Socioeconomic inequalities in sexual victimisation in a nationally representative sample of the Swedish population.

AIMS: Sexual victimisation is a key public health concern because of its physical, psychological and social consequences. Nationally representative studies exploring sexual victimisation and re-victimisation are still scarce. The aim of the current study was to explore associations of sexual victimisation with sociodemographic factors including sexual orientation in Sweden. METHODS: We used Swedish data from a national population survey linked to nationwide registers. The sample consisted of 3349 individuals aged 30-44 years, (2021 women and 1328 men). With a latent class analysis we identified groups of individuals with distinctly different experiences of sexual victimisation. Multinomial logistic regression was used to explore how common characteristics could explain latent class membership classes. RESULTS: Experiences of sexual victimisation were common: 48% of women and 13% of men had experienced sexual harassment, 47% of women and 12% of women sexual assault, 11% of women and 1% of men attempted intercourse and 8% of women and 1% of men rape. Among women four groups were identified who had distinctly different experiences of exposure to sexual victimisation such as low victimisation, sexually harassed and assaulted several times, highly sexually victimised with low re-victimisation and finally high victimisation. Both women and men who were highly sexually victimised had to a higher extent a non-heterosexual sexual identity. CONCLUSIONS: Non-heterosexual orientation is a robust indicator of a high level of sexual victimisation as well as re-victimisation among both male and female adults.

Having a child without wanting to? Estimates and contributing factors from a population-based survey in Sweden.

AIMS: The aims of the current study were to identify the prevalence of unwanted childbirth (UC), to explore the association with sociodemographic factors and to identify possible contributing factors such as psychosomatic health, contraceptive use, experiences of induced abortion and sexual violence. METHODS: We used Swedish data from the randomised population-based study SRHR2017 on sexual and reproductive health and rights (SRHR), based on self-administered surveys, linked to nationwide registers. The national sample consisted of 14,537 women and men aged between 16 and 84 years. With logistic regression, we examined differences in self-reported experience of UC, stratified by sex, in relation to socio-economic factors, as well as several possible contributing factors. RESULTS: Despite advances in SRHR and fertility control, 6% of women and men in Sweden reported UC. This experience tends to be unevenly distributed in the population according to age, country of birth and, to some extent, income and educational attainment. Previous experience of induced abortion, sexual violence and threat from a partner were significantly associated with UC, whereas self-reported good health was protective. CONCLUSIONS: Mechanisms behind unintended, unplanned, unwanted or mistimed pregnancies are complex. Current results focus on the role of individual factors and personal experiences. In addition, in line with previous understanding, there is a need for adopting a broader socio-ecological perspective on fertility intentions.

Are Men Who Buy Sex Different from Men Who Do Not?: Exploring Sex Life Characteristics Based on a Randomized Population Survey in Sweden.

The buying and selling of sex is a topic of frequent discussion and a relevant public health issue. Studies of sex workers are available, while studies addressing the demand side of sex are scarce, especially based on robust population data. The current study provides national estimates of the prevalence of and factors associated with having paid for sex among men in Sweden. We used a randomized population-based survey on sexual and reproductive health and rights among ages 16-84 years, linked to nationwide registers. The sample consisted of 6048 men. With a logistic regression, we analyzed what sex life factors were associated with ever having paid for or given other types of compensation for sex. A total of 9.5% of male respondents reported ever having paid for sex. An increased probability of having paid for sex was identified in men who were dissatisfied with their sex life (aOR: 1.72; 95% CI: 1.34-2.22), men reporting having had less sex than they would have liked to (aOR: 2.78; 95% CI: 2.12-3.66), men who had ever looked for or met sex partners online (aOR: 5.07; 95% CI: 3.97-6.46), as well as frequent pornography users (aOR: 3.02; 95% CI: 2.28-3.98) Associations remained statistically significant after adjustment for age, income, and educational attainment. Sex life characteristics such as poor sex life satisfaction, high online sex activity, and frequent pornography use are strongly associated with sex purchase. These findings can help guide and support counselling and prevention activities targeting sex buyers.

Sexual Orientation-Related Differences in Sexual Satisfaction and Sexual Problems-A Population-Based Study in Sweden.

