ONCE BITTEN TWICE SHY ''. (Chat échaudé craint l'eau froide). Chorégraphe: Lorna Cairns (Scotland) Novembre Danse en ligne: 32 Temps – 4 Murs. Once Bitten Twice Shy. 32 Count, 4 Wall, Improver. Choreographer: Lorna Cairns (UK) Nov Choreographed to: Gone Gone Gone by Robert Mizzell. PDF | On Dec 24, , J Marshall and others published Once bitten, twice shy.
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Free download of Once Bitten, Twice Shy by Linda Louise Rigsbee. Available in PDF, ePub and Kindle. Read, write reviews and more. PDF version of Once Bitten, Twice Shy by Linda Louise Rigsbee. Book One in the series, An Ozark dairy goat farm is an unlikely meeting place for a wealthy. “Once Bitten, Twice Shy”: Participant Perspectives in the Aftermath of an Early HIV Vaccine Trial Termination P.A. Newman*,a, S. Yima, A. Daleyb, R. Walissera, .
In broad daylight. Within arm's reach of his lieutenants. But I'd gotten away clean. Didn't that count for anything? Their main focus seemed to be kidnapping children from the U. I'd tracked him to a resort and pushed him off a mountain. Okay, we'd both fallen off, but I'd landed on my skis in nice, fluffy powder. He'd dropped on a rock. But it's my responsibility to make sure my agents survive. I hooked you up with a guy who's been alive nearly years.
I was just hoping some of his interest in life would rub off on you. It sobered Pete instantly. If you were, you'd have died eight months ago. But you're not sensible either. You need somebody around who's not afraid to get in your face and tell you when you're acting like an idiot.
Dammit, I should've yelled when I still had the gumption. But I couldn't deny the sense in what Pete said. And it was kind of nice to be looked after, cared for. I had only been alone a little over half a year. But it had felt like thousands. I sighed. We talked for awhile longer. Which was when I discovered, while Pete wanted me to stop taking crazy chances, his bosses appreciated the fact that I was willing. In reality, you're his bodyguard.
You've met the members of our oversight committee. Senators Fellen, Tredd and Bozcowski had pretty much cured me of ever wanting to vote again. Pete went on. I weigh one-twenty when I remember to eat, which isn't regularly. No question this guy, Vayl, could snap me like a twig any time the urge hit him. I laughed. Pete didn't. Real close. Which was why he revealed a secret no vampire has ever told anyone before.
There are two moments when vamps are completely vulnerable. When they're taking blood. And when they're making a kill. He might have other reasons for wanting you there, but the fact that some ear-breather nearly smoked my best agent is enough for me and more than enough for the powers that control my budget.
He wants a partner. You're it. Vayl invokes her when I step out of line. I nearly flipped him off, but since he's still got one foot mired in the s, I thought better of it and stuck my tongue out at him instead. I wasn't sure he'd see me making faces at him in the rear-view, but of course Vayl sees everything. I realized I'd come to count on that as much as I sought his approval which, at the moment, had ditched me. Six months. Scary how much Vayl had learned about me in such a short span.
In my defense, given time he could worm the true ages out of the entire cast of Desperate Housewives. Still, the only living person who knew more about me was my sister, Evie, and she was just that nosy. It's supposed to be freezing. And to be honest, all those palm trees would've sent me skipping around in circles if I'd been on vacation.
But we Midwesterners have a thing about winter holidays and snow, and this year I had yet to experience either one. Vayl went still, a sight that will creep you out big-time if you've never seen it before.
He sort of resembles a statue anyway, as if Da Vinci had chiseled his square forehead, high cheekbones and long Roman nose from smooth, pale stone.
His curly black hair was cut so short that right now I'd almost swear someone had painted it on. The temperature inside our silver Lexus suddenly dropped ten degrees. A breeze ruffled my red curls, playing them across my shoulders as if they were harp strings.
Strange to think of Ohio as a base for any operation more dangerous than cataract surgery. But that's why we're still doing the government's business. Of course, people know we kill bad guys. They just don't want the gory details. But if you asked them in a dark room where their neighbors couldn't hear, they'd tell you we're not nearly as proactive as they'd like. Witches, vamps, weres… some would vote to throw them all on a gigantic bonfire and have done.
But there's good sorts among those others who have earned, and deserve, the same rights and protections we humans get. Vayl is one of them. And after six months of watching his back, I was glad I hadn't pulled a diva on Pete and stomped out of his office when he'd suggested the partnership. We'd clicked like checkers from the start. At this point I couldn't imagine working without him.
But he did have his quirks. He sort of came alive again, catching me off guard, as it would if, say, I were strolling through a botanical garden and the cherub in the fountain suddenly started flapping its wings. He sat forward, his smile just a twitch of the lips. Because she finally pulled into the United Methodist Church parking lot, praise God, leaving the rest of us free to party until some other octogenarian found it necessary to take to the streets after dark.
In Ohio, old folks know better than to drive at night. Yet another reason Cleveland rocks. We drove straight to our very old, very exclusive hotel.
Called Diamond Suites, it towered above the pink stucco wall that surrounded it and its gardens, rising nearly twelve stories before reaching its peak with a steep, red tile roof.
