Men registered in dating

Another kind of study is to conduct a prospective cohort study, looking at differences in HIV incidence between two groups of people according to their usage of condoms.This cannot be a randomised controlled study, but participants’ HIV and STI incidence can be related to their condom use either at baseline or preferably (because behaviours change over time) by means of regular questionnaires and monitoring.

Thirdly, in long-term serodiscordant relationships, studies have shown that the HIV-negative partner can acquire a degree of immunity to their partner’s HIV.

Research early on in the epidemic showed that 40 to 70% of men who claimed they use condoms 100% of the time in fact did not use them for every act of intercourse.

Twenty years later, 51 to 66% of women taking part in a microbicide study reported 100% condom usage at different time points during the trial, but the researchers calculated from inconsistency in their answers that the actual proportion who maintained 100% condom use was 25%.

For these reasons, HIV transmission within long-term serodiscordant relationships, especially heterosexual ones, may be rarer than it is between casual sex partners.

For all these reasons, large studies may be needed to establish differences in HIV (and HSV and HPV) incidence between condom users and non-users.

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These can be done in individuals whose characteristics are known and can be controlled for, and if the relationship truly is monogamous then infections by acute STIs and from outsiders can be ruled out.

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