PROCEDURE

The case originated in an application (no. 56529/00) against the Kingdom of Sweden lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Swedish national, Mr Eie Enhorn (“the applicant”), on 3 April 2000.

The applicant, who had been granted legal aid, was represented by Mrs E. Hagstrom, a lawyer practising in Stockholm. The Swedish Government (“the Government”) were represented by their Agent, Mrs E. Jagander, of the Ministry of Foreign Affairs.

The applicant alleged that he had been deprived of his liberty in breach of Article 5 of the Convention.

The application was initially allocated to the Fourth Section of the Court (Rule 52 § 1 of the Rules of Court).

By a decision of 10 December 2002, the Chamber declared the application admissible.

The Government, but not the applicant, filed observations on the merits (Rule 59 § 1).

On 1 November 2004 the Court changed the composition of its Sections (Rule 25 § 1). This case was assigned to the newly composed Second Section (Rule 52 § 1). Within that Section, the Chamber that would consider the case (Article 27 § 1 of the Convention) was constituted as provided in Rule 26 § 1.

THE FACTS

I. THE CIRCUMSTANCES OF THE CASE

The applicant was born in 1947 and is homosexual. In 1994 it was discovered that he was infected with the HIV virus and that he had transmitted the virus to a 19-year-old man with whom he had first had sexual contact in 1990.

In this context, on 1 September 1994 a county medical officer (smittskyddsläkaren) issued the following instructions to the applicant pursuant to the 1988 Infectious Diseases Act (smittskyddslagen – “the 1988 Act”). “[The applicant] is not allowed to have sexual intercourse without first informing his partner about his HIV infection. He is required to use a condom. He is to abstain from consuming such an amount of alcohol that his judgment would thereby be impaired and others put at risk of being infected with HIV. If the applicant is to have a physical examination, an operation, a vaccination or a blood test or is bleeding for any reason, he must tell the relevant medical staff about his infection. He must also tell his dentist [about it]. Moreover, the applicant is prohibited from giving blood and donating organs or sperm. Finally, he is to visit his consulting physician again and to keep appointments fixed by the county medical officer.” It appears to be in dispute whether the instructions were included in the applicant's medical record as prescribed by section 16 of the 1988 Act. It is not in dispute, however, that the applicant was informed of the instructions, which were issued to him on 1 September 1994, both orally and in writing.

The applicant kept three appointments with the county medical officer in September 1994 and one in November 1994. He also received two home visits by the county medical officer. He failed to appear as summoned five times during October and November 1994.

On 2 February 1995 the county medical officer petitioned the County Administrative Court (länsrätten) for a court order that the applicant be kept in compulsory isolation in a hospital for up to three months pursuant to section 38 of the 1988 Act. The court's record of the applicant's statement reads, inter alia, as follows: “After learning about his HIV infection he had hardly had any sexual relationships. Henceforward he would only have sexual relations with other HIV infected persons. The applicant did not wish to visit the county medical officer or a psychiatrist, but finding his communication with his consulting physician satisfactory he intended to pay the latter monthly visits.” The county medical officer stated, among other things: “[The applicant] may not be sexually active at present, but experience has shown that when the opportunity arises he is likely to have sexual relations, preferably with younger men and without thinking of the consequences. [The applicant] refuses to face his situation, does not want to change his conduct and distorts reality in such a way that he is never to blame for anything. In order for [the applicant's] behaviour to change it is necessary for him to consult a psychiatrist. Having regard to his [resistance thereto], the risk of him spreading the disease is obvious.”

A statement of 16 February 1995 was submitted to the County Administrative Court by a deputy chief physician and specialist in psychiatry, S.A., who had met the applicant twice in a psychiatric ward at an infection clinic. He found, inter alia: “Having learnt that he was HIV-positive, the applicant reacted with a high level of anxiety, which he attempted to alleviate with alcohol. He has maintained that he drinks three strong beers at night in order to be able to sleep. He has had periods of extensive [alcohol] abuse as a consequence of learning that he was infected with HIV but also when he lost his job. [The applicant's] lack of social contact and his feeling of being an outsider, in combination with possible alcohol abuse, could increase the risk of destructive sexual relations.”