Parking lot full of high-end rentals. Automatic, card-key entry door with bullet proof glass. Lobby full of complimentary goodies from fluffy white towels to imported shampoos, all graciously displayed on the shelves of antique armoires. Not a single soul in sight. His hands full of bags, Vayl leaned over and nudged me with an elbow.
An unladylike habit, I know, but one which, like swearing, has its place. Rumor had it Vayl had won his cane and his first gold mine in a game of five-card stud.
Vayl's lips twitched again. Not for the first time I thought, If he ever truly smiles his face is going to shatter. But I tried not to think it too loud. On the plane he'd overheard the flight attendants discussing the pilot's stun gun from the back of the plane as he sat beside me in the front row. A man with that kind of ability only needs to listen slightly harder to hear my harsh thoughts.
Vayl had reserved the penthouse, so we took elevator 6A to twelve. At that point I did a little soft-shoe—the semiclaustrophobic's version of the I-gotta-pee-dance—until Vayl figured out which way to slip our key card into the metal slot on the elevator's control panel so the door would open.
After I'd leaped out and regained a somewhat steady pulse, I took stock. We stood in a small enclosed entryway decorated with a massive flowery mural that involved all four walls, including the elevator doors, and half of the ceiling. Tiles in the pastel pink so common to Florida covered the floor. I wrinkled my nose at the color. Something about pink makes my stomach churn. Maybe it's the resemblance to Pepto Bismol. Personally, my taste runs toward bolder colors. That's why I currently wore an emerald green silk shirt under my black jacket.
Unlike Vayl's coat, which reached his knees and looked like it could comfortably hide a shotgun, or a sword, or possibly a small pony, mine stopped just below my waist and, because it had been tailored to mask my shoulder holster, fit superbly. My black slacks felt a little loose, probably because I'd missed lunch all month.
And since the Weather Channel had warned of a cold spell hitting Florida at the same time we did, I'd worn my new boots.
Hopefully they'd hold up longer than my last pair, which had fallen apart the first time I'd stepped in a puddle of blood. I tugged my trunk through a set of white French doors that opened into a sunken living room furnished with flowered couches and chairs, glass tables and Pepto-pink carpeting. On the opposite end of the room, next to ceiling-to-floor curtains in Elvis velvet, sat a bigger glass table surrounded by chairs.
I noticed it mainly because the chairs had rollers, which keyed a memory from my childhood. My brother, sister and I were staying with our Granny May at her farm for the summer. Her kitchen chairs had wheels, so we spent part of each day either pushing each other around the room or having spinning contests to see who fell off first.
Good times. I felt a throb of homesickness for those few golden moments when my sibs and I were friends, teammates and coconspirators.
Why couldn't it have lasted forever? Move on. Still carrying a suitcase, our laptop, his garment bag and cane, Vayl strolled into the room and took inventory. His eyes rested momentarily on a cut glass vase full of white orchids and moved on to a silver bucket filled with ice and a bottle of champagne. I liked it because it looked the way I felt most of the time, battered and old.
Right now it appeared sorely out of place, and if the furniture could talk I was sure it would shame my low-class luggage right out of the building.
The pack on my back wouldn't score any points either. Despite the fact that it dressed in basic black, it too had seen better days. But it worked, carrying my weapons in well-padded pockets along with my ammunition and cleaning cases. So rather than run to the nearest Motel 6, I just kept walking, taking my most treasured possessions toward another set of French doors to my left which no doubt led to a grossly sumptuous bedroom.
Already across the room, he set the laptop on the table, and moved to the curtains, which I expected him to stroke like a pet panther. Instead he flicked them back, peered out the window. Satisfied, he looked over his shoulder at me. But no, the bell had dinged, forcing me back into the ring for Round 14 of the Never-Ending Battle. Nope, no blows traded, damn it all. Our struggle was just a continuous conversation during which Vayl tried to figure out how I'd grown to adulthood without acquiring the slightest refinement, and I continued to be baffled that a man old enough to remember when bathrooms were windowless shacks built above deep stinkin' holes could be fooled into thinking that ugly flowers and crappy-tasting liquor meant something.
Can't we just agree that I'm a cretin and you're a snob and move on? Then I realized he was laughing. Depositing his stuff on an end table, he collapsed on the nearest couch and heaved with barely suppressed merriment. He looked… now why would the word 'yummy' come to mind? Under his coat he wore a dark blue sweater that hugged his torso as if they'd been reunited after a long separation.
On the plane he'd mentioned his gray slacks had been tailored by a guy named Lawrence Clay who spoke with a lisp and sewed like a savant.
His shiny black shoes had come straight off the shelf—in Italy. Since he'd assumed the identity of a high-end antiques dealer named Jeremy Bhane, his elegance was called for. It baffled me that such a thing could come so naturally. Or that I should find it so… delectable. What is the deal with these food metaphors, girl? I asked myself. Miss too many entrees, did you?
Or are you hungry for something a little more—no, no, no, don't you dare go there. For damn sure not with your badass vampire bossman. He could never replace Matt anyway. No one could. You suddenly look… haunted. I mean, no," short, fake laugh while I fished for something to say, "I was just wondering why you don't smile more.