INTRODUCTION: Human sexuality is a natural and important part of peoples' life and well-being. The underlying interactions affecting sexual satisfaction are complex, and sexual orientation differences partly remain to be identified as well as explained. AIM: Our aim was to investigate sexual orientation-related differences in sexual satisfaction and sexual dissatisfaction and differences in sexual function and sexual-related problems. METHODS: We used Swedish data from SRHR2017 (sexual and reproductive health and rights), based on self-administered surveys, linked to nationwide registers. The national sample consisted of 14,537 women and men aged 16-84 years. With logistic regression, we examined sexual orientation-related differences in self-reported sexual satisfaction and sexual dissatisfaction, stratified by sex. MAIN OUTCOME MEASURES: The main outcome measures of this study are odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Bisexual women were more dissatisfied with their sex life, as compared with heterosexual women (OR: 1.8; 95% CI: 1.3-2.6), as were bisexual men compared with heterosexual men (OR: 2.7; 95% CI: 1.7-4.4). A bisexual or lesbian identity was a robust risk factor for premature orgasm (OR: 2.1; 95% CI: 1.1-3.9 and OR: 8.0; 95% CI: 3.2-20.0, respectively). Lesbian women seemed to have lower risk for many sexual-related problems (however not significant). Gay men lacked arousal (OR: 3.3; 95% CI: 1.6-6.9), had no orgasm (OR: 2.6; 95% CI: 1.4-4.7), and were at lower risk of experiencing premature ejaculation (OR: 0.4; 95% CI: 0.2-0.9), as compared with heterosexual men. CONCLUSION: Our findings contribute to the sparse evidence of some sexual orientation differences in sexual satisfaction and sexual dysfunctions. Especially bisexual women and men appear to experience less sexual satisfaction in relation to heterosexual and homosexual women and men. Björkenstam C, Mannheimer L, Löfström M, et al. Sexual Orientation-Related Differences in Sexual Satisfaction and Sexual Problems-A Population-Based Study in Sweden. J Sex Med 2020;17:2362-2369.

Meeting Sexual Partners Online and Associations With Sexual Risk Behaviors in the Swedish Population.

BACKGROUND: Online arenas may facilitate sexual encounters. However, to what extent finding sexual partners online is associated with sexual risk behavior and sexual health outcomes is still not fully explored. METHODS: A stratified randomized population based study on sexual and reproductive health and rights of 50,000 Swedes was conducted in 2017. The final sample consisted of 14,537 women and men aged 16-84 years. We identified sexual health factors associated with finding sexual partners online and estimated prevalences thereof. RESULTS: Having used the internet to meet sexual partners was reported by 11% (95% confidence interval: 10.1-12.3) of men and 7% (95% confidence interval: 6.0-7.4) of women and was most common among men aged 30-44 years (13.7%). After adjustment, those reporting a non-heterosexual identity were most likely to meet sexual partners online. Meeting sexual partners online was also associated with reporting several sexual risk behaviors: condomless sex with temporary partner during the past 12 months, adjusted odds ratio (AOR): 5.1 (3.8-6.8) for women and AOR: 6.0 (4.5-7.9) for men, and having had a test for sexually transmitted infections (STIs) generated a 4-fold AOR for both sexes, STI diagnosis showed a 2-fold AOR, ever having paid or given other compensation for sex AOR: 4.8 (2.7-8.8) for women and AOR: 4.2 (2.9-6.1) for men as well as ever having received money or other compensation for sex AOR: 4.0 (1.3-11.9) for women and AOR: 6.0 (2.4-15.1) for men. CLINICAL TRANSLATION: Meeting sexual partners online was associated with sexual risk behaviors, which is of importance in tailoring sexual health interventions and STI/HIV-control activities. STRENGTHS AND LIMITATIONS: Few studies of online sexual behaviors are based on population-based surveys of the general population with results stratified by sexual identity. However, the use of lifetime prevalence of ever having used the internet, smartphone, or app to meet sexual partners has limitations. CONCLUSION: Meeting sexual partners online was associated with sexual risk behaviors in a randomized sample of the Swedish population, which is of importance to tailoring sexual health interventions. Deogan C, Jacobsson E, Mannheimer L, et al. Meeting Sexual Partners Online and Associations With Sexual Risk Behaviors in the Swedish Population. J Sex Med 2020;17:2141-2147.

Targeted Victimization and Suicidality Among Trans People: A Web-Based Survey.

