The Adult Film Industry: Time to Regulate? Corita R
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Policy Forum The Adult Film Industry: Time to Regulate? Corita R. Grudzen*, Peter R. Kerndt he United States adult fi lm adult fi lms—approximately 17% for chlamydia and gonorrhea rates were industry produces 4,000–11,000 adult performers [5]. In 2004, only 4.0% and 0.7%, respectively [8]. Some Tfi lms and earns an estimated $9– two of the 200 adult fi lm companies might argue that this program of STD $13 billion in gross revenues annually required the use of condoms for testing keeps rates of HIV and other [1]. An estimated 200 production all penile–anal and penile–vaginal STDs lower than in other sex-related companies employ 1,200–1,500 penetration [2]. Performers report industries, and in fact, a recent study of performers [2]. Performers typically that they are required to work without prostitutes in San Francisco found 6.8% earn $400–$1,000 per shoot and are condoms to maintain employment. and 12.4% positivity rates for chlamydia not compensated based on distribution These practices lead to high and gonorrhea, higher than rates in or sales. transmission rates of STDs and the adult fi lm industry [9]. Los Angeles County is the largest occasionally HIV among performers. Between January 2003 and March center for adult fi lm production After four performers contracted HIV 2005, approximately 976 performers worldwide. In 1988 the California in 1998, Sharon Mitchell, a former were reported with 1,153 positive STD Supreme Court, in People v. Freeman, adult fi lm performer, founded Adult test results. Of the 1,153 positive test found adult fi lm production to be Industry Medical (http:⁄⁄www.aim-med. results, 722 (62.6 %) were chlamydia, protected as free speech under the First org), a clinic to counsel and screen 355 (30.8%) were gonorrhea, and Amendment, since such fi lms were not performers monthly for HIV using a 126 (10.9%) were coinfections with considered obscene based on prevailing PCR test (Figure 1). It was expanded chlamydia and gonorrhea [10]. Less community standards. Unlike other later to include other STD testing. The is known about the prevalence and legal but highly regulated activities testing program began as an effort risk of transmission of other STDs such as gambling and commercial sex to reduce transmission of infections such as syphilis, herpes simplex virus, work in Nevada, the adult fi lm industry through early diagnosis, treatment, human papillomavirus, hepatitis B or was legalized in California through and “quarantine” should a performer C, trichomonal infection, or diseases case law, not by statute, and has for test positive for HIV. Performers are transmitted through the fecal–oral the most part escaped governmental required in most cases to pay for all route. oversight. Regulation of the industry screening tests, and to sign a consent Efforts to reduce the risk of HIV and has been limited to prevention of child form that permits disclosure of their other STD transmission must include pornography. Title 18, Section 2257 of test results to other performers and the use of condoms. Even with the the United States Code of Regulations producers before fi lming. Both of PCR testing currently used within the explicitly prohibits performers under these practices are explicitly prohibited industry, a recently infected performer age 18 and provides for civil and under California Occupational Safety can test negative during the window in criminal prosecutions for any violation and Health Administration (Cal/ which they are highly infectious and [3]. Adult fi lm production companies OSHA) regulations. HIV-positive are required to have a Custodian female performers are permanently Funding: The authors received no specifi c funding of Records to document and retain excluded from participating in adult for this article. records of the age of all performers, to fi lms. Competing Interests: The authors have declared enforce the age entry restriction. that no competing interests exist. Adult fi lm performers engage in Worker Safety and Public Health Citation: Grudzen CR, Kerndt PR (2007) The adult prolonged and repeated sexual acts The current practice of periodic fi lm industry: Time to regulate? PLoS Med 4(6): e126. with multiple sexual partners over HIV and STD testing may detect doi:10.1371/journal.pmed.0040126 short periods of time, creating ideal some disease early, but often fails to Copyright: © 2007 Grudzen and Kerndt. This is an conditions for transmission of HIV prevent transmission. The most recent open-access article distributed under the terms and other sexually transmitted diseases HIV outbreak occurred when three of the Creative Commons Attribution License, (STDs). All the more concerning, performers who had been compliant which permits unrestricted use, distribution, and reproduction in any medium, provided the original high-risk practices are on the rise with monthly screening contracted author and source are credited. [4]. These practices include sex acts HIV in April of 2004 [6]. At that time, Abbreviations: Cal/OSHA, California Occupational that involve simultaneous double a male performer who had tested HIV Safety and Health Administration; STDs, sexually penetration (double-anal and vaginal– negative only three days earlier infected transmitted diseases anal intercourse) and repeated facial three of 14 female performers. Corita Grudzen is a Robert Wood Johnson Clinical ejaculations. At the same time, condom Other STDs are also highly prevalent Scholar at the University of California, Los Angeles, use is reportedly low in heterosexual in the industry. Among 825 performers Los Angeles, California, United States of America. screened in 2000–2001, 7.7% of females Peter Kerndt is the Director of the Sexually Transmitted Disease Program in the Los Angeles and 5.5% of males had chlamydia, and County Department of Public Health, Los Angeles, The Policy Forum allows health policy makers around 2% overall had gonorrhea [7]. These California, United States of America. the world to discuss challenges and opportunities for rates are much higher than in patients improving health care in their societies. * To whom correspondence should be addressed. visiting family planning clinics, where E-mail: [email protected] PLoS Medicine | www.plosmedicine.org 0993 June 2007 | Volume 4 | Issue 6 | e126 on television and the Internet could decrease condom use. Requiring condoms may infl uence viewers to see them as normative or even sexually appealing, and devalue unsafe sex. With the growing accessibility of adult fi lm to mainstream America, portrayals of condom use onscreen could increase condom use among viewers, thereby promoting public health. In contrast to heterosexual adult fi lms, homosexual-targeted productions more consistently require condoms. Due to the large number of HIV-positive performers, there is no requirement for HIV testing and condom use is the norm. Despite the ubiquitous use of condoms, homosexual adult movies are popular and profi table for production companies. In fact, there is some evidence that homosexual male audiences would not tolerate movies with unsafe sex, likely due to their proximity to many with HIV in the homosexual community. Some homosexual audiences regard watching sex without condoms as “watching death on the screen” [16]. Regulation of Sex-Related Industries Legislators can look to Nevada for a model for the successful regulation of a legal sex-related industry. Since the doi:10.1371/journal.pmed.0040126.g001 institution of mandatory condoms in Nevada’s brothels in 1988, not a single Figure 1. Screenshot of the Web site of Adult Industry Medical Health Care Foundation sex worker has contracted HIV [17]. Workers must be repeatedly tested go on to transmit the virus to others. in commercial sex work through for HIV, syphilis, gonorrhea, and A meta-analysis suggests that condoms escort services or use intravenous chlamydia to maintain a state health are 90%–95% effective in preventing drugs, risking HIV and hepatitis C and work card. There are numerous HIV transmission [11]. Condoms are infection. The use of condoms would other international models for condom especially important given the high-risk prevent performers who had acquired enforcement in sex work, from Mexico sex acts increasingly being performed HIV and STDs outside the workplace City to Amsterdam. While there is no in the industry. When looking at HIV from transmitting these infections to clear model for mandatory condom exposure risks by site, receptive anal sex other performers in the workplace. use in adult fi lm, Brazil boasts an 80% has the highest risk at 80 instances of Additionally, condoms would help condom usage rate in their adult fi lms transmission per 10,000 exposures [12], prevent unwanted pregnancy and the [18], while still maintaining a large higher than needle stick injuries (10–50 complications of STDs, which include share of the international market per 10,000) [13] or receptive vaginal ectopic pregnancy, pelvic infl ammatory as the world’s second largest adult penetration (10 per 10,000) [14]. Pre- disease, and infertility. Little is fi lm industry [18]. This suggests that existing infection with other STDs also currently known about the prevalence condom use in adult fi lms does not increases the risk of HIV transmission. of these diseases in performers. have to erode profi tability. It is also One study showed that the relative risk The portrayal of unsafe sex in possible to use fi lming techniques to of HIV acquisition in a vaginal receptive adult fi lms may also infl uence viewer reduce the visual effect of condoms, partner increases 2- to 4-fold when the behavior. In the same way that images by using fl esh tone–colored condoms receptive partner is infected with herpes of smoking in fi lms romanticize or by digitally removing them post- simplex type 2 [15]. tobacco use, viewers of these adult production. Facial ejaculations could Performers may also be exposed fi lms may idealize unprotected sex be simulated through the use of inert to HIV and other STDs outside the [16].