Safer Sex for Sex Workers Part 2: Public Health Issues in the Adult Film Industry
1. Public Health Issues in the Adult
Film Industry
Peter R. Kerndt, MD, MPH
Director, STD Program
Los Angeles County DHS
Policy Implications of an Outbreak
2. Background
In April, 2004, four cases of HIV were
found in the adult film industry (AFI) in Los
Angeles County
Workplace transmission of HIV suggested
by sexual contact histories and subsequent
gene sequencing
How can AFI workers be protected from
HIV and other STDs? How can the next
outbreak be prevented?
3. Overview of Presentation
The HIV Outbreak of April 2004
The Adult Film Industry today: avoidable
risks in worker health and safety?
AFI health and safety issues
AFI health and safety solutions
Where do we go from here?
4. Why LAC DHS is Concerned
about the Adult Film Industry
Public health:
DHS obligated to stop spread of communicable
diseases, including to sex industry workers
Workers can help spread STDs in the general
population through their private sex partners
Worker health:
STDs can have severe health consequences
STDs are preventable
Appropriate health safeguards for AFI workers can
prevent spread of HIV and other STDs
5. Before April, 2004
The LAC DHS Sexually Transmitted
Disease Program (STDP) was already
working on AFI issues:
Collaborated with Adult Industry Medical
Health Care Foundation (AIM) to pilot
routine syphilis, chlamydia and gonorrhea
screening for AFI performers
Convened an interagency working group to
address AFI work practices
and then…
7. The Index Case
April 9, 2004: a male performer tests positive for
HIV by PCR DNA test (Roche Amplicor HIV-1) at
AIM
Positive test confirmed April 12, 2004
Reported in Adult Video News (AVN) April 13
STDP notified verbally April 14
Index Case was AFI veteran:
40 years old male
Described as “mild mannered”, an “Old Pro”
Working in AFI since 1998
Performed in 250 films
The 2004 HIV Outbreak
8. The Index Case (continued)
Tested regularly for HIV: according to AIM,
had been tested every 3 weeks for 7 years,
always negative, including:
– negative HIV test Feb. 12, 2004
– negative HIV test March 17, 2004
Went to Brazil in late February:
Engaged in unprotected insertive vaginal, anal,
and double-anal penetration
Experienced flu-like illness that self-resolved
The 2004 HIV Outbreak
9. The Index Case (continued)
Returned to California March 10
Over the next month, continued
performing in adult films
had direct sexual contact with 13 female performers
engaged in unprotected oral, vaginal, and/or anal sex
engaged in unprotected double-anal sex with 3 of the
female performers
by self report, had no private sexual partners since Feb
12
Positive HIV test April 9
The 2004 HIV Outbreak
10. The Film “Split That
Booty 2” is suspected as
the film that documents
the at-risk work practices
for the Index patient
The Index Case (continued)
11. The Three Female Cases
Within three weeks, 3 of the 13 females who worked with
Index Case after his return from Brazil test HIV-positive =
23% attack rate
1st
female case tested HIV+ on April 13
– Sexual contact with Index Case: March 24
– Last negative HIV test: March 20
– Age 21
2nd
female case tested HIV+ on April 25
– Sexual contact with Index Case: March 24
– Last negative HIV test: April 13
– Age 26
3rd
female case tested HIV+ on May 5
– Sexual contact with Index Case: March 30
– Last negative HIV test: April 12
– Age 25
The 2004 HIV Outbreak
12. The Three Female Cases (continued)
All three HIV+ females had unprotected
double-anal intercourse with Index Case
Increased potential for mucosal tears
Index Case said he did NOT have double-
anal intercourse with any other occupationa
sex partners during this period
The 2004 HIV Outbreak
13. F #1 Pos 4/13
F #5 Pos 4/25
F #3 Pos 5/5
F #1 Last Neg 3/20
F #2 Last Neg 4/13
F #3 Last Neg 4/17
F #1 Sexual Contact with Index 3/24
F #2 Sexual Contact with Index 3/24
F #3 Sexual Contact with Index 3/30
14. Industry Responses:
The Quarantine List
Within days of Index Case test result, AIM establishes
a “Quarantine List” of exposed performers
Voluntary effort, no legal authority, self-enforced
List maintained on publicly accessible AIM website,
using performer stage names (not legal names)
AIM attempts to identify, contact, and provide HIV
testing to all potentially exposed performers
The quarantine list ultimately includes:
25 first generation partners (had sex with one of the 4
cases)
36 second generation partners (had sex with first
generation)
The 2004 HIV Outbreak
15. Index HIV +
Case
HIV + ♀
Secondary♀
Sex contact
Primary ♀
sex contact
Secondary ♂
sex contact
2004 AFI Outbreak: Sexual Contacts
16. Industry Responses:
Quarantine List Testing
At first: stop until June 8 (2 mos after Index Case positive)
May 11: AIM begins “clearing” performers who tested
negative at least 30 days after exposure
According to AIM, PCR-DNA, other tests, would detect any infection
within 30 days
AIM maintains list on website until June 30. By then:
24 of 25 known first generation partners tested negative at least
once since exposure, cleared to work
35 of 36 known second generation partners tested negative at least
once since exposure, cleared to work (or else their first-generation
partner cleared)
The 2004 HIV Outbreak
17. Industry Responses:
The Moratorium
After Index Case positive, AIM, AVN,
others in industry call for 60-day
moratorium on all filming
Voluntary effort, no legal authority,
self-enforced
At least 18 production companies
reportedly halt production, probably
more participate, though many
apparently do not
Duration of actual work stoppage for
various producers not known
The 2004 HIV Outbreak
18. Public Health Responses: LAC DHS
4-20: LAC DHS Field staff obtain test results for
many performers on AIM website
4-21: LAC DHS Health Officer Dr. Jonathan E.
Fielding instructs AIM to work with DHS as needed
to address industry outbreak; more test results
obtained
STD Program staff subsequently interview and
provide assistance to all 4 AFI HIV cases
The 2004 HIV Outbreak
19. Public Health Responses: LAC DHScontinued
8-04: Health Officer letter to AIM:
testing is not adequate protection
recommending condoms for all sex acts
9-04: Health Officer letter to 760 AFI production
company custodians of records, recommending:
condom use for all sex acts
routine periodic HIV/STD screening
HAV/HBV vaccination
worker education
The 2004 HIV Outbreak
20. Public Health Responses:
Cal/OSHA
6-4: Cal/OSHA initiates investigation, per LAC DHS request
9-15: Cal/OSHA issues citations to 2 production companies
Both companies involved in film production during which HIV
transmission occurred
Total of 4 citations each
Failure to comply with bloodborne pathogens (BP)
standard
Failure to report serious work-related illness
Failure to record injuries and illnesses
Failure to prepare and follow and written illness and injury
prevention program, or IIPP
Total fines = $30,560 per company
The 2004 HIV Outbreak
21. Public Health Responses: Cal/OSHAcontinued
September 2004: CA Department of Industrial
Relations creates webpage for AFI
www.dir.ca.gov/dosh/AdultFilmIndustry.html
Provides information for industry workers and employers
on compliance and assistance resources
Through citations and the webpage, Cal/OSHA has
asserted that existing occupational regulations apply to
AFI, specifically including:
Bloodborne Pathogens standard (CCR T8 §5193)
Illness and Injury Prevention Program (CCR T8
§3203)
The 2004 HIV Outbreak
22. Public Health Responses: Cal/OSHAcontinued
Basic requirements of the Bloodborne
Pathogens (BP) standard:
Protect employees from hazards from blood and
other potentially infectious materials (OPIM, e.g.,
semen)
– Use personal protective equipment (e.g., condoms),
work practice controls, and engineering controls to
prevent exposure
Create Exposure Control Plan (ECP)
Provide HBV vaccination
Provide worker training
Provide medical (confidential) monitoring
The 2004 HIV Outbreak
23. Public Health Responses: CDC
5-18/19: CDC NIOSH and CDC NCHSTP conduct
LA site visit, per LAC DHS request for Technical
Assistance
CDC NIOSH and CDC NCHSTP establish
convincing evidence of occupational HIV
transmission among AFI performers, through gene-
sequencing…
The 2004 HIV Outbreak
24. Public Health Responses: Using Gene-Sequencing to
Establish Occupational Transmission
The Index Case and 2
Female Cases provided
whole blood specimens
Gene sequencing was
performed on the p17
region of gag and the gp-41
region of env using
standard techniques
Sequencing was performed
by two different CDC
scientists on separate days
The sequences of the 3 HIV
samples were identical:
meaning this was the same
exact strain of HIV….very rare!