In a judgment of 16 February 1995, finding that the applicant had failed to comply with the measures prescribed by the county medical officer, aimed at preventing him from spreading the HIV infection, the County Administrative Court ordered that the applicant should be kept in compulsory isolation for up to three months pursuant to section 38 of the 1988 Act. The order took effect immediately, but the applicant failed to report to the hospital; the police accordingly took him there on 16 March 1995.

It appears that the order and others subsequently issued by the County Administrative Court were upheld on appeal by the Administrative Court of Appeal (kammarrätten), so that the applicant's compulsory confinement was repeatedly prolonged by periods of six months at a time.

While being isolated the applicant had the opportunity to go outdoors every day together with members of the hospital staff, but not on his own. Also, he was able to accompany staff members on different activities outside the hospital grounds. The applicant absconded from the hospital several times, first on 25 April 1995. The police, whom he had contacted voluntarily, returned him to the hospital on 11 June 1995. On 27 September 1995 he ran away again and was at large until the police found him on 28 May 1996. The applicant absconded for a third time on 6 November 1996 but returned of his own accord on 16 November 1996. He ran away for the fourth time on 26 February 1997 and was not returned until 26 February 1999. During the period from 26 February until 2 March 1999 the applicant was detained in his room.

On 14 April 1999 the county medical officer petitioned the County Administrative Court anew for an extension of the applicant's compulsory isolation. According to the record of a hearing held in camera on 20 April 1999, the applicant explained, among other things, the following: “... before 1994 he had had ten to twelve sexual relations per year. His partners were partly old acquaintances, partly new ones, whom he met in parks and so on. The boy, who was 15 years old when they met, took the initiative both emotionally and sexually. Today [the applicant] realises that he infected the boy, which he finds very regrettable. A relative with psychiatric problems, with whom [the applicant] had had a longer sexual relationship, was likewise the initiator. While he was on the run from [26 February] 1997 until [26 February] 1999, he had had no sexual relations. He had taken precautions against spreading the disease and, having had to visit physicians twice during his period at large, on both occasions he had informed them about his HIV infection. Mostly he had kept to himself. From October 1997 until June 1998 and from August 1998 until February 1999, he had lived at a farm hostel and, during the periods in between, when the hostel was full, he had camped. He had spent his time shopping, cooking, watching TV, spending money on lottery games and drinking beer. He had drunk approximately six strong beers a week and never got drunk. He dreamt of living on his own in a flat, supporting himself on sickness benefit. He had lost all sexual desire and would in future have to decline all sexual relations. If he were to be exempted from compulsory isolation he would follow the instructions issued by the county medical officer.”

The owner of the farm hostel gave evidence on the applicant's behalf. The record of his statement reads, inter alia, as follows: “[The applicant], under a pseudonym, had stayed at his farm hostel from October 1997 until June 1998 and from August 1998 until January 1999. [The owner] had talked briefly with him almost every day during those periods. [The applicant] had not bothered anybody and had not formed any personal relationships. He used to go shopping once a day, usually for beer, and [the witness] would estimate that he had drunk between four and six cans of beer every day ... [The applicant] had gone to Stockholm or Norrköping on a few occasions in order to deal with money matters ... However, in Norrköping he had primarily gone to the liquor store ... [The witness] could hardly imagine that [the applicant] had had any sexual relations while living at the hostel ...”

Also on the applicant's behalf, an opinion was submitted by a chief physician, P.H., on 16 April 1999 regarding the applicant's alcohol consumption. Having examined various laboratory tests performed since 31 July 1995 in order to check the applicant's liver, he found no divergent results. The most recent laboratory test, carried out on 18 March 1999, indicated that the applicant had a healthy liver. It was noted that subsequent to his return the applicant had been in contact with a chief physician and specialist in psychiatry, C.G., who was not connected to the hospital.

