The Power of the Shared Experience: MTN-020/ASPIRE Trial Participants' Descriptions of Peer Influence on Acceptability of and Adherence to the Dapivirine Vaginal Ring for HIV Prevention.

Women are disproportionately at risk of acquiring HIV in East and Southern Africa, despite global declines in incidence. Female-initiated HIV prevention methods, like the dapivirine vaginal ring, are needed to end the HIV epidemic. In-depth interviews and focus groups retrospectively explored peer influence on acceptability of and adherence to the ring during the ASPIRE trial, a phase III placebo-controlled trial. Results were analyzed using an inductive analytic approach. Study participants (peers) of all ages and adherence groups developed important interpersonal connections and reported being more open and honest with each other than with external peers or study staff. Study peers who knew each other prior to joining appeared to have a stronger influence on each other's adherence than peers who met in the study. External peers provided primarily negative input about the ring and study, which sometimes led to ring removals. Peers' influence on each other's behavior in both prosocial and detrimental manners could have repercussions on adherence to a biomedical intervention, and consequently, individual disease risk and clinical trial outcomes. Future ring demonstration and implementation studies could use peer networks to intentionally influence uptake and adherence to the ring.

Relationship Type and Use of the Vaginal Ring for HIV-1 Prevention in the MTN 020/ASPIRE Trial.

Gender roles and imbalances in sexual power contribute to the heightened HIV-1 risk faced by women in Sub-Saharan Africa. This has led prevention research to focus on the development of female controlled methods. Despite the design of products such as vaginal rings to be used autonomously by women, male partners and women's perceptions of relationships influence HIV prevention choices. To understand the influences that male partners and dyadic dynamics had on the use of the Dapivirine Vaginal Ring in the ASPIRE trial, this analysis of qualitative data explored the types of intimate partner relationships that women engaged in. This paper describes how partners facilitated or challenged women's ring use and how women dealt with these challenges within six different types of relationships characterized by power dynamics and commitment levels. We offer insights into how future use of female-initiated HIV prevention products can be promoted through recognition of different relationship types.

Soft x-ray spectroscopy from image sequences with sub-100 nm spatial resolution.

A method is described whereby a sequence of X-ray images at closely spaced photon energies is acquired using a scanning transmission X-ray microscope, and aligned. Near-edge absorption spectra can then be obtained both from large, irregular regions, and from regions as small as the spatial resolution of the microscope (about 40 nm in the examples shown here). The use of the technique is illustrated in examination of a layered polymer film, a micrometeorite section, and an interplanetary dust particle section.

An experimental study of the placebo effect in African traditional medicine.

In an experimental study on the placebo effect in Malawi, an independent East African nation, 21 Malawian college students were tested individually in two 1-hour sessions on successive afternoons, using a one-group, two-condition before-after counterbalanced experimental design. Subjects were falsely told that a physiologically neutral substance they consumed would arouse the body, affecting oral temperature and pulse. Before-after measurements were taken during each day's session. On one of the days, the placebo resembled a traditional African herbal concoction, whereas on the other day, the placebo appeared to be a commercial Western-style medicine. The placebo effect was evaluated for each medication by comparing pre- and posttreatment scores. After the session, the subjects completed a questionnaire on their beliefs in the power of each style of medication. The placebo response was demonstrated in both medication conditions for oral temperature, but the strength of the placebo effect did not vary between medication styles. No significant relationship was found between the placebo effects and self-reported attitudes toward the two types of medication.