The 2004 HIV Outbreak
25. Public Health Responses: Establishing
Occupational Transmission
continued
Epidemiology also supports
occupational transmission
All 3 female cases tested HIV-negative shortly
before or within 3 weeks after unprotected
sexual contact with the Index Case
All 3 female cases tested HIV-positive within
one month of exposure to the Index Case
The 2004 HIV Outbreak
26. Public Health Responses: Ongoing
Collaboration to draft model Exposure
Control Plan (ECP) for AFI
LAC DHS
Cal/OSHA
CA DHS
NIOSH
Other agencies (e.g., Los Angeles City
Attorney’s AIDS/HIV Discrimination Unit)
The 2004 HIV Outbreak
27. Industry Responses…One Year Later
Mostly business as usual
Some changes at AIM. Reportedly:
Creation of a sex-scene contacts database, to facilitate
future partner identification and notification
Some increases in education and testing services
No widespread changes in industry norms regarding:
Condoms
Employer financing of testing
Work practices
Training and education of workers
The 2004 HIV Outbreak
28. Policy One Year Later
Cal/OSHA has established that BP
applies to AFI: it is the “law of the land”
But: no subsequent enforcement, and
no apparent compliance by industry
The 2004 HIV Outbreak
31. Large and Legal
Legal in CA: People v. Freeman, 1988
CA State Supreme Court decision (250 Cal.Rptr.
598)
Court ruled pornography is not pandering if content
protected by 1st
amendment
Economic value:
Estimated gross revenue from up to 11,000 films
annually: as high as $13 billion
Estimated retail value of product produced in LA
County in 2002: $3 billion (LA Economic
Development Corp.)
The Industry: Avoidable Risks?
32. Other Characteristics that
Impact Health and Safety
Movement across borders not uncommon: non-US
performers shoot in US, and US companies shoot overseas
2 Female Cases were non-US nationals
Index Case presumably became infected while filming in
Brazil
Workers not organized
Typically transient in industry
“Rebel” and “outcast” social status impedes organizing
Males (In straight industry) more long-term, would likely
need to push organizing effort
The Industry: Avoidable Risks?
33. In LA County
~ 200 AFI production companies
An estimated 5-10 large companies produce
half of films, or more*
Approximately 5 major film distributors*
More than 700 legal custodians of records
6,000 workers (total)
1,200 sex performers
An estimated 75% of performers are female*
Only 30-100 regular male performers*
Most women make only one film*
* anecdotal information from industry sources
The Industry: Avoidable Risks?
34. Making an Adult Film*
Films shot in private homes or film studios
Performers paid $400 to $1,000 per scene (men
paid less than women)
Production costs:
Approximately $10,000 equipment costs
Typical production cost: $13,000 - $16,000 / film
– as low as $5,000 / film
– as high as $50,000 / film for larger companies
“Successful” films typically sell 1,500 -2,000 units
Wholesale price:
– approx. $8-$10 per unit for “vanilla” films
– Approx. $10-$13 per unit for “gonzo” films
* anecdotal information from industry sources
The Industry: Avoidable Risks?
35. Beyond Home DVD / Video
Cable TV
Comcast: $50 million from “adult “
films in 2002
DirecTV: $200 to $500 million from
adult films in 2002
Hotels:
Hilton, Marriot, Hyatt, Sheraton and
Holiday Inn, all offer adult films on in-
room pay-per-view television systems.
Estimated 50% of hotel guests watch
adult film, accounting for nearly 70 %
of in-room profits.
The Industry: Avoidable Risks?