A statement was submitted to the court by a consulting psychiatric chief physician, P.N., connected to the special care facility at the hospital to which the applicant had been admitted. After the applicant's involuntary return, P.N. had attempted to establish contact with him three times, but in vain. He claimed that on the latest occasion, in March 1999, the applicant had made a lunge at him. In P.N.'s view, the applicant had not made any positive progress since 10 October 1996, the date of P.N.'s most recent official opinion regarding the applicant's condition, in which he had, inter alia, made the following assessment: “The applicant suffers from a paranoid personality disorder and from alcohol abuse. He is considered to be completely devoid of any sense of being ill and also lacks awareness. The combination of a sexual leaning towards younger men and a possible alcohol-related neuro-psychological functional impairment with, from time to time, a probably paranoid personality disorder, close to psychosis, and previous dangerous behaviour from the infection-spreading viewpoint, is deemed unfavourable. The chances of eliminating or limiting the continuous risk of the infection being spread by means of a prolonged placement in isolation in accordance with the Act are deemed – all facts considered – to have not yet completely vanished.”

Also submitted was a statement of 8 April 1999 by B.S., a psychologist at the special care facility at the hospital who had met the applicant once. B.S. found that the applicant was intellectually above average and that he appeared immature and fragile and showed signs of being suspicious and distrustful.

The statement of the county medical officer, who gave evidence before the court, is recorded, inter alia, as follows: “During the last two years when he was on the run, [the applicant] sought medical treatment twice and it has been established that both times he said that he had the HIV virus [as opposed to the period when he absconded between September 1995 and May 1996, during which he failed three times to inform medical staff about his condition]. Moreover, [the applicant] has [finally] accepted that he infected the young man with whom he had a long-lasting relationship from the beginning of the 1990s, thus admitting that it was not the other way around. Also, he has agreed to sign a treatment plan and to consult two physicians of his own choice ... These circumstances suggest the beginning of an improvement in [the applicant's] attitude towards treatment. Nevertheless, it has not been established that [the applicant] has materially changed his attitude regarding the risk that he may spread the disease. He continues to show himself unable to accept the aid and support measures he is entitled to receive; he has refused to consult the psychiatrist P.N. and the psychologist B.S. Moreover, having been in touch with the physicians whom [the applicant] has [recently] contacted voluntarily [P.H. and C.G.], the county medical officer considers that these consultations were partly economically motivated [on account of the fact that the applicant needed medical certificates in order to continue to receive sickness benefit], partly motivated by his wish to be declared mentally healthy, but [not motivated] by any willingness to commence treatment. During [the applicant's] contact with the doctors in question, they did not discuss the risk of spreading the disease at all. A treatment plan was not formally signed [by the applicant]. In conclusion, in the county medical officer's opinion, [if released the applicant] will not voluntarily comply with the instructions given or limit the spreading of the disease.” As regards the laboratory tests concerning the applicant's liver, the county medical officer found these to be of doubtful value, since they had been performed in connection with the compulsory isolation of the applicant at the hospital, but never in connection with a period of intoxication.

On 23 April 1999 the County Administrative Court delivered its judgment, finding against the applicant for the following reasons: “[The applicant] is HIV-positive and thus carries the HIV infection. He has been subjected to compulsory isolation since February 1995 and has during this period absconded from the hospital on several occasions – on the latest occasion for more than two years. During these two years he did not have any contact with the county medical officer or the consulting physician. Periodically he has used a false name and has been living a very secluded life, obviously owing to the risk of being discovered. A life at liberty makes great demands upon the person carrying the infection. During the time preceding his compulsory isolation, [the applicant] was not able to follow the practical instructions issued. Subsequently, he has consistently declined the help offered by the consulting physician and the psychiatrist at the special care facility at the hospital and has instead responded with aversion and mistrust – and by escaping. [The Court] finds that it has been difficult for [the applicant] to accept the information regarding the HIV infection and that he needs help in dealing with this critical situation. It appears from the evidence that [the applicant] still shows aversion to the treatment offered and that he is considered likely to abscond. [The Court] has not been convinced that [the applicant] is not misusing alcohol and finds that, especially in connection with alcohol consumption, [the applicant] is likely to be unable to control his sexual behaviour. Against this background, [the Court] finds that there is good reason to suppose that, if he remains free, [the applicant] will not comply with the practical instructions issued and that this entails a risk of the infection spreading.”