PURPOSE: The aim of this study was to investigate the associations between a series of empirically known risk and protective factors and suicidality among trans people in Sweden. METHODS: Participants were self-selected anonymously to a web-based survey conducted in 2014. Univariable and multivariable logistic regression analyses were performed to assess associations between contributing factors and suicide ideation in the past 12 months and lifetime suicide attempts. RESULTS: The analysis included 796 trans individuals, between 15 and 94 years of age, who live in Sweden. A total of 37% of respondents reported that they have seriously considered suicide during the past 12 months and 32% had ever attempted a suicide. Offensive treatment during the past three months and lifetime exposure to trans-related violence were significantly associated with suicidality. Less satisfaction with contacts with friends and acquaintances and with one's own psychological wellbeing were associated with suicide ideation in the past 12 months. Lack of practical support was associated with lifetime suicide attempts. CONCLUSIONS: Our findings show that suicidality is directly correlated with trans-related victimization. Preventing targeted victimization is, therefore, a key preventive intervention against this elevated suicidality.

A meta-analysis and systematic literature review of factors associated with sexual risk-taking during international travel.

BACKGROUND: International travel facilitates global spread of sexually transmitted infections (STI). Travellers could contribute to onward transmission of pathogens rarely encountered at home and export new strains to the destination. The aim was to systematically examine evidence regarding determinants of travel-related sexual risk-taking and identify knowledge gaps and areas for targeted interventions. METHOD: Articles published in peer-reviewed journals from 2000 to 2017 were screened in 6 databases and assessed for relevance against criteria. Data was extracted for factors associated with travel-related STI or proxies. Meta-analyses estimated pooled prevalence of casual sex and non-condom use. Adjusted odds ratios of predictors were pooled to generate a combined estimate. RESULT: Forty-nine articles qualified for inclusion. A heterogeneity test indicated variation across studies. The pooled prevalence of casual travel sex was 35% and prevalence of non-condom use 17%. Expectations of casual sex strongly predicted sex with a new partner when travelling abroad. Planning to have sex indicated condom use. CONCLUSION: The studies largely represented sub-groups of risk-taking populations from a European context, indicating substantial knowledge gaps. Studies investigating migrants travelling to visit friends and relatives, older travellers, and female travelers are needed. Post-travel harm reduction activities may serve as a focus for future interventions.

Health, disability and quality of life among trans people in Sweden-a web-based survey.

BACKGROUND: Swedish research concerning the general health of trans people is scarce. Despite the diversity of the group, most Swedish research has focused on gender dysphoric people seeking medical help for their gender incongruence, or on outcomes after medical gender-confirming interventions. This paper examines self-rated health, self-reported disability and quality of life among a diverse group of trans people including trans feminine, trans masculine, and gender nonbinary people (identifying with a gender in between male of female, or identify with neither of these genders) as well as people self-identifying as transvestites. METHODS: Participants were self-selected anonymously to a web-based survey conducted in 2014. Univariable and multivariable regression analyses were performed. Three backward selection regression models were conducted in order to identify significant variables for the outcomes self-rated health, self-reported disability and quality of life. RESULTS: Study participants included 796 individuals, between 15 and 94 years of age who live in Sweden. Respondents represented a heterogeneous group with regards to trans experience, with the majority being gender nonbinary (44 %), followed by trans masculine (24 %), trans feminine (19 %) and transvestites (14 %). A fifth of the respondents reported poor self-rated health, 53 % reported a disability and 44 % reported quality of life scores below the median cut-off value of 6 (out of 10). Nonbinary gender identity (adjusted Odds Ratio (aOR) = 2.19; 95 % CI: 1.24, 3.84), negative health care experiences (aOR = 1.92; 95 % CI: 1.26, 2.91) and not accessing legal gender recognition (aOR = 3.06; 95 % CI: 1.64, 5.72) were significant predictors for self-rated health. Being gender nonbinary (aOR = 2.18; 95 % CI: 1.35, 3.54) and history of negative health care experiences (aOR = 2.33; 95 % CI: 1.54, 3.52) were, in addition, associated with self-reported disability. Lastly, not accessing legal gender recognition (aOR = 0.32; 95 % CI: 0.17, 0.61) and history of negative health care experiences (aOR = 0.56; 95 % CI: 0.36, 0.88) were associated with lower quality of life. CONCLUSIONS: The results of this study demonstrate that the general health of trans respondents is related to vulnerabilities that are unique for trans people in addition to other well-known health determinants.

