drug users 1991-1996 than Denmark where there was legal access to drug injection equipment and a lower level of HIV counselling and testing. Further investigations among intravenous drug users are necessary before concluding that the effects of HIV testing and counselling is better than legal access to drug injection equipment to keep HIV at a low level. But HIV counselling and testing should be advocated in countries where such efforts are lacking or have a low priority.

Tittel

Aspekter ved HIV epidemiene I Danmark, Norge og Sverige. Utvikling, konsekvenser av nasjonale strategier og av antiiretrviral behandling.

Sammendrag

Nysmitte av HIV i et land kan ikke beskrives ved hjelp av observerte data alene fordi noen er smittet uten å vite det selv. I avhandlingen beregnes størrelsen av den reelle utvikling av HIV/AIDS epidemiene i de Skandinaviske land 1977-1995 blant menn smittet gjennom sex med menn. HIV epidemien blant disse startet tidligere i Danmark enn i Norge og Sverige. Nysmitte var også større i Danmark i en lang periode på 80-tallet og dermed ble utbredelsen av HIV blant menn som hadde sex med menn også større i Danmark. Tilsvarende beregninger blant personer smittet gjennom deling av sprøyter er brukt som mål på effekt av forebygging av denne type smitteoverføring. Nysmitte var lavere i Sverige og Norge (høyt nivå på HIV testing) enn i Danmark (lavere nivå på HIV testing) Forbud mot tilgang til sprøytebruk i Sverige og lovlig tilgang til rene sprøyter i Danmark (og i Norge) var derfor mindre viktig i en samlet forebyggingsstrategi. I avhandlingen beregnes effekten av de nye medisintyper som ble tatt i bruk i stor skala i Norge i 1996. Blant personer diagnostisert med HIV ble risikoen for å utvikle AIDS kraftig redusert i 1996-2000 i forhold til før 1996. Effekten var mindre for personer smittet gjennom deling av sprøyter enn for personer smittet seksuelt. Hvis hver HIV positiv i gjennomsnitt viderefører smitten til færre enn én ny person, vil en epidemien avta. Det beregnes for 1981/82 at menn smittet ved sex med menn i alle tre land ville smittet ca 15 nye over sykdomsforløpet. På 90-tallet var tilsvarende tall redusert til under én, men med lavere verdi i 1995 i Danmark (0,55) og Sverige (0,58) enn i Norge (0,85). Epidemiene var på retur, men med lavere takt i Norge.

Bidragsytere

Inaktiv cristin-person

Ellen Johanna Amundsen

  • Tilknyttet:
    Forfatter
    ved Avdeling for rusmidler og tobakk ved Folkehelseinstituttet
1 - 1 av 1