On 12 June 1999 the applicant again absconded, leaving his whereabouts unknown. In the meantime, he had appealed against the above judgment to the Administrative Court of Appeal, before which he relied on an opinion of 14 May 1999 by the aforementioned chief physician and specialist in psychiatry, C.G., which stated, inter alia, the following: “The opinions [by other psychiatrists and one psychologist] resulting from previous examinations were fairly unanimous in their conclusion that [the applicant] was a man with a paranoid personality disorder, who misused alcohol. 'Misuse' in psychiatric terms is defined as a maladaptive use of substances ... This diagnosis is to be distinguished from alcohol dependency, which means a compulsive use of alcohol with abstinence and social complications, and is more difficult to master. The diagnosis 'paranoid personality disorder' is defined as a pervading suspiciousness and lack of trust in other people, whose motives are consistently perceived as malicious. It follows from the definition of 'paranoid personality disorder' itself that this is manifest in the patient's personality from the time he or she becomes an adult. Owing to the fact that the person in question perceives the disorder as part of his or her own self, the motivation for change is usually insufficient. It is not correct to talk in terms of lack of awareness of a disease, since it is not considered that a disease is involved but rather a variation in personality, although the latter may well cause complications in relations with other individuals and society. When such complications occur, an individual with a personality disorder may display different symptoms such as depression, anxiety, etc. In [my] interview with [the applicant], the latter was fairly open and talkative. When he talked about experiences from his time at school, he displayed different emotions. He also showed empathy as far as other people from those years were concerned. He was also partly able to shoulder responsibility for his own mistakes, without blaming others. However, he was very rigid in his interpretation of what had occurred in his adult life and particularly the events of recent years after he had been informed that he had the HIV virus in September 1994. His attitude towards the county medical officer and the staff at the infection ward, whom he believed had kept harassing him unjustly, was almost hateful. [The applicant] felt that he had been subjected to persecution between 1994 and 1995. This could possibly be interpreted as a symptom of delusion. From 1996, he had not experienced feelings of persecution, inter alia since he had secured his own liberty. With regard to sexual relations, [the applicant] has stated that he preferred sexual contact with boys around the age of 17. He was not interested in pre-pubescent boys. He had been celibate since 1996 and had no longer any particular sexual desires or fantasies. He was fully aware that he was carrying the HIV virus and was careful to stress that he was not afraid to die. His attitude towards medication against the HIV infection was negative. The reasons for this were that such medication could have side effects and perhaps, above all, because it would entail limitations on his freedom since he would be subjected to various check-ups. [The applicant] spontaneously expressed a wish to have further talks on a voluntary basis. When asked whether such talks could be part of a treatment plan in cooperation with the county medical officer and the staff at the infection ward, he answered 'no', the reason being that he would feel ashamed of himself if he were to give up this fight.” In conclusion, C.G., found that the applicant fulfilled the criteria for a paranoid personality disorder, and that, judging from previous information, the applicant suffered from misuse of alcohol but not from alcohol dependency. According to C.G. the applicant could be described in everyday terms as an odd person, but not as mentally ill. With regard to the risk that the applicant might pass on the HIV infection to other persons, C.G. believed that neither he nor anyone else could do anything but guess. The weightiest indications in this regard, however, ought to be deduced from the applicant's behaviour during the years he had spent at large.

In a judgment of 18 June 1999, the Administrative Court of Appeal found against the applicant. Leave to appeal against the judgment was refused by the Supreme Administrative Court (Regeringsrätten) on 5 October 1999.

Several applications for an extension of the applicant's compulsory isolation were submitted by the county medical officer after June 1999 and granted, until on 12 December 2001 an application was turned down by the County Administrative Court, which referred to the fact that the applicant's whereabouts were unknown and that therefore no information was available regarding his behaviour, state of health and so on.