And I thought maybe it's because your fangs would show. We had two vamps on my Helsinger crew. Stellar people. Surprise, surprise, it had a huge round bed with a fuscia duvet and a mirrored headboard. I'd call the carpeting a nauseating mix of Pepto-pink and cherry-flavored Nyquil. I liked the whirlpool tub in the next room though, and the shower was big enough for me and the cutest six guys I could round up on short notice. He shrugged. His left eyebrow moved upward a couple of notches.
I forgot to breathe as I wondered just how many women had lost themselves in those emerald green eyes. Over nearly three hundred years?
Don't make me laugh. And don't think about him that way anymore. You're his assistant. I sighed, feeling a whole new level of bummed. I was supposed to hang out with my sister tonight, not hop a flight to Miami. She's already mad that I missed Christmas, and if this trip triggers her labor I'm never forgiving myself.
Or you. So can we just start the briefing? The quicker this is over the faster I can crawl home. At the knees of my kid sister. Oh, how the mighty have fallen. He checked his pocket watch. And when I bleed, I get pissed. It's like he's implying a tough girl like me needs a miracle to transform herself into a beautiful lady and, as we all know, miracles take time.
What an ass! His touch, bare fingers on my cheek, startled me. I could tell by his feverish warmth that he'd eaten when he woke at sunset. The decent vamps, the ones who were trying to blend, all fed without killing. Many had willing donors. Others bought their blood from one of two government licensed suppliers. More would likely pop up as vamps like Vayl made obvious the advantages of integration.
He said, "I have offended you. It felt a little too… nice. Now," I took him by the shoulders and turned him toward the doors, "let me unpack and I'll meet you in the pit, um, living room in five minutes.
I didn't. I sat on the bed, fished a pack of cards out of my bag and began to shuffle them. Blend, bend, bridge, over and over I shuffled the dog-eared pack until Evie's tears, my ghosts, Vayl's unintended insult and the immense suckage of the holidays, which I'd spent equally blacking out and melting down, receded beneath the steady thrum of the cards.
Vayl had draped himself across one of the couches when I came into the living room. All he needed was an ivy crown and some half-dressed bimbo fanning him with palm fronds between bites of grapes and he'd have been a dead ringer for a gorgeous Julius Caesar. Aw, who was I kidding, he'd probably palled around with the man before Cleopatra showed up and ruined all their fun.
I sank down on the couch opposite him, curling my feet underneath me. He will expect both of us to behave with a certain amount of savoir faire. We're supposed to be a couple of big spenders? His name is Mohammed Khad Abn-Assan and he has either lifted, tucked or liposuctioned half of Hollywood. I understand several of his celebrity clients will be there tonight.
So what's the charity? It brings in millions of dollars a year, supposedly to pay for reconstructive surgery for child victims of disfiguring accidents. Only I'm guessing the kids will never see a dime. The Sons of Paradise? Are you telling me we're going to hit a financial bastion of the most extreme of the extremist terrorist groups? Why not all of it? It's good there's people like us around to balance things out.
Kind of like this carpet. The vamps I'd known before him didn't have that particular ability, but then it wasn't really fair to compare.
Vamps have their individual gifts and weaknesses, just like humans. The one sitting across from me, for instance, wore his eighty-year string of successful missions like a mantle. He had infiltrated the most exclusive factions, beaten the highest tech security systems, faced the most powerful supernatural forces ever seen on earth and won. So why did he need me? After six months he still hadn't given me a plausible explanation. But as far as we can tell he has suddenly gained great power within the Sons of Paradise.
We believe he has brought them a new partner, one with the money and clout to rock this country to its core. There is not much chatter about this person or persons, but when you listen to the whispers you hear scary things. Both Vayl and I knew we'd have to go after him eventually. His lethal mix of charisma and savagery along with rumors that he'd accepted fealty oaths from a dozen large nests, two covens of black witches in Scotland and several packs of Spanish weres had made him the subject of several of Pete's bulletins.
A museum piece, it had been handcarved in India and was almost as famous around the office as its owner. A procession of intricately detailed tigers marched around the leg of the cane up to a gold band, which separated it from the multifaceted blue jewel that topped it.
When you twisted the head, the tigers shot away from it, revealing a hand-hammered sword whose maker had been dust for centuries. I hadn't expected to see the cane until the party. It was unusual for Vayl to carry it with him here, where he should've felt safe.
Where I'd felt pretty cozy myself. I sat up straighter and looked around the room. Assan has powerful friends. And…" "What? Something about this feels… wrong. It's fun occasionally, sort of like an archaeological dig without the sweating. I stood before the bathroom mirror resembling the pale, regal daughter my mother would've preferred, wondering how I was supposed to hide my modified Walther PPK, which I called Grief, underneath material that clung like an obsessive ex-boyfriend.
I'd gone for an oriental look and discovered the red mandarin collar and short, half-moon sleeves suited me fine, especially with my hair pinned up and swirled around the way I'd seen it done in Cosmo. Fake diamonds dangled from my ears, and though no one could see, they matched my belly button ring perfectly. The hilarious bit was that Pete had been the one to give it to me. His face had slowly flooded with color as he'd handed me the case.
