LA porn industry not doing enough to prevent HIV, finds investigation

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An investigation into four cases of heterosexual HIV transmission in the Los Angeles pornographic film industry in 2004 has revealed that the pornographic film makers involved did not comply with Californian State occupational health regulations. The investigation is reported in the September 23rd edition of Morbidity and Mortality Weekly Review. Condoms are not routinely used in heterosexual pornography produced in Los Angeles, and state and federal government investigators found that performers were relying on monthly HIV viral load tests (which they paid for themselves) to determine their HIV infection status.

“This investigation identified important and remedial gaps in the prevention of AIDS and other sexually transmitted [infections] in the adult film industry”, comment the report authors.

In early April 2004 a 40-year old male pornographic film performer was identified as being infected with HIV during routine monthly HIV monitoring using a PCR test which looks for HIV’s genetic material. Tests in February and March 2004 had been negative. In the period between the last two negative tests the man had been engaged in the production of a pornographic film in Brazil, where he had experienced a ‘flu-like illness'.

Glossary

morbidity

Illness.

hepatitis B virus (HBV)

The hepatitis B virus can be spread through sexual contact, sharing of contaminated needles and syringes, needlestick injuries and during childbirth. Hepatitis B infection may be either short-lived and rapidly cleared in less than six months by the immune system (acute infection) or lifelong (chronic). The infection can lead to serious illnesses such as cirrhosis and liver cancer. A vaccine is available to prevent the infection.

polymerase chain reaction (PCR)

A method of amplifying fragments of genetic material so that they can be detected. Some viral load tests are based on this method.

pathogen

Any micro-organism which can cause disease. There are four main types: bacteria, fungi, protozoa, viruses. Parasitic worms are sometimes described as pathogens.

mucosa

Moist layer of tissue lining the body’s openings, including the genital/urinary and anal tracts, the gut and the respiratory tract.

The man had unprotected sex with thirteen women in pornographic films after his return from Brazil and infection with HIV. Three of these women tested HIV-positive. The authors of the report note, “during film production all three of the infected female partners had engaged with the index patient in specific acts associated with increased possibility of mucosal tears.”

The indicated genetic testing confirmed that the man was the source of the HIV infection in the three women.

Los Angeles health officials were notified of the man’s HIV infection within days of his positive result, and Californian occupational health officials, together with the US government Centers for Disease Control and Surveillance subsequently became involved in the outbreak.

A total of 25 pornographic performers who had direct sexual contact with the four HIV-infected individuals were identified. None tested HIV-positive. In addition, 36 performers who had had sexual contact with these 25 individuals were traced, and again none tested HIV-positive.

Two pornographic film makers and some of the performers with newly-diagnosed HIV infection had citations issued against them by occupational health officials for “failing to comply with the state’s bloodborne pathogen standard, failing to report a serious work-related illness, and failing to prepare and follow a written occupational injury and illness prevention programme.”

“The occurrence of HIV transmission in the adult film industry underscores the existence of serious risk for HIV infection in this industry and the need to fully inform workers of these risks and for employing safeguards to reduce transmission of HIV and other STIs”, write the editors of the report. They note that 1,200 performers are involved in the production of pornographic films in Los Angeles and that “production companies in the heterosexual segment of this industry have generally not required condom use for any type of sexual act.” Condoms have been routinely used in mainstream gay pornography for anal sex since the late 1980s, although a submarket for “bareback” films and recently emerged.

In place of condoms, many production companies and performers rely on periodic HIV screening. However, as the authors emphasise, “as demonstrated by the recent incidents of HIV transmission in this industry, screening alone is not adequate to prevent transmission of HIV and others STIs because infected persons can transmit these diseases for a period before their infection can be diagnosed.”

As well as being an inadequate means of controlling the transmission of infection, the authors note with concern that performers typically had to meet the costs of HIV and STI screening and vaccination for hepatitis B virus. These costs could mean that individuals “reduce the range and frequency” of testing.

“Findings from this investigation emphasise the need to review current health and safety policies in the adult film industry and ensure that they are designed in accordance with [occupational health] requirements”, conclude the authors.

References

HIV transmission in the adult film industry – Los Angeles, California, 2004. Morbidity and Mortality Weekly Review 54: 923 – 926, 2005.

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