LOS ANGELES—If a study just touted by the AIDS Healthcare Foundation (AHF) on the eve of the November election that appears to support Measure B does anything, it supports a rigorous testing regime. What it does not do is provide any scientific basis for supporting Measure B, which would make the failure to use barrier protection in adult films shot in Los Angeles County a criminal offense.
First, however, we need to acknowledge that the medical professionals behind the study—most notably Dr. Peter R. Kerndt and Cristina Hart-Rodriguez, both of the LA County Department of Public Health's HIV and STD Program, as well as Paula Tavrow, Ph.D., an affiliate of UCLA's Reproductive Health Interest Group—have for years been ardent proponents of governmental oversight of the adult entertainment industry, as well as virulent critics of the industry's most popular health clinic, the Adult Industry Medical Health Care Foundation (AIM), which was forced to close its doors after being sued by AHF over gratuitous charges of HIPAA privacy violations that were eventually dropped. That these individuals have chosen to release a study two years after the data was presumably acquired is in and of itself suspicious, and the timing of the release only adds to that suspicion. Why, one can fairly ask, was this study not published years ago?
That said, it has been released and is being used by AHF as an argument for voters to vote yes on Measure B, which is soundly opposed by the industry. With no way to independently assess the accuracy of the data collection or any of the other claims made by the authors of the study before voters go to the polls this Tuesday, we are left to unscientifically assess what the study definitively proves and does not prove.
First, and perhaps most significantly, of the participants identified as allegedly having been infected with either Chlamydia and gonorrhea, the study fails to tie any of them to sexual activity either on or off the set while infected. The study liberally implies that infected individuals worked and could have infected fellow performers, but no actual transmission connection is made. Instead, the study systematically concludes what might occur in instances where an asymptomatic infected individual whose industry mandated test failed to identify an infection was allowed to perform.
Needless to say, no one in the industry would be comfortable with a situation in which an infected party is allowed to perform after having been tested and determined by an insufficient testing regimen to be infection-free, but again, the study fails to prove any correlation between allegedly missed infections and transmissions on or off set. That they could occur is possible, of course, but wouldn't a prudent course of action then be to add oral and anal swabs to the standardized testing currently done by the industry?
In lieu of that as a solution, the study, if correct, makes a case for complete barrier protection and not just condom use. Notably, AHF has gone out of its way to downplay the mandating of complete barrier protection (condoms, face shields, gloves and dental dams—even hazmat suits) by performers, knowing that voters would likely consider that too extreme, but the study they sponsored and are now promoting more than makes that case, flawed as that case may be.
Perhaps worst of all, the study is utterly disingenuous when it describes how and when performers get tested. Fully cognizant of the fact that performers are not allowed to perform on the overwhelming majority of porn sets without a valid test that is no more than 28 (or 14, depending on the studio) days old, the authors nonetheless included in their study 51 performers—nearly one-third of all performers tested—who had not worked in an adult film for more than 30 days, making the time and place of their exposure impossible to pin down, and very likely not on an adult film set at all.
That percentage is extraordinarily important, considering that of the 168 "adult performers" who took part in this study, only 47 (28 percent) had at least one undiagnosed STD—and that's 2 percent less than the number of performers (30 percent) who hadn't made a movie in at least 30 days, and whose infections, if they had sought film work while still infected, might very well have been caught by the normal industry testing, especially if they had any specific complaints and requested that an (optional) oral swab be taken and tested.
Nonetheless, the authors contend, "Performers may rely on the presence of STI symptoms to seek out testing, and health care providers serving performers may look for symptoms to administer presumptive treatment. Based on these results, however, relying on symptoms would not have captured a third of urogenital (i.e. urine) infections and nearly all oropharyngeal (i.e. oral) and rectal (i.e. anal) infections."
Moreover, the study claims that, "Because performers in the AFI are a highly stigmatized population and are a difficult population to identify for any study, we used a convenience sample of performers who sought services at a trusted primary care clinic, which may have introduced selection bias." Despite the fact that the study suggests that that "trusted primary care clinic" was AIM (since it's the only clinic mentioned by name in the entire study), at least one source has reported that that "trusted" clinic was the West Oaks Urgent Care Center, under the medical management of Dr. Robert Rigg, a physician who was not only notorious among the adult community, but who has been accused by at least one actress—Lara Roxx, one of the victims of current AHF employee Darren James, who infected several actresses in 2004—of giving poor medical care.
“The day after that scene, I had a rash appeared on my ass; a rash like I’ve never had before, and I was in pain. I couldn’t sit on my butt,” Roxx told AVN shortly after her HIV diagnosis. “That stupid doctor [Rigg or someone under his supervision] prescribed me stupid antibiotics without even looking at it [the rash]. He was like afraid... The first medicine, the antibiotics I was taking, were so strong that they gave me a yeast infection, so the rash on my butt was gone, but I had a huge, huge—the biggest yeast infection I’ve ever had in my life... After that, I saw another doctor from AIM, because I was like, 'Fuck Dr. Rigg.'"