If you don't have a way to keep the gem on you once it's signaling, it has been tested safe on the digestive system, so you can swallow it. Once they receive the signal, their orders are to try to contact you and, failing that, to coordinate a massive search and rescue. I'd been careful with the eyeliner, so my eyes looked larger, greener, more soulful than usual. I had fine, fragile features that fooled almost everyone I met, a real advantage in my line of work. And the fact that my body leaned harder towards bony than athletic didn't hurt either.
My legs were by far my best feature. They occasionally peaked through the side slits of my calf-length, red satin skirt. I wore red, low-heeled sandals I could actually run in, and I'd chosen a sequined handbag to match, so that's where I finally stowed my weapon.
When I came out, Vayl's bedroom doors were still shut. I rapped on one. Back in thirty. Diamond Suites was situated about fifteen minutes from Assan's location. The Lexus purred under me like a snoozing lioness as I drove there, but I resisted the urge to wake her up on the Interstate. Pete's blood pressure tended to spike when he thought I'd done any excessive spending, and I figured he'd stroke out if I showed up with a speeding ticket on the way to a location. I took a leisurely tour of Assan's digs, trying not to gape too much at the enormous, brilliantly lit mansions fronted by country club style landscaping.
The lawns were so well manicured you could've used them for putting greens. What a hoot if Dave and his buddies had lived here, because they actually would have.
I could imagine them all, full of that eighteen-year-old cockiness you wish guys would never lose, drinking Albert's beer and calling their shots like it was a game of 8-ball. I spared my twin one more minute, wondering what part of the world held him tonight, hoping he was okay.
Like me, Dave's pretty high up the hush-hush ladder. Like me, he'd started in a different part of the Agency, but now he's a Special Ops stud, so he spends the majority of his time overseas.
It's an excellent excuse not to keep in touch and we use it like a dust rag. If we were careful we'd never have to speak to each other again.
A hell of an accomplishment for people who used to complete each other's sentences.
You're working Jasmine, so work. Focus on the work. The work will keep you sane. At least in everybody else's eyes. I took a deep breath and let it out with a laugh when I saw the fancy, scrolled metal sign on the gate in front of Assan's house.
Anything with an entrance right out of Jurassic Park and enough fencing to contain a herd of brachiosaurus demands a name, and Assan had chosen Alpine Meadows. Without a mountain in sight. Nor were there any cute Austrian kids running around singing "Do, Re, Mi.
But I did find a couple of quick routes out just in case the boogers hit the blender. Then I went back for Vayl. I didn't see him when I pulled into the parking lot, but I could feel him waiting for me. Although it was more than that.
It's an extra sense, one I've only had since… well, for about 14 months. And I'm not the only one who's fascinated by it. During our first mission together, Vayl had admitted part of the reason he requested our pairing was the fact that I can smell vamps. Not literally. Still, it's almost a visceral scent, something near the back of the nose and just behind the eyeballs that whispers immortal to the base of my brain.
Different vamps make me react different ways, but that's the basic idea. We'd been stalking a renegade named Gerardo, who the Italian authorities had asked us to bag before he decimated yet another convent.
Apparently he'd run through so many in Europe that he'd felt the need to emigrate. Having trailed our quarry to the hushed halls of the Monastery of St. Bernadette in Oregon, we hoped the sisters had enough brains to keep themselves barricaded in their cells and that my inner alarm would sound before one of them needed to escape for a quick pee. And I'm not sure it would help if I did. The Sensitivity doesn't work that way. Best case scenario, all I know is he's in the same room as us.
If we nurture it, develop it, I think you will be amazed to discover what lies deep beneath the water. I'd seen vamps fight before. Fought beside them, in fact. But Vayl surpassed them all. He attacked Gerardo with the ferocity of a starving crocodile, his lips drawn so far back from his teeth I could see his rear molars without squinting. They both fell back into the fountain, slamming the statue of Bernadette that stood in the middle hard enough to make her wobble.
When they emerged, blood bubbled from a huge gash in Gerardo's shoulder. He broke free of Vayl's grip and tried to jump out of the water. Vayl caught him halfway and he fell hard on the concrete rim. Like a lion on a zebra, Vayl latched onto the back of Gerardo's neck, the look in his eyes just as fierce and nearly as primal. Suddenly I knew why the Romans had packed their coliseum on a regular basis. I wanted to roar with approval. My gladiator was kicking ass, baby. A sound to my right distracted me.
A nun shuffled out of the shadows. I ran toward her. This isn't something you should see," I said. She'd jumped me almost before I realized she smelled undead.
But the newbies are sloppy. Lack of training, maybe, or an overabundance of hunger. My crossbow bolt pierced her heart before she could even form a decent snarl. When I looked back at the fountain, Vayl stood alone as well.
We'd smoked both our vamps without sustaining any major personal damage. Always a cause for celebration. Vayl had pointed to the little bits of ash and dust that had fallen where the nun had stood moments before.