37. General AFI Work Practices that can
Increase HIV/STD Risks to Performers
Multiple partners over short time periods
Increases risk of STD/HIV infection
Increases potential for rapid spread
Prolonged episodes of sexual contact
Can increase transmission risk
Prolonged contact and friction can also increase
abrasion, in turn increasing transmission risk
Lack of protective equipment (condoms, gloves,
dental dams)
The Industry: Avoidable Risks?
38. STD Risks to AFI Performers:
“Genital Fluid-Based” STDs
Transmission:
Contact of semen, vaginal and cervical
secretions, and/or discharge with mucous
membrane
Vaginal, anal, oral sex and shared sex toys
STDs include:
Chlamydia
Gonorrhea
HIV
Hepatitis B
Hepatitis C
Bacterial vaginosis
Trichomoniasis
The Industry: Avoidable Risks?
39. Transmission:
Intravenous drug use, needle
sharing
Vaginal, anal bleeding during sex,
menstrual blood
STDs include:
HIV
Hepatitis B
Hepatitis C
STD Risks to AFI Performers:
“Bloodborne” STDs
The Industry: Avoidable Risks?
40. Direct contact of skin to skin or mucous
membranes:
Syphilis
Herpes (HSV)
HPV (warts)
Direct contact: skin to skin contact, also
shared bedding or clothes
Pubic lice
Scabies
STD Risks to AFI Performers:
“Skin-to-Skin” STDs
The Industry: Avoidable Risks?
41. STD Risks to AFI Performers:
“Fecal-Oral” STDs
Usually transmitted through contaminated food or
water; CAN be transmitted sexually through:
Analingus
Oral sex immediately after anal sex
Oral contact with sex toys immediately after anal
contact
STDs include:
Hepatitis A
Campylobacter
Shigella
Salmonella
Giardia
Cryptosporidium
Entomoeba histolytica
The Industry: Avoidable Risks?
42. Straight vs. Gay Male Adult Film:
a Tale of Two Industries with Different Work
Practices and Risk Reduction Norms
The Industry: Avoidable Risks?
43. Straight AFI
Minimal condom use
Industry sources estimate
condoms used in <20% of vaginal
and anal sex scenes
Only a few production companies
are “condom only” (though these
are larger companies)
Performers can try to work
“condom only,” but may not get
work
No company (even “condom
only”) uses condoms for oral sex
The Industry: Avoidable Risks?
44. Widespread use of routine
HIV/STD testing
Industry standard, promoted by
AIM, is to test monthly
Performers and producers have
access to test results
Performers generally must pay for
testing
HIV-positive performers excluded
from work
Straight AFI, cont’d
The Industry: Avoidable Risks?
45. Straight AFI, cont’d
High-risk sex acts relatively
common
Pervasive use of ejaculation into
the mouth
Growing use of internal ejaculation
with vaginal and anal sex
Pervasive use of unprotected anal
sex
Some use of double-vaginal and
double-anal sex
Other risks:
– Sharing of sex toys
– Oral-anal contact
– Ejaculation into eye (typically
accidental)
The Industry: Avoidable Risks?
46. Gay Male AFI
Extensive condom use
Estimated 80-90% of gay male films
use condoms
Condoms NOT used for oral sex
No industry testing norm for
HIV or other STDs
Many HIV-positive men work
in the industry
Some “bareback” companies
shoot exclusively without
condoms
The Industry: Avoidable Risks?
47. Risks Come Home to Roost:
Previous Incidents of AFI HIV Transmission
Straight AFI
1998: one male performer transmits HIV to
at least 5 female performers
Other reported incidents of HIV
transmission in 1999, 1997, and 1995
Gay Male AFI
Unknown, due to lack of testing
Extensive presence of HIV-positive men in
Gay Male AFI makes transmission
possible
The Industry: Avoidable Risks?
