Public Health Issues in the Adult Film Industry : 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
Background : 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?
Overview of Presentation : 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?
Why LAC DHS is Concerned about the Adult Film Industry : 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
Before April, 2004 : 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…
The HIV Outbreak of 2004 : The HIV Outbreak of 2004
The Index Case : 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
The Index Case (continued) : 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
The Index Case (continued) : 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
The Index Case (continued) : 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)
The Three Female Cases : 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
The Three Female Cases (continued) : 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 occupational sex partners during this period
The 2004 HIV Outbreak
Slide13 : 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
Industry Responses: The Quarantine List : 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
Industry Responses: Quarantine List Testing : 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
Industry Responses: The Moratorium : 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
Public Health Responses: LAC DHS : 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
Public Health Responses: LAC DHS continued : Public Health Responses: LAC DHS continued
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
Public Health Responses: Cal/OSHA : 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
Public Health Responses: Cal/OSHA continued : Public Health Responses: Cal/OSHA continued 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
Public Health Responses: Cal/OSHA continued : Public Health Responses: Cal/OSHA continued 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
Public Health Responses: CDC : 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
Public Health Responses: Using Gene-Sequencing to Establish Occupational Transmission : 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
Public Health Responses: Establishing Occupational Transmission continued : 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
Public Health Responses: Ongoing : 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
Industry Responses…One Year Later : 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
Policy One Year Later : 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
The Adult Film Industry Today: Avoidable Risks in Worker Health and Safety? : The Adult Film Industry Today: Avoidable Risks in Worker Health and Safety?
The Industry: Background : The Industry: Background The Industry: Avoidable Risks?
Large and Legal : 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?
Other Characteristics that Impact Health and Safety : 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?
In LA County : 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?
Making an Adult Film* : 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?
Beyond Home DVD / Video : 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?
The Industry Revealed: Work Practices and Prevention Gaps : The Industry Revealed: Work Practices and Prevention Gaps The Industry: Avoidable Risks?
General AFI Work Practices that can Increase HIV/STD Risks to Performers : 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?
STD Risks to AFI Performers: “Genital Fluid-Based” STDs : 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?
Slide39 :
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?
Slide40 :
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?
STD Risks to AFI Performers: “Fecal-Oral” STDs : 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?
Straight vs. Gay Male Adult Film: a Tale of Two Industries with Different Work Practices and Risk Reduction Norms :
Straight vs. Gay Male Adult Film: a Tale of Two Industries with Different Work Practices and Risk Reduction Norms The Industry: Avoidable Risks?
Straight AFI : 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?
Straight AFI, cont’d :
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?
Straight AFI, cont’d : 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?
Gay Male AFI : 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?
Risks Come Home to Roost: Previous Incidents of AFI HIV Transmission : 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?
Slide48 : 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?
Slide49 : Other STD Transmission: Straight AFI, cont’d STDs Reported by AIM, 2002 (self-reported data)
Slide50 : 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.
Slide51 : 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?
Slide52 : Unknown, due to lack of testing
Other STD Transmission: Gay Male AFI The Industry: Avoidable Risks?
Current AIM “Testing Requirements” (as shown on website, May 2005) de facto prevention norms for the straight AFI : 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
Current AIM “Testing Requirements” cont’d : 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
Current AIM “Testing Requirements” cont’d : 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
Are Current Industry Efforts Enough? Key Policy Issues in AFI Worker Health and Safety : Are Current Industry Efforts Enough? Key Policy Issues in AFI Worker Health and Safety
Problems with Testing as Prevention : 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
More Problems with Testing as Prevention : 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
Still More Problems with Testing as Prevention : 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
Other Gaps in AFI Worker Health and Safety: Relationship of Performers to Production Companies : 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
Other Gaps: Education and Training : 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
Other Gaps: General lack of employer responsibility for health and safety : 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
Other Gaps: Condoms : 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
Condoms, cont’d : 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
Slide65 : Scientific evidence on condom effectiveness NIH, HHS 2001 Hypothetical Relative Risk Model of Condom Use
The Special Case: Condoms for Oral Sex : 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
Other Issues: Testing : 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
Testing, cont’d : 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
What did we learn? AFI Health and Safety Solutions : What did we learn? AFI Health and Safety Solutions
Current AFI Regulation and Oversight : 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.
LAC DHS Recommendations : 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
Beyond the Set: Other Possible Levels of Intervention : 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
“Harm Reduction” Recommendations of Paul Koretz (based largely on strategies suggested by Dr. Thomas Coates) : “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
“Harm Reduction” Recommendations of Paul Koretz (based largely on strategies suggested by Dr. Thomas Coates) : “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
Additional Recommendations, suggested by NIOSH staff : 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.
Further Recommendations from NIOSH staff : 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.
Slide77 : AND what do you say?