While I often felt like yanking my hair out by the roots, Vayl maintained his cool. He just kept saying, "We are missing a vital link in the chain. When we discover what it is, you will rocket forward. But that does not mean you should stop trying. I looked around the lot, wishing I could ping some sort of radar off him. After all this time, I still hadn't figured out how to narrow my search. I'd learned only that if I paid attention to the awareness, it might alert me when he moved.
Leaving the car running, I turned off the headlights and turned on the night vision. It was easier than it sounded. One of my roommates in college was a techno-wizard named Miles Bergman. The tall, skinny son of a Russian dissident and an environmental biologist, his paranoia prevents him from working for the government outright. But he does sell us the rights sometimes exclusive to use his gadgets. Pete loves the arrangement, because it means he doesn't have to put out any extra cash for pesky items like health insurance and vacation days.
One of the many cool inventions Bergman developed for me was a set of night vision contact lenses. I squeezed my eyes shut for a couple of seconds and when I opened them the interior of the Lexus looked like it had been parked under a green streetlamp.
The cars surrounding me could've come straight from Enterprise of Emerald City. All lovely shades of lime, they lined up like contestants at the Miss Oz Beauty Pageant. Only one wasn't what she seemed. One hid a dark, long-lived secret. But which? I scanned the lot quickly, never letting my eyes rest in one place for too long.
And I still nearly missed him. He stood between a Toyota Tundra and a Jeep Cherokee, an inkblot in the shadows, tapping his cane on the side of his shoe.
As if I had shouted, he stepped forward. I unlocked the doors as he made his way to the car, just another well-to-do gentleman going out on the town. He looked like an Oscar winner, handsome and elegant in his black tuxedo. Even his cane worked, an integral part of the affluent man's evening clothes rather than an assassin's tool.
He slid into the car beside me, which shook me more that I let on. I preferred him sitting in the back, like a boss, rather than in front, like a date. I moved to change gears and nearly yelped when his hand covered mine. I tried not to fidget while he took stock of my hair, dress, shoes, though every second that passed squeezed at my nerves, as if he'd wrapped them in barbed wire and turned a crank that pulled it tighter until they screamed. I wanted to thump him. Didn't he know he was being rude?
And unsettling? And rude? I opened my mouth to tell him exactly what I thought when he said, "You look incredible. Like a goddess. I take back everything I said earlier. Even my brain reverted. All I could think for a second was, He likes me!
He really likes me!! I squeezed my eyes shut, took my vision back to normal. It helped restore my equilibrium too. But, being temporarily divine, I barreled on. I don't give a crap about that part. I just saw a pattern and wondered—" Vayl sighed and the whole car filled with the sound, like a mournful wind bouncing off the walls of an empty canyon. I do not want to kill innocents, so I take their blood during battle.
I can taste whether or not the donor gave it willingly or with his last gasp. Not much changed. But the easing of the lines around his eyes and lips told me I'd said the right thing. Which was when I realized it mattered to Vayl what I thought of him. When had that happened? Probably during your last blackout, spat a bitter, scared corner of my mind. I regarded it as if it stood separate from me, a flat-chested freshman wearing too much eye shadow and the confidence of a lame-duck president.
Shut the fuck up, I told it. Then I drove my boss to the job. We arrived at the gates of Assan's mansion behind a short line of vehicles that included two limos and a gleaming black Corvette. One by one the drivers showed the guards their invitations and were allowed to enter.
I hadn't seen any guards on my scouting trip, though intel had informed us Assan kept anywhere from 10 to 12 on staff. These two shopped in the big and beefy section and still their suit coats barely buttoned, maybe on purpose, so all the guests could see the outline of the guns riding underneath.
One looked to have some Chinese ancestry. He wore his black hair pulled back into a ponytail. His partner reminded me of Schwarzenegger in his bulkier days. If he spoke with an Austrian accent I'd struggle not to laugh in his face. Unprofessional, I know, but the more stressed I get, the more likely I am to bow to inappropriate hilarity. I could already feel the giggles tickling the back of my throat. Up close he overwhelmed the eyeballs, built like a tractor with the confidence that came from knowing he could mow us flat without breaking a sweat.
Vayl sat forward. I felt the magic cross my skin on its way to Arnold Jr. He nodded, handed the invitation back to me and stepped away from the car.
The rumble in Vayl's throat could've been anything from a growl to a burp. I stole a look at his face, and from the way his lips were quivering decided it was a chuckle.
The valet had a hard time understanding why any high society dame would want to park her own car. Then Vayl spoke to him and made it all better. He directed us around the side of the house, where I backed into the space closest to the front door. I sort of specialize in quick getaways. Too bad I wasn't driving a Hummer, It would've been fun to pull straight in and then mow over the perfectly trimmed hedges and gigantic urns on the way out.
Like a good little blueblood, I waited for Vayl to stroll around and open my door for me. We took a path lined with Japanese lanterns around to the front of the house, uh, mansion, um, pretentious freaking monstrosity posing as a home. Yeah, that's more like it. At the top of white marble steps that led to doors the size of rocket silos, a barrel-chested, pock marked man with the eyes of a scorpion took our invitation and added it to a lace-lined basket at his feet.
I had a sudden image of him skipping through the woods holding that basket in front of him like Little Red Riding Hood, and laughed out loud. He and Vayl both looked at me strangely.