48. In 18 months of pilot STD testing of AFI
performers in June 2000-Dec 2001:
For female performers (n=390)
– Chlamydia prevalence 3-fold greater than similarly-
aged LAC females: 7.7% vs. 2.6%*
– Gonorrhea prevalence 5-fold greater than similarly-
aged LAC females: 2.0% vs. 0.4%*
For male performers (n=435)
– Chlamydia prevalence nearly 7-fold greater than
similarly-aged LAC males: 5.5% vs. 0.8%*
– Gonorrhea prevalence 6-fold greater than similarly-
aged LAC males: 2.0% vs. 0.3%*
Other STD Transmission: Straight AFI
* Using highest available age-group rates for 2001; rates in 2001 were higher than all comparable
rates in 2000. Source: STDP Sexually Transmitted Disease Morbidity Report 1998-2002
The Industry: Avoidable Risks?
50. Year Chlamydia Gonorrhea Syphilis
2003 271 157 2
2004 383 182 0
2005 (through
May 15)
174 89 2
Other STD Transmission: Straight AFI, cont’d
STDs Reported for AIM Clients (no denominator), 2003-2005*
* Note: Based on STD case reports by AIM or laboratory. Total individuals
tested not known (no denominator data). Not all individuals tested and
reported by AIM are necessarily AFI performers.
51. In 2003-2005, STD case reporting by AIM to
STDP indicates that:
114 individuals were diagnosed with at least one
STD in two of the three years*
12 individuals were diagnosed with at least one
STD in all three years*
Other STD Transmission: Straight AFI, cont’d
* Note: total individuals tested not known (no denominator data). Not all
individuals tested and reported by AIM are necessarily AFI performers.
The Industry: Avoidable Risks?
52. Unknown, due to lack of
testing
Other STD Transmission: Gay Male AFI
The Industry: Avoidable Risks?
53. Current AIM “Testing Requirements”
(as shown on website, May 2005)
de facto prevention norms for the straight AFI
For new performers:
HIV test by PCR DNA
Urine NAAT for chlamydia and gonorrhea
Syphilis serology
View “Porn 101” video and “Responsibilities of
Performers” fact sheet
HAV/HBV/HCV serology
HAV/HBV vaccine if not immune
TB skin test
(Females) Pelvic exam with evaluation for HSV,
genital warts, Pap smear with reflex HPV, and
vaginal cultures for BV and trichomonas
(Males) Genital exam, with evaluation for HSV and
genital warts
54. Current AIM “Testing Requirements”
cont’d
For continuing performers:
Monthly:
– HIV PCR DNA test
– Gonorrhea test
– Chlamydia test
Every six months:
– Syphilis test
– (Females) Genital exam and Pap smear
– (Males) Genital exam
55. Current AIM “Testing Requirements”
cont’d
AIM “requirements” voluntary, self-
enforced
Unknown extent that performers and
companies comply, but…
Index was highly compliant, still was source
of outbreak
56. Are Current Industry Efforts Enough?
Key Policy Issues in AFI Worker
Health and Safety
57. Problems with Testing as Prevention
Any “window period” (time between infection
and ability of test to detect) renders testing
alone imperfect for prevention:
Examples from 2004 HIV outbreak:
– Index Case tested monthly (or even more frequently)
for years, yet infected 3 partners in only 1 week
(March 24-30)
– One Female case still tested negative 20 days after
date of exposure, and did not test positive until one
month after exposure; could have unknowingly
infected others
Substantial STD reports and rates show
inadequacy of testing alone to prevent STDs
Key Policy Issues in AFI Worker Health and Safety
58. More Problems with Testing as Prevention
Technical problems:
Roche Amplicor HIV-1 not approved for
individual diagnosis; used for research and
blood banks
Tests not always able to detect all variants of a
disease under all conditions. Example from
2004 outbreak:
– test in use at time of outbreak was less sensitive
to non-B sub-types of HIV, more common
outside U.S
– could have missed infection contracted outside
US (though outbreak did involve subtype B)
Key Policy Issues in AFI Worker Health and Safety
59. Still More Problems with Testing as Prevention
Legal and policy problems:
For prevention value, test results must be shared
with employers and other performers
– Violates principles of worker medical monitoring
confidential, for benefit of worker
– May violate CA Health and Safety Code §120980(f),
prohibiting use of HIV testing to determine suitability
for employment
– May violate laws on privacy of health records
In Gay Male Industry, viewed with suspicion, as
