This month, The Centers for Disease Control and Prevention released the first well-documented report on HIV transmission among male adult performers, providing a detailed look at a case where the virus was spread on set. The incident occurred during a film production in the fall of 2014 and involved a performer who was within the 14-day recommended testing window for healthy work clearance, but had contracted HIV from outside sexual contact and transferred the virus to another performer before his newly positive status was known.
Currently, many adult film production companies rely on regular testing as their main form of performer protection, requiring a clean bill of health within 14 days prior to the start of filming. For these companies, performer test results are uploaded to a database that allows producers to see whether or not a performer is eligible to perform, without compromising the rest of their medical privacy.
Proponents of this system believe that rigorous testing protects performers better than a condom mandate because such a requirement could push the adult industry out of Porn Valley, an area with the infrastructure and reporting services required to run a database of STI test results. Such a move would likely push performers to work in areas without such rigorous requirements for testing and/or condom use, increasing their risk of disease. Additionally, with the athletic and oftentimes lengthy style of performative sex comes an increased risk of condom breakage and tearing of delicate mucosal tissues, two things that could increase the risk of disease transmission, especially absent an implemented testing protocol.
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However, there is no question that the 14-day protocol leaves some gaps in coverage.
In the CDC’s report, the performer in question had unprotected insertive and receptive oral and anal sex with a non-work contact who turned out to be HIV positive. The incident happened six days before the performer had his HIV nucleic acid amplification test (NAAT) to clear him for work, at which point he still tested negative for HIV despite his recent infection. Unfortunately, that six-day window between exposure and test wasn’t long enough for the performer to test positive on even the highly sensitive HIV NAAT, which generally takes at least 10 days to show a positive.
At 15 days post-exposure, the performer did a one-day film shoot during which no one contracted the virus; the following day, the performer became symptomatic for acute HIV infection, presenting with a rash, fever, and sore throat. The day after symptoms appeared, the performer participated in a three-day film shoot, during which, out of the six condomless, or “bareback” exposures, transmission occurred in one of these cases. According to Christopher Ried, MD, the Medical Director of HIV/STD Services for the Orange County Health Care Agency and author on the CDC’s report detailing the transmission, this pattern fits with what we know about HIV transmission.
“You’re contagious before the symptoms but highly contagious when you’re symptomatic,” he told the Daily Beast in an email.
But why is the CDC publishing this report now? As members of the industry noted, this case of HIV transmission is old news; dragging it back up through the current media cycle could be damaging to the industry and their current battle against condom requirements in the state of California. So why put this case back in the spotlight?
According to the California Department of Public Health, known as CDPH, “the CDC considers cases of possible occupational transmission of HIV to be ‘Cases of Public Health Importance’ requiring more thorough investigation than most newly diagnosed cases of HIV.” Basically, if it happens at work, it’s no longer just personal business: it’s a matter of public health. And it falls to the CDPH to investigate occupational transmission of HIV to help identify methods of preventing future infections among employees.
To meet this end, the CDPH issued an Occupational Health Alert (PDF) in late 2014; the resulting CDC Morbidity and Mortality Weekly Report represents the collaborative findings from the agencies involved in the investigation.
So what did what did we learn from these findings?
One note of interest is that none of the performers with whom the patient worked, nor any of his non-work sexual contacts, were on Pre-Exposure Prophylaxis for HIV, also known as PrEP, a medication (Truvada) that, when used as directed, can decrease risk of HIV infection by up to 90 percent.
Though the CDPH doesn’t have any data on the current prevalence of PrEP usage rates among porn performers, given the rising awareness of the drug, usage rates are likely higher today than they were in 2014. PrEP is undoubtedly a prudent step in protecting performers, but it’s important to note that the medication does not protect against other sexually transmitted infections. Additionally, as employers cannot verify that performers adhere to the PrEP regime, the drug seems to be yet another imperfect but important tool in safeguarding porn star health.
The CDC’s report is especially timely given this week’s meeting in Oakland on the proposed condom law: on Thursday, the Cal/OSHA board rejected the proposal mandating condoms in porn.
Relevant to this, the CDC’s report detailing the 2014 on-set transmission provides detailed recommendations to prevent the spread of HIV and other STIs in the adult film industry. Among the recommendations: frequent tests for HIV and other STI’s, vaccinations for Hepatitis A and B, and HPV, strict condom use, and discussing the use of PrEP with health care providers.
The issue of regulating condom use in porn is hotly contested, with many citing First Amendment rights, performer autonomy, and the complex health risks from going condom-only as reasons to keep the Nanny State out of the so many well-lit, camera-filled bedrooms around California. Others consider the risks faced by adult performers to be outside what anyone should have to endure at work, and see the condom mandate as a straightforward attempt to keep America’s porn stars and starlets safe and healthy.
It’s unclear how this battle is going to play out, but one thing is certain: when it comes to using a test to prevent disease transmission, there is no such thing as a sure thing. But lest we get too cocky about an easy fix, the propensity for condoms to break should serve as a clear reminder that this issue isn’t nearly as simple as “just wrap it up.”