I patted Vayl's arm. So many candelabras lined the walls that even if the lights winked out you still could've seen well enough to read the fine print on an iffy contract. And the art! I smiled up at Vayl as if I belonged among people who thought nothing of owning paintings bigger than my apartment.
I had never felt so sorely out of place. Even my teeth felt fake. Somewhat reassured, I said, "Thank you darling. And may I say you grow more handsome with each passing day? Speaking of the devil, here he came, greeting his guests with the slick friendliness of a tiger shark at a daily feeding. His white tuxedo set off his dark hair and skin to perfection, and the gold rings on six out of ten of his fingers highlighted his remarkably slender, blunt-nailed hands.
I managed not to flinch as he came at me, all teeth and glittering black eyes. Sometimes things would be so much simpler if you could just pull out your gun and shoot the bad guy. Reason number seventeen why Indiana Jones is my hero. Oh God, not now. But God had taken a coffee break and my senses had gone along for the donuts. Another sound had replaced Assan's prattle in my shivering brain. A loud buzzing, like an oven timer on steroids, gave warning.
Next my vision would narrow to a speck and then, poof! I might come back to myself in five minutes. Or it might take a couple of days. Afterwards, if I asked the right questions, I might find out what I'd said and done in the meantime. This can't be happening. But it was, and I felt like I was dying, drowning in the flooded hull of my sinking sanity.
I looked at Vayl, hoping he'd throw me a life preserver as I tried not to blow it, not to panic. He squeezed my hand, hard. A throbbing pain shot from fingertips to elbow. And the darkness retreated. We are, of course, staunch supporters of New Start and delighted to finally meet its famous founder. He reached back and pulled a Jessica Simpson clone to his side.
I'd been so distracted I hadn't noticed her pin us. She stood at least three inches taller than me, which gave her a good half foot on her husband. My little brownout had taken the oomph from my muscles and deposited the whole seething mass in my stomach. If she shook too hard I'd puke all over her Vera Wang. But Amanda wasn't up to heavy lifting either.
She squeezed my hand as if it was made of porcelain, did the same for Vayl, then dropped her arm like concrete encased it as she murmured, "Pleased to meet you. Amanda Abn-Assan, I knew, was giving almost everything she had to the task of just staying upright. I looked at Vayl quickly, to see if he'd noticed the puffiness under her eyes. The look he gave me said he had. Now why would the wife of a brilliantly successful surgeon have been crying recently? Several reasons came to mind, but none that totally satisfied my gut feeling about her.
It was a mystery worth solving. Assan excused himself and Amanda, leaving Vayl and I to stand around trying to look natural.
Vayl snagged a couple of champagne flutes off a passing waiter's tray and we toasted each other. My face started to hurt from all the smiling. Vayl bent down to lay a kiss just below my ear that I felt clear to my toes. Okay, Jaz, don't hyperventilate now. It's just skin touching skin, here. That's all. The fact that your knees feel a little weak is probably just an estrogen spike.
Yeah, that's it.
He whispered, "Let us begin. Ready, in fact, to sprint from my current position if it would distance me from these highly inappropriate feelings. I would concentrate all my efforts on identifying the security measures and memorize the layout of the place. Then, after all the guests had left, we'd return and eliminate Assan. That was the job, and God help me, I loved it. My whole body buzzed with anticipation. I lived for this.
This was what chased away the looping thoughts and the nerves and the nightmares. Only the work allowed me to manage a conversational tone as I said, "I'll be right back, darling. Make sure you miss me! What a load of bull.
And yet it was reassuring to know if Pete ever dumped us we could always write dialogue for Days of Our Lives. I gave him my biggest, phoniest smile and turned toward the grandest staircase I'd ever seen that wasn't plastered across a movie screen. Red plush carpeted the steps, which would hide the blood nicely if anyone ever got shot on them. They split halfway up at a landing that held an ornate golden bench on which to rest should the hike have left you winded.
Since I needed to scope out the second floor, I made like Scarlet O'Hara in reverse and swept up the first flight. A discreet little sign with a southern belle printed on it encouraged me to take the next flight to my left and another sign posted at the head of the stairs suggested I try the first door I came to. I reached down to adjust my sandal strap and get a good look around.
At the top of the stairs a sitting area with couches draped in white silk and a matching oversized ottoman separated the ladies' bathroom hall on my side from the men's bathroom hall on the other side.
In November , the trial NIH-PA Author Manuscript sponsors announced that all volunteers would be told whether they received vaccine or placebo, warned of possible risks, and encouraged to follow up for risk reduction counseling and monitoring .
Further analysis of the study data showed that the rate of HIV acquisition was significantly higher for a subset of volunteers uncircumcised men and those with pre-existing immunity to the adenovirus [Ad5] used in the investigational vaccine who received the test vaccine than those who had received the placebo [7,10]. The objective of the present study is to explore the experiences and perspectives of HIV vaccine trial participants, as well as key informant service providers and clinical investigators, in the aftermath of the Step Study, and implications for future biomedical HIV prevention trials.