invasive and possibly undermining of condom norm
Key Policy Issues in AFI Worker Health and Safety
60. Other Gaps in AFI Worker Health and Safety:
Relationship of Performers to Production Companies
Many companies, some performers, see performers
as independent contractors. If so:
Companies not subject to occupational health
regulations
No workers’ comp
Cal/OSHA has no jurisdiction
Probably not true in most cases
Cal/OSHA, CA Labor Commissioner see similarity
to workplaces where employer-employee status
established (e.g., regular film industry, exotic
dancers)
Key Policy Issues in AFI Worker Health and Safety
61. Other Gaps: Education and Training
Widespread lack of worksite information;
posting of worker safety and rights
information mostly absent
Not clear that educational materials or
counseling on health and safety routinely
accessed by performers
No employer-sponsored training on health
and safety
Key Policy Issues in AFI Worker Health and Safety
62. Other Gaps: General lack of employer responsibility for
health and safety
No written Injury and Illness prevention
plans (IIPP, per T8 CCR §3203)
Materials to aid safety, e.g., lube and
condoms not necessarily provided on set
Performers sometimes forced to choose
between riskier activities and not working
that day (as claimed by Female Case #1)
Key Policy Issues in AFI Worker Health and Safety
63. Other Gaps: Condoms
(Straight) AFI arguments against requiring condoms:
Not acceptable to (straight) consumers; decreases
sales
Spoils the fantasy
Will only displace production:
– filming will move out of state or overseas
– companies that comply will lose business
Not always effective (condoms, like tests, can fail)
Hard to enforce: AFI was underground industry for
years, “can do that again”
Not necessary – more companies moved to
condoms during outbreak
Key Policy Issues in AFI Worker Health and Safety
64. Condoms, cont’d
Counter-arguments on condoms
Highly effective in preventing HIV and other STDs
– Would likely have prevented all 3 female cases of HIV in 2004
Without requirement, workers effectively denied choice - too
much economic pressure not to use, fear of not being asked to
work again
Most production will not move
– too rooted in CA
– CA legal protection of industry
– Some companies too big to move
Consumers will accept if everyone uses
If level playing field (all companies must comply), then no
competitive disadvantage
– some argue condom requirement should therefore be at national
level
Key Policy Issues in AFI Worker Health and Safety
65. Condom Use Event Semen Exposure
(volume, average over event
probability
Relative Risk
Compared to non-Use
Failure to use a Condom 3.3 ml 1.0
Condom Used, but it breaks 1 ml X 2/100 0.006
Condom Used,
No break but it has visibly
detectable hole
10 -2
ml x 1/400 0.000008
Condom Used,
No break, no visibly detectable
hole, but still passes virus
6 x 10-6
ml x .023 .00000004
Condom used, no break, no
leak
0.0 ml 0.0
Scientific evidence on condom effectiveness NIH, HHS 2001
Hypothetical Relative Risk Model of Condom Use
66. The Special Case: Condoms for Oral Sex
Industry opposes:
No AFI company, straight or gay male, currently uses condoms for
oral sex
Even companies that advocate universal condom use oppose
requiring for oral sex
Risk of HIV from oral sex relatively low, as stated by government
health authorities
But:
Bloodborne Pathogens standard requires prevention of ALL contact
with blood or OPIM (such as semen)
Other STDs (syphilis, herpes, gonorrhea, chlamydia) can be
transmitted by oral sex
Assumption of risk is different in an occupational setting, with implicit
and explicit coercive economic pressures, and the risk is preventable
Key Policy Issues in AFI Worker Health and Safety
67. Other Issues: Testing
Sharing test results, and using results to
limit employment poses legal and policy
problems
But - medical testing is used to exclude or
limit employment in certain settings:
Healthcare workers: TB, some skin lesions
(e.g., herpetic whitlow)
School staff: TB
Food handlers: chronic typhoid
Key Policy Issues in AFI Worker Health and Safety
68. Testing, cont’d
Should testing, such as currently already
practiced in straight AFI, be required?
How handle performers with incurable
conditions (HIV, chronic HCV or HBV, HSV)?
How safeguard privacy?
