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Sexually transmitted infection testing of adult film performers: is disease being missed?

Sexually transmitted infection testing of adult film performers: is disease being missed?

| On 13, Mar 2013

It has been estimated that pornography in Los Angeles County, with its approximately 200 adult film production companies, is a $1 billion industry. After several instances of human immunodeficiency virus (HIV) transmission involving performers were reported, regulatory recommendations were made. There were, unfortunately, no means of enforcement and the industry failed to self-regulate. The Adult Industry Medical Health Care Foundation was, however, created to provide monthly HIV testing to heterosexual performers and, in 2003, added urine-based screening for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT). Because participation is entirely voluntary and the anatomic sites tested are limited, knowledge of the prevalence and incidence of sexually transmitted infections in the industry has been unknown.

In an attempt to reduce this uncertainty, investigators from the Los Angeles County Department of Public Health offered extensive testing for NG (oropharyngeal, rectal, and urogenital) and CT infection testing (rectal and urogenital) to consecutive adult film industry performers who sought care at a primary care clinic. Oropharyngeal and rectal swab specimen collection was offered to all, as was a urine specimen from men and a vaginal swab specimen from women. All specimens were evaluated using a nucleic acid amplification test. Because only 1 man agreed to rectal sampling, results from this site were not evaluated in men. The women had worked for a median of 3 years in the industry and the men for 7 years, and 79% had worked in the previous 30 days. Condoms were always used for vaginal intercourse off the set by only 5% of performers and on the set by only 1%.

Forty-seven of 168 (112 female, 56 male) individuals tested had evidence of infection with either NG or CT; limiting testing to urogenital samples would have missed 11 of the 47 (23%). The more frequently identified pathogen, NG, was identified in 25% of the total cohort, with the oropharynx being positive in 79% of these. All CT infections in women were found in both rectal and urogenital specimens and 60% of GC infections in women involved all 3 sites, whereas 17% only involved the oropharynx. The infection was asymptomatic at all sites in 40% of women and 53% of men; >90% of rectal and oropharyngeal infections were asymptomatic in both sexes. This experience demonstrates the need for routine testing of multiple sites in adult film performers.

Nevada state law requires brothel workers to always use condoms and to be tested weekly for sexually transmitted infections and this has been very effective. No comparable enforceable regulations had existed in California for adult film performers. However, on 6 November 2012, 57% of voters in Los Angeles approved measure B, the Safer Sex in the Adult Film Industry Act, that requires the use of condoms during all penetrative vaginal and anal sex scenes filmed in the city. It also requires education about sexually transmitted diseases as well as payment of a permitting fee by producers and empowers the Los Angeles Police Department to perform spot checks on any set once a film permit is issued. The New York Daily News reported that, in response to these regulations, adult film legend Ron Jeremy said that as a result of the “condom law,” pornography would start being outsourced and “you’ll hear more accents in your porn” [1].

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↵ New York Daily News. Porn industry exec files suit claiming Los Angeles condom law impinges on free speech. Available at: Accessed 25 January 2013.