Materials and methods We conducted a mixed methods investigation including a baseline survey upon enrollment, from October — October , and in depth interviews after the unblinding of volunteers, from January — August , at the Toronto site of the Step Study. Participants and recruitment The vaccine trial eligibility criteria were: The sociobehavioral study included a brief, confidential, self-administered baseline questionnaire, which took approximately 10 — 15 minutes to complete.
Seven questions assessed sociodemographic characteristics and 13 items check as many as apply assessed motivations for participating in the HIV vaccine trial. Concerns about participating 5 items , perceived HIV risk 2 items , HIV vaccine optimism 3 items , and trust in medical providers 5 items and medical research 3 items were assessed on a 4-point Likert-type response scale.
Motivations, concerns, perceived HIV risk, and HIV vaccine items were based on our formative research [5,11] other published research on HIV vaccine trial participation [12,13], and a systematic review of the WTP literature . Questions on trust in medical providers  and medical research  were based on items validated in national U. NIH-PA Author Manuscript Upon discontinuation of the Step Study and unblinding of volunteers, clinic staff handed out in person a letter of invitation to participate in a one-time, face-to-face, confidential one- hour interview.
Trial participants who did not return to the clinic were mailed the letter of invitation. In the interest of confidentiality, all communication with trial participants was conducted by clinic staff. Due to IRB regulations, the sociobehavioral research team did not have access to a list of trial participants and all contact with the team had to be initiated by the participant. In order to encourage candor and mitigate any perceptions of coercion, interested trial volunteers were instructed to contact a research assistant who was independent of the clinical trial research team to inquire about or arrange an interview.
Interviews were conducted by trained research staff in a university setting off site from the clinic. Page 3 learning that the experimental vaccine did not work. Questions explored initial motivations for participating, experiences in the trial, and reactions upon hearing about the trial termination and to being unblinded.
Key informant interviews serve as a form of data source triangulation i. Key informants were purposively sampled based on involvement with the trial or experience with populations eligible to participate. All participants provided informed consent.
Face-to-face interviews were digitally recorded, transcribed verbatim and uploaded into NVivo software QSR International. We used thematic analysis to review transcripts, including line-by-line, in vivo and focused coding, and a constant comparative method [20,21]. First, two investigators SY, RW independently coded the same three transcripts and then met with the principal investigator PN to review codes and create a codebook. Next, we applied codes to analyze subsequent transcripts and generated new codes as they arose in an iterative process [19,20].
Differences in coding were resolved by consensus among three investigators. Data source triangulation between trial volunteers and key informants , investigator triangulation 2 investigators independently coded the transcripts , and peer debriefing investigators discussed emerging themes and interpretations with other researchers enhance the validity of the findings [18,19].
Baseline questionnaires and post- trial interviews were strictly confidential and data were not linked. Results 3. Fifteen 14 men, 1 woman trial volunteers participated in an in depth, face-to-face post-trial interview. All the men identified as gay or bisexual. Page 4 3. Pre-trial experiences 3.
Motivation to enroll in the STEP study: Another participant explained: I've had so many people, so many friends of mine die; I've watched so many people die. I've seen so much and anything that I can do to help try and stop it, why wouldn't I? Protection motivation also emerged as a reason for joining the trial, reflecting multi-faceted motivations on the part of 8 volunteers: I think a couple of things: One, they were hoping to be protected I think, if they did get the vaccine; and then there was a big component of altruism and trying to further science.
Informed consent and ethics: A participant explained that he did not feel the consent process was adequate: They never actually said that anything like this could possibly happen, but of course if they did nobody would take the trial. So it was in the back of my mind, wondering, did they know that this was ever a possibility? Because of course if they told anybody nobody would take it 43 y. Another participant in retrospect questioned the integrity of the trial based on the unforeseen outcomes: And so a small voice in my head is saying, well, this is kind of fucked up 45 y.
Page 5 Alternatively, 6 participants indicated steadfast confidence in the informed consent process and acceptance of the possibility that the trial results were unexpected: Another participant explained that while he had held out hope for the test vaccine, he was nevertheless aware that it might not work; however, he expressed dismay that he was not aware of possible health risks of the trial: I was hopeful it was going to work.
But I also felt confident that my health was not in peril because I'm healthy and I certainly didn't want to become unhealthy to save the world. I'm no martyr 48 y. Additionally, divergent perspectives emerged between trial NIH-PA Author Manuscript participants and key informants regarding the informed consent process. In-trial experiences 3. Engagement in research and relationship with the research team: A volunteer explained: I felt like I was part of the whole process and like an important part of the whole process.
Additionally, volunteers expressed feeling welcomed and accepted as an important component of their trial experience: So I guess that was helpful 40 y. Page 6 Similarly, key informants acknowledged the importance of establishing personal relationships with the trial volunteers: Reactions upon study closure: I felt sick.
I'm sure it's not like finding out that you are HIV-positive but it was that similar kind of feeling. I didn't want to think about it…it's like there's something foreign in your body that you wish wasn't there. I just wish I hadn't done it 40 y.