How address issues in gay male AFI?
Key Policy Issues in AFI Worker Health and Safety
69. What did we learn?
AFI Health and Safety
Solutions
70. Current AFI Regulation and Oversight
Child pornography statutes
18 USC §§ 2252, 2256-2257
California Penal Code §§ 311.3 - 312.7
Strictly adhered to by industry
Filming permits
By city ordinances
Obtained through multiple agencies, e.g.,
EIDC in Los Angeles
Currently not often obtained in L.A.
71. LAC DHS Recommendations
Changes in work conditions and practices
Mandatory condom use for all sex acts
Education and training
Vaccination for HBV/HAV, and other STDs as
vaccine becomes available (e.g., HPV, HSV)
Testing and treatment
Not sufficient, but necessary to reduce
overall risk
Employers should pay for program
CA DHS should decide specific
requirements and adjust as needed
72. Beyond the Set:
Other Possible Levels of Intervention
Point of sale: using video/DVD sellers to
enforce health and safety policies
child pornography model
internet competition issues
Special effects: use to “erase” condoms,
simulate riskier acts
Producers claim currently too costly
– If large-scale use, costs may become reasonable
Some (e.g., gay male industry) say condoms
should be seen to enforce “social norm”
More enforcement of film permitting, to enable
other worksite enforcement
73. “Harm Reduction” Recommendations of
Paul Koretz
(based largely on strategies suggested by Dr. Thomas Coates)
Mr. Koretz, D-West Hollywood, Chairs the CA Assembly Labor and Employment Committee,
and held hearings on AFI in June following the 2004 outbreak
Use condoms for all non-oral sexual intercourse
Have performers memorize the five bodily fluids that
transmit HIV
Use the female condom
No ejaculation into a body cavity (including mouth)
Use a condom for non-oral intercourse after initial
penetration (“dipping”)
NO ejaculation on mucosal surfaces
Liberal use of lubricant
Always use diaphragm for vaginal intercourse
Vaccinate performers for HAV and HBV
Mandatory use of herpes-suppressing medications
2x monthly HIV testing using most sensitive methods
available
Monthly testing for gonorrhea, chlamydia, and syphilis
Performers should be aware of the existence of PEP for
HIV
74. “Harm Reduction” Recommendations of
Paul Koretz
(based largely on strategies suggested by Dr. Thomas Coates)
August 16, 2004: Mr. Koretz urges industry to
use voluntarily require performers to use
condoms, and to implement the 13 harm
reduction strategies recommended by Dr.
Coates, or risk legislative action
No action by AFI to date; no legislation
75. Additional Recommendations,
suggested by NIOSH staff
Avoidance of riskier sexual behavior involving
multiple partners
Simulation of sex acts using acting, editing,
digital imaging
Ejaculation outside the partner(s) body, away
from mucous membrane areas
Require use of barriers, which protect the
partner from contact with semen, vaginal fluids,
mucous membranes, fecal material, etc.
Condoms and lubricant should be available at
no cost to the employees and must be used
without fear of reprisal or penalty.
76. Further Recommendations
from NIOSH staff
Production companies should
expand opportunities for workers
to participate in decision-making
Ensure workers are able to
report health and safety issues
without fear of reprisal.
Three of 13 female performers tested HIV-positive,( they had had negative tests in preceding 30 days) (23% attack rate) Two of the three HIV-infected females engaged in unprotected anal sex with the index case during film production on March 24.
Three of 13 female performers tested HIV-positive,( they had had negative tests in preceding 30 days) (23% attack rate) Two of the three HIV-infected females engaged in unprotected anal sex with the index case during film production on March 24.
At outset: quarantined performers asked not to work until June 8 (2 months after Index Case tests positive) May 11: AIM begins clearing performers from list who tested negative at least 30 days after exposure According to AIM, the HIV tests being used, including PCR-DNA, would detect any infection within 30 days AIM maintains list on website until June 30. By then: 24 of 25 known first generation partners have tested negative at least once since exposure, and have been cleared to work 35 of 36 known second generation partners have tested negative at least once since exposure, and have been cleared to work (or their first-generation partner has been cleared)