So the adjective "trusted" as a description of the adult industry's opinion of Dr. Rigg should be taken with a grain (or two or ten) of salt. And in that regard, the assertion by the study authors that "we do not know why each participant was seeking care when he/she was recruited" rings hollow.
The authors continue, "Our sample could therefore represent a group who felt that they were at high risk for STIs or specifically seeking treatment of a known STI, thus overestimating positivity. If care seeking was based on the presence of symptoms, we could potentially have missed asymptomatic cases. This seems unlikely, however, because nearly half of our cases were asymptomatic."
Is it not also possible that performers were seeking treatment because, despite having no symptoms, they had already tested positive at another clinic? Interestingly, a close perusal of the study finds no mention of whether any of the study participants were aware of their infections before taking part in the study. Such information is not mentioned in the text or included in the data points or charts, leading us to suspect that the question was not asked. This raises the point that the study, which repeatedly asserts that its findings indicate missed infections, does not actually provide any data that supports that claim. It is, as a result, inferred.
But to repeat, in suggesting that performers rely on symptoms to seek out testing, the authors of this study are not being honest with the public. However, the advice proffered immediately after that dishonest comment that "performers must be tested for STIs at all anatomical sites and that treatment given to performers should be appropriate for clearing oropharyngeal infections as well as urogenital and rectal infections" does make sense if the goal is to make sure that all possible sources of infection are inspected and cleared before a performer is allowed to work.
But if readers of the study are to take at face value its findings that the current testing regime—which uses urine to test for Chlamydia and gonorrhea, with mouth swabs available upon request—could miss asymptomatic infections in the mouth or rectum, and agree with its recommendations that "barrier protection is needed on adult film sets for all penetrative sexual acts, and unprotected sexual intercourse with multiple anatomical sites within a single scene should be discouraged within this industry," it needs to be understood that they are not just talking about condoms!
The authors contend that the results of the study "indicate" that barrier protection is needed, but we cannot find any part of the study, which is rife with equivocal terms like "may" and "might" and "likely," that actually makes that case. However, we do agree that the study, if its data is correct—an unproven supposition at this point in time—has supported its contention that, "For health care providers serving performers, our results indicate that screening of the oropharynx and rectum should be routine, and performers found to be positive should be appropriately treated to clear infection from all infected sites."
Those two conclusions are not the same! Increasing the effectiveness of testing is not the same thing as putting an entire industry (and livelihoods) at risk by forcing performers to literally don full-body barrier protection. While an argument can be made that consumers might be willing to accept condoms in porn—a supposition not borne out by the industry's experiences in going "all condom" after the 1998 Marc Wallice and 2004 Darren James incidents—it is not even conceivable that they will tolerate face masks, rubber gloves and dental dams. In light of that, we feel secure in continuing to believe that the goal of the authors and the AHF, despite their routine denials, is to harm the industry rather than work with it to improve performer safety.
That disingenuousness is most apparent in this reference to current AHF associate Derrick Burts, who allegedly contracted HIV on a gay set where condoms were used, but who also advertised his services on the internet as a gay male escort: "A male performer diagnosed as having HIV in 2010 had 16 primary sexual contacts within the 8 weeks before his HIV and oropharyngeal [throat-swab] GC [gonorrhea] diagnosis, 2 of whom were discovered later to have had HIV at the time of filming." AVN is certainly of the opinion that gay performers should undergo the same testing regimen as hetero performers, but to include them as evidence that the testing that hetero performers undergo every 28 days is insufficiently effective is simply ludicrous.
We might add that the comparison of the study's data with that of brothel workers in Nevada is gratuitous at best and dishonest at worst, since the work environment of each, including the exposure of the target group to external influences could not be more different. In other words, brothel sex workers work in a very controlled environment in which they do not leave the brothel premises, whereas no such controls exist for adult performers, and certainly do not exist for independent performers such as webcam performers, who also come under Measure B. The authors of the study do not go so far as to suggest, however, that adult performers should be forced to live under the controlled environment imposed on brothel workers.
It also needs to be noted that the rates of infection among adult performers alleged in the study are not consistent with those provided to Dr. Lawrence S. Mayer in 2011 by the most frequently attended clinic in the industry, AIM, using Centers for Disease Control methodology. Meyer's analysis—available here—indicated far less rates of infection than did this study.
In conclusion, we are more than a little troubled to discover that health care professionals with serious oversight responsibilities in the Los Angeles community have released a study that appears to have a political agenda rather than one solely fixated on what is best for the health of the target community. What we mean by that is that the target community—adult performers—in addition to being safe in their work, also need to be able to work.
Despite its dubious agenda, however, the study may unwittingly have suggested ways that the industry's testing regime can be strengthened through the use of standardized oral and rectal swabbing for STDs.
The study is available for purchase here.