Innovative Approaches: Learning from the Adult Film Industry
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Chapter 1: The Adult Film Industry's Health Protocols
The adult film sector has established a comprehensive system for testing and tracing, which can be examined and potentially adapted for broader public health applications.
This industry has consistently depicted unprotected sexual encounters; however, it has remarkably maintained a record of no on-set HIV transmissions for over 15 years. Their methods for managing sexual health during an epidemic provide valuable insights. As we navigate through the current pandemic, we have the opportunity to leverage the lessons learned from this field.
Dr. Sharon Mitchell, a former adult film actress, was pivotal in developing contact tracing, testing, and isolation measures during the 1998 HIV outbreak. Her deep understanding of both the industry and public health led her to found the Adult Industry Medical Clinic (AIM), which implemented rigorous testing protocols that certified thousands of adult performers.
Stephen Simon, the AIDS coordinator for Los Angeles, noted that AIM’s methods surpass those of any public health organization. He stated, "Their testing and partner tracking procedures are far superior to anything I can imagine from a public health entity. Coupled with the availability of post-exposure prophylaxis, their containment policy is remarkably effective." (The Lancet, 2004)
Following a data breach in 2011, AIM's influential protocols were transferred to the Free Speech Coalition (FSC), which now oversees the Performer Availability Screening Services (PASS), the standard for the mainstream adult film industry.
Current procedures mandate that performers undergo testing for HIV and other sexually transmitted infections (STIs) every two weeks. Test results are uploaded to the PASS system, accessible to producers and directors, which indicates whether a performer is cleared to work with a simple green checkmark or a red X for unapproved status. In the event of a positive HIV test, the FSC enforces a production halt until all contacts are notified and retested. Only after confirming no risk can production recommence. (Globe and Mail)
This robust system features biweekly checks for all participants, automatic contact tracing, and built-in lockdown protocols. Such a model could be adapted for other industries, such as meat processing, by requiring employee testing every two weeks, database approvals for work, and automatic shutdowns and tracing procedures during outbreaks.
“In many respects, their approach serves as a template for what we aim to achieve with COVID,” remarked Ashish Jha, a physician at Harvard University’s Global Health Institute, who advocates for widespread testing to manage the coronavirus. “The adult film industry demonstrates that this model can work; we simply need to scale it up.” (STAT News)
It is unwise to disregard the lessons from past epidemics like HIV/AIDS due to social stigmas. The adult film sector, a multi-billion dollar industry, has demonstrated an ability to navigate through an epidemic that could have severely impacted it, alongside regular STIs. Although a significant portion of adult film scenes involve unprotected sex, the industry has effectively managed to limit the spread of infections (albeit with room for improvement, as rates of chlamydia and gonorrhea remain concerning).
Given the current transmission of diseases through oral contact and the inherent risks associated with indoor settings, we must consider adopting the adult film industry's security measures before returning to regular activities.
Countries that have effectively controlled their outbreaks—such as Mongolia, Taiwan, Trinidad & Tobago, and New Zealand—have employed measures like border controls or rapid containment strategies similar to those in South Korea. Conversely, nations like the United States and the UK have fallen short of achieving containment due to delays and indecision.
The regular testing of White House staff could serve as a model for scaling across various industries if there is a genuine commitment to controlling the pandemic (which may not be the case under the current administration, but could change in the future).
The adult film industry provides a straightforward model for wider application.
Mitchell recalls the recent HIV outbreak as a trying time. "An actor contracted the virus in Brazil. Although he tested negative upon returning, no test can detect HIV within just seven days of exposure. He tested positive three weeks later, which necessitated quarantining 60 individuals who had first or second generation exposure to him. I identified three women who had unprotected anal sex with him during his most infectious period, and they all tested positive; however, they were on quarantine. This early detection was critical. No other model globally can claim to have handled this situation as effectively." (The Lancet, 2004)
The adult film industry is under constant scrutiny, presenting an opportune moment to examine its practices.