It appears that since 2002 the applicant's whereabouts have been known, but that the competent county medical officer has made the assessment that there are no grounds for the applicant's further involuntary placement in isolation.
NOT_CONFIDENTIAL
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CODE
DIRECT
56529/00
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ORG
NO_MASK
Kingdom of Sweden
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DEM
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Swedish
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PERSON
DIRECT
Mr Eie Enhorn
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DATETIME
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3 April 2000
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Mrs E. Hagstrom
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LOC
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Stockholm
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NO_MASK
Swedish
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Mrs E. Jagander
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Ministry of Foreign Affairs
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DATETIME
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10 December 2002
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1947
SEX
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DEM
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homosexual
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1994
HEALTH
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DEM
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HIV virus
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correct
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19-year-old
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1990
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1 September 1994
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DEM
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HIV infection
HEALTH
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DEM
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HIV
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1 September 1994
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September 1994
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November 1994
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October and November 1994
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2 February 1995
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County Administrative Court (länsrätten)
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three months
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HIV infection
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HIV
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16 February 1995
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County Administrative Court
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S.A.
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HIV
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anxiety
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HIV
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16 February 1995
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HIV infection
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NO_MASK
County Administrative Court
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three months
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16 March 1995
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County Administrative Court
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Administrative Court of Appeal (kammarrätten)
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six months
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25 April 1995
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11 June 1995
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27 September 1995
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28 May 1996
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6 November 1996
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16 November 1996
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26 February 1997
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26 February 1999
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26 February until 2 March 1999
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14 April 1999
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County Administrative Court
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20 April 1999
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1994
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15 years old
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[26 February] 1997
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[26 February] 1999
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HIV infection
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October 1997
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June 1998
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October 1997
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June 1998