Nevertheless, 4 participants expressed very clearly that while they were disappointed, they realized the trial outcome was within the realm of possibility. For example, It was a damn shame it didn't work out, but I can't say I was shocked. NIH-PA Author Manuscript Thus a majority of participants expressed feeling distressed and upset, while others were disappointed yet cognizant and accepting of the uncertainties involved with the investigational vaccine. Key informant investigators may have had greater experience with the latter participants or sustained a more positive perspective, but participant and investigator perspectives were divergent.
Post-trial experiences 3. Study termination and unblinding: Page 7 Open communication between trial investigators, sponsors, pharmaceutical companies and participants was identified as vital by participants and key informants alike.
Four participants specifically described their perceptions of slow and sporadic communication, three of whom indicated they first heard of the trial closure through the media rather than from trial staff or investigators. An additional two participants first learned of the trial results from the present sociobehavioral study interviewers. A participant attributed his negative feelings not to the results per se but to inadequate communication throughout the study termination process: Participants specifically discussed their fear and frustration at hearing initially about the study termination through the media: You know, I read it first and, but it was months before anybody told me.
I would definitely caution people against that in the future. A participant who was told she had received the test vaccine struggled with articulating her understanding of the complex results revealed in the unblinding process enhanced susceptibility to HIV infection among those with high Ad5 [adenovirus] neutralizing antibody titers: I was dumbfounded.
This is my first blood test and I just hope it comes out negative. But now I just feel like a sick person 35 y. Page 8 Two volunteers who had dropped out of the trial were among those who contacted research staff of the present study and were interviewed.
After completion the interviewer provided contact information and urged them to follow up with the research clinic for their own NIH-PA Author Manuscript safety. These volunteers indicated complete surprise upon hearing about the results: That information was never passed on to me.
It was my understanding that Thus different perspectives emerged between participants and key informants regarding the nature of communication in the process of early termination and unblinding. Post-trial follow-up and support: Four participants described being left for long periods of time without contact from investigators.
After the initial roll-out of results, a participant reported that follow-up subsided: Did a lot of these people in this clinical trial actually contract HIV while they were doing the trial and what percentage? What's their life like now, are they being compensated or anything? Trial participants and key informants both discussed counseling for volunteers, beyond the traditional risk reduction counseling conducted in HIV prevention trials.
A participant explained: A key informant also explained broader challenges and disappointment regarding post-trial dissemination of information in HIV vaccine and other biomedical prevention trials: Page 9 The information has not been in favor of big pharma or small pharma coming up with solutions…because of the trials not having the kind of outcomes that are appropriate to continue with.
Research is research. However the unforeseen termination of the study led four participants to specifically express mistrust of clinical trials: The pharmaceutical company, I think that they in many ways tied the hands of the researchers.
NIH-PA Author Manuscript Another participant indicated fear, even after unblinding, that he may have actually received the test vaccine: Page 10 3. Willingness to participate: I am more aware of what can happen in a trial and the risks of it. It happened unfortunately to a lot of people who are going to have to deal with that n. A participant articulated his complex feelings and ambivalence, reflecting the widespread NIH-PA Author Manuscript motivations based on altruism in conflict with fears for personal health and safety: I feel very conflicted now more so than when I started in the trial because I still rationally believe that these trials are important and I understand that they need to happen.
Alternately, 9 participants described ongoing motivations to participate in HIV vaccine trials based on altruism, the memory of a friend and a desire for new HIV prevention technologies. When asked whether they would consider volunteering for a future HIV vaccine trial or not, these participants responded: Participants also accurately articulated the need to include the results of the Step Study in future trial consent processes: Key informants described reservations about future HIV vaccine trials as well, and their increased scrutiny of experimental vaccines: Page 11 4.
Discussion This mixed methods investigation examined in depth the experiences and perspectives of NIH-PA Author Manuscript volunteers, largely gay men, at one site of the Step Study Phase 2b HIV-1 vaccine trial upon the early termination of the trial. The experimental vaccine was not efficacious and a subgroup of test vaccine recipients were unexpectedly placed at increased susceptibility to HIV infection [7,9].
The most striking disparity was simultaneously what participants identified as the most troublesome aspect of their trial experience: Over half of participants interviewed went so far as to retroactively doubt the NIH-PA Author Manuscript integrity of the informed consent process given the unexpected adverse effects of the test vaccine; however, many expressed acceptance of the fact that a clinical trial involves inherent uncertainties and reported that they had understood the possible risks of participation.
Nevertheless, participants questioned and were upset by perceived delays and gaps in communication, particularly in waiting for the trial to be unblinded and in first hearing about the results from the media rather than from investigators. Furthermore, what may constitute quick, efficient and transparent communication and decision-making in the complex world of clinical trials, among trial sponsors, data safety monitoring boards and investigators, may seem like protracted periods of uncertainty among participants.
As participants may continue to engage in similar risk behaviors to those that initially made them eligible for the trial, they may understandably harbor reality-based fears that the test vaccine rendered their even unchanged level of risk behaviors more dangerous. The fact that the present sociobehavioral study succeeded in recruiting two participants who had NIH-PA Author Manuscript previously dropped out of the trial and was the initial conduit for informing them of the overall trial results suggests that relatively low-cost community outreach efforts may help to mitigate loss to follow-up and enhance communication of results.