Sexual risk-taking during travel abroad - a cross-sectional survey among youth in Sweden.

BACKGROUND: The aim was to assess sexual risk-taking behaviour in a sample of Swedish youth who were sexually active while travelling abroad and to examine possible associations with sexual risk-taking behaviour during such travel. METHODS: From a population-based sample of 2189 Swedes 18-29 years, 768 who were sexually active while abroad, were assessed by a questionnaire concerning socio-demographic background, life-style, travel duration, sexuality, mental health, heavy episodic drinking (HED) and drug-use. RESULTS: Approximately 1/4 reported intercourse with a casual partner abroad. Casual sex was associated with HED, 18-24 years, and drug use in both sexes, and for women, also with ≥one month of travel. Among youth with casual partners, 48% reported non-condom use. Non-condom use with a casual partner was associated with 18-24 years, ≥one month of travel for women, and poor self-rated mental health for men. About 10% had ≥2 partners abroad. Having ≥2 partners abroad was associated with ≥one month of travel, and for men also with HED. CONCLUSION: Male sex, 18-24 years of age, ≥1 month of travel, HED, and drug use were significantly associated with sexual risk-taking during travel abroad. Poor self-rated mental health and foreign-born parentage might also constitute risk factors for men.

The problem of non-response in population surveys on the topic of HIV and sexuality: a comparative study.

BACKGROUND: Throughout the Western world, response rates are falling in population surveys. The aim of the study was to explore for the presence of non-response bias in two Swedish research projects on HIV ['HIV in Sweden' (HIS11)] and sexuality ['Sex and health' (UngKAB09)]. METHODS: The study used four data sets (two from each project), each of which had been generated using different methods. By comparing means and percentages on 15 items across the data sets, we explore the potential presence of non-response bias due to interest in the survey topic (topic salience), and discuss the suitability of two increasingly common methods for recruiting respondents: the pre-recruited probability web panel and the self-selected web survey. RESULTS: While a higher proportion of the respondents in the HIS11 substudies had been tested for HIV and were inclined to perceive themselves as being at high risk of HIV infection, the respondents in the UngKAB09 substudies were on average more sexually active. Further, while there was little variation in the results between the HIS11 substudies (postal/web survey and pre-recruited web panel), there were some fairly large differences in the results between the UngKAB09 substudies (web surveys, one of which was based on a self-selected sample). CONCLUSION: The study concludes that (i) there are signs of non-response bias that may be due to topic salience, (ii) while care must be taken when using self-selection sampling methods, the pre-recruited probability web panel might provide a cost- and time-effective alternative for recruiting respondents in future population surveys.

Window of opportunity for intersectoral health policy in Sweden--open, half-open or half-shut?

'Health in All Policies' (HiAP) is defined as a 'horizontal, complementary policy-related strategy with a high potential for contributing to population health'. To ensure that health impacts are highlighted across sectors, the support of actors in different sectors, not just the health sector, is needed. Public health, here defined as a universally important but a low prioritized politics area, needs to involve high politics areas to fulfil the HiAP strategy. This study aimed to analyse the agenda setting, formulation, initiation and implementation of the intersectoral public health policy and one tool of HiAP, health impact assessment (HIA), at the national and local level (exemplified by Stockholm County) in Sweden. A literature search was carried out of scientific and grey literature on intersectoral health policy and HIA in Sweden. The study was a policy analysis, using a content analysis method, and the theoretical framework of Kingdon where the results were examined through problem identification (why a window of opportunity opens for an intersectoral health policy and HIA), the factors and impact of politics (support for the formulation and implementation of policy) and policy (how best to solve the problem). The results showed that actors perceived the problems (the rationale) differently depending on their agenda and interest. Politicians and experts had a high impact on the formulation of the policy, agreeing on the policy goals. However, there was little focus on implementation plans implying that the political actors were not in agreement, and the experts sometimes showing conflicting evidence-based opinions on how to best ensure the policy. Without this in place, it is difficult to involve high politics areas, and vice versa, without the involvement of high politics, it is difficult to achieve the policy. However, this is a long-term process, where small steps need to be taken, leaving the policy window half-shut.