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August 1998
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January 1999
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Stockholm
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Norrköping
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Norrköping
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P.H.
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16 April 1999
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31 July 1995
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18 March 1999
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C.G.
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P.N
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P.N
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March 1999
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P.N
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10 October 1996
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paranoid personality disorder
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001-68077_a8_e62
001-68077_a8_em84
DEM
QUASI
paranoid personality disorder
NOT_CONFIDENTIAL
check
001-68077_a8_e63
001-68077_a8_em85
DATETIME
QUASI
8 April 1999
NOT_CONFIDENTIAL
correct
001-68077_a8_e64
001-68077_a8_em86
PERSON
QUASI
B.S.
NOT_CONFIDENTIAL
insert
001-68077_a8_e65
001-68077_a8_em87
DATETIME
NO_MASK
two years
HEALTH
check
001-68077_a8_e14
001-68077_a8_em88
DEM
QUASI
HIV virus
NOT_CONFIDENTIAL
insert
001-68077_a8_e66
001-68077_a8_em89
DATETIME
QUASI
September 1995
NOT_CONFIDENTIAL
check
001-68077_a8_e67
001-68077_a8_em90
DATETIME
QUASI
May 1996
NOT_CONFIDENTIAL
check
001-68077_a8_e58
001-68077_a8_em91
PERSON
QUASI
P.N
NOT_CONFIDENTIAL
correct
001-68077_a8_e53
001-68077_a8_em92
PERSON
QUASI
P.H.
NOT_CONFIDENTIAL
check
001-68077_a8_e57
001-68077_a8_em93
PERSON
QUASI
C.G.
NOT_CONFIDENTIAL
check
001-68077_a8_e68
001-68077_a8_em94
DATETIME
QUASI
23 April 1999
NOT_CONFIDENTIAL
check
001-68077_a8_e27
001-68077_a8_em95
ORG
NO_MASK
County Administrative Court
HEALTH
insert
001-68077_a8_e69
001-68077_a8_em96
DEM
QUASI
HIV-positive
HEALTH
check
001-68077_a8_e19
001-68077_a8_em97
DEM
QUASI
HIV
NOT_CONFIDENTIAL
check
001-68077_a8_e70
001-68077_a8_em98
DATETIME
QUASI
February 1995
NOT_CONFIDENTIAL
insert
001-68077_a8_e65
001-68077_a8_em99
DATETIME
NO_MASK
two years
NOT_CONFIDENTIAL
insert
001-68077_a8_e65
001-68077_a8_em100
DATETIME
NO_MASK
two years
HEALTH
check
001-68077_a8_e18
001-68077_a8_em101
DEM
QUASI
HIV infection
NOT_CONFIDENTIAL
check
001-68077_a8_e71
001-68077_a8_em102
DATETIME
QUASI
12 June 1999
NOT_CONFIDENTIAL
check
001-68077_a8_e72
001-68077_a8_em103
ORG
NO_MASK
Administrative Court of Appeal
NOT_CONFIDENTIAL
check
001-68077_a8_e73
001-68077_a8_em104
DATETIME
QUASI
14 May 1999
NOT_CONFIDENTIAL
check
001-68077_a8_e57
001-68077_a8_em105
PERSON
QUASI
C.G.
HEALTH
check
001-68077_a8_e62
001-68077_a8_em106
DEM
QUASI
paranoid personality disorder
HEALTH
check
001-68077_a8_e62
001-68077_a8_em107
DEM
QUASI
paranoid personality disorder
HEALTH
check
001-68077_a8_e62
001-68077_a8_em108
DEM
QUASI
paranoid personality disorder
HEALTH
insert
001-68077_a8_e74
001-68077_a8_em109
DEM
QUASI
personality disorder
HEALTH
insert
001-68077_a8_e75
001-68077_a8_em110
DEM
QUASI
depression
HEALTH
insert
001-68077_a8_e29
001-68077_a8_em111
DEM
QUASI
anxiety
HEALTH
check
001-68077_a8_e14
001-68077_a8_em112
DEM
QUASI
HIV virus
NOT_CONFIDENTIAL
check
001-68077_a8_e20
001-68077_a8_em113
DATETIME
QUASI
September 1994
NOT_CONFIDENTIAL
insert
001-68077_a8_e76
001-68077_a8_em114
DATETIME
QUASI
1994 and 1995
NOT_CONFIDENTIAL
check
001-68077_a8_e77
001-68077_a8_em115
DATETIME
QUASI
1996
NOT_CONFIDENTIAL
correct
001-68077_a8_e78
001-68077_a8_em116
DEM
QUASI
age of 17
NOT_CONFIDENTIAL
check
001-68077_a8_e77
001-68077_a8_em117
DATETIME
QUASI
1996
HEALTH
check
001-68077_a8_e14
001-68077_a8_em118
DEM
QUASI
HIV virus
HEALTH
check
001-68077_a8_e18
001-68077_a8_em119
DEM
QUASI
HIV infection
NOT_CONFIDENTIAL
check
001-68077_a8_e57
001-68077_a8_em120
PERSON
QUASI
C.G.
HEALTH
check
001-68077_a8_e62
001-68077_a8_em121
DEM
QUASI
paranoid personality disorder
NOT_CONFIDENTIAL
check
001-68077_a8_e57
001-68077_a8_em122
PERSON
QUASI
C.G.
HEALTH
check
001-68077_a8_e18
001-68077_a8_em123
DEM
QUASI
HIV infection
NOT_CONFIDENTIAL
check
001-68077_a8_e57
001-68077_a8_em124
PERSON
QUASI
C.G.
NOT_CONFIDENTIAL
check
001-68077_a8_e79
001-68077_a8_em125
DATETIME
QUASI
18 June 1999
NOT_CONFIDENTIAL
insert
001-68077_a8_e72
001-68077_a8_em126
ORG
NO_MASK
Administrative Court of Appeal
NOT_CONFIDENTIAL
insert
001-68077_a8_e80
001-68077_a8_em127
ORG
NO_MASK
Supreme Administrative Court (Regeringsrätten)
NOT_CONFIDENTIAL
check
001-68077_a8_e81
001-68077_a8_em128
DATETIME
QUASI
5 October 1999
NOT_CONFIDENTIAL
check
001-68077_a8_e82
001-68077_a8_em129
DATETIME
QUASI
June 1999
NOT_CONFIDENTIAL
check
001-68077_a8_e83
001-68077_a8_em130
DATETIME
QUASI
12 December 2001
NOT_CONFIDENTIAL
check
001-68077_a8_e27
001-68077_a8_em131
ORG
NO_MASK
County Administrative Court
NOT_CONFIDENTIAL
check
001-68077_a8_e84
001-68077_a8_em132
DATETIME
QUASI
2002
Eie Enhorn
SWE
CHAMBER
Task: Annotate the document to anonymise the following person: Eie Enhorn