Friday, November 16, 2007

Analyzing The "Adult Film Industry" Report

Health study rife with errors

By Mark Kernes
Nov 05, 2007

LOS ANGELES – Somehow, one would think that if a doctor who's been involved in the health of performers in the adult video industry wrote a report on condom use that might impact that industry, he'd want the industry to know about it, right?

But that report, "The Adult Film Industry: Time To Regulate" by Corita Grudzen and Dr. Peter Kerndt was published in the Public Library of Science Medicine Journal on June 19, 2007 – so one has to question why it's taken almost five months for that report to be made known to the very industry which most likely will be affected by it? Could it be because the report is rife with errors, starting with its first sentence?

"The United States adult film industry produces 4,000–11,000 films and earns an estimated $9–$13 billion in gross revenues annually," the report states, attributing that information not to any adult industry publication, but rather to Reefer Madness, reporter Eric Schlosser's 2003 examination of porn, marijuana and the migrant labor force.

But much as that "$9-$13 billion ... gross revenue" figure has gained traction in the mainstream media, those familiar with the adult industry know it to be wildly overstated as to adult video production.

For one thing, the $13 billion figure is generally held to be accurate for gross retail sales of all adult entertainment products, from videos to magazines to novelties to adult cabaret door fees, most of which never filters back to the adult video production companies. In fact, AVN reported in its March, 2007 issue that wholesale sales of adult videos and DVDs for 2006 topped out at just $980 million – down $26 million from the previous year, and a far cry even from the Grudzen/Kerndt report's lowest figure.

According to the report, "Adult film performers engage in prolonged and repeated sexual acts with multiple sexual partners over short periods of time, creating ideal conditions for transmission of HIV and other sexually transmitted diseases (STDs)." But in fact, since the founding of the Adult Industry Medical (AIM) Healthcare Foundation in the wake of the 1998 discovery that a single performer, Marc Wallice, had infected several actresses with HIV, less than half a dozen (hetero) performers have contracted the disease, almost all of them from performer Darren James, who had reportedly worked condomless with an untested actress in South America, then was tested within the "window period" for the industry-standard PCR-DNA test, which test reported a false negative for James.

The Grudzen/Kerndt report, however, glosses over the circumstances of the James situation, saying simply, "The most recent HIV outbreak occurred when three performers who had been compliant with monthly screening contracted HIV in April of 2004. At that time, a male performer who had tested HIV negative only three days earlier infected three of 14 female performers."

In the wake of the James situation, AIM founder Dr. Sharon Mitchell instituted a quarantine period for performers returning from working overseas, and not one HIV transmission between performers working in the U.S. has since been reported.

Other statistics in the report are equally deceptive.

"Among 825 performers screened in 2000–2001, 7.7% of females and 5.5% of males had chlamydia, and 2% overall had gonorrhea," the report claims. "These rates are much higher than in patients visiting family planning clinics, where chlamydia and gonorrhea rates were 4.0% and 0.7%, respectively. Some might argue that this program of STD testing keeps rates of HIV and other STDs lower than in other sex-related industries, and in fact, a recent study of prostitutes in San Francisco found 6.8% and 12.4% positivity rates for chlamydia and gonorrhea, higher than rates in the adult film industry."

"Between January 2003 and March 2005, approximately 976 performers were reported with 1,153 positive STD test results," it continues. "Of the 1,153 positive test results, 722 (62.6 %) were chlamydia, 355 (30.8%) were gonorrhea, and 126 (10.9%) were coinfections with chlamydia and gonorrhea [10]. Less is known about the prevalence and risk of transmission of other STDs such as syphilis, herpes simplex virus, human papillomavirus, hepatitis B or C, trichomonal infection, or diseases transmitted through the fecal–oral route."

Dr. Mitchell disputes all of that.

"First of all, syphilis is virtually non-existent in the adult industry," she notes. "We see maybe one case a year, if that. Herpes, 60% of people have it, no matter how you slice it, general public or industry. People have had it. Everybody's had herpes-1; there's not much you can do about it. We medicate everyone for herpes. We vaccinate damn near everybody for Chlamydia and gonorrhea; we vaccinate everyone for HPV. Everyone gets regular PAP smears every three months, or at the outside every six months, so we're very well aware of trichomonal infections, and all that stuff is around 1.8%, or I'd say 2.4% on a bad month. I think one month it went up to 4%, but you've got to remember, the general public is like 15% right now; they're really high, and we're more than 80% below the general public on any given month."

As for the "976 performers [who] were reported with 1,153 positive STD test results" between January of '03 and March of '05, Dr. Mitchell observes, "That's over two years of time, 26 months, and you have to remember we test 2,000, 2,500 people a month throughout the country, most of them performers, and a lot of these people, they could be partners that we've medicated, and also, it could be somebody who got an infection once or twice that year, so their cohorts aren't right. They're going to bend those stats to make us look like we're all diseased."

According to the Online Medical Dictionary, in a clinical study, a "cohort" is "a well-defined group of subjects or patients who have had a common experience or exposure and are then followed up for the incidence of new diseases or events."

To Dr. Mitchell, who hadn't seen a copy of the report despite the fact that she and Dr. Kerndt have worked together in the past, "I just think it's the same old thing about trying to put condoms on."

And sure enough...

"Efforts to reduce the risk of HIV and other STD transmission must include the use of condoms," the report claims.

But while no one doubts the effectiveness of condom use in preventing disease transmission, the problem with their use in the adult industry has always been that a large segment of the viewing public sees condoms as destructive of the sexual fantasy created by the videos, especially in non-storyline productions, and sales have been shown to drop when condoms are introduced. Even the report itself notes that, "Vivid Entertainment Group, one of the largest producers of adult film in the US, temporarily implemented a condom-only policy after the HIV outbreak in 2004 but has since reversed this company policy."

The "reversal," of course, consisted of having made condom use optional rather than banning condoms altogether (as "reversal" would connote), and the company didn't make that move lightly.

"[Vivid co-owner] Steven [Hirsch] just felt that AIM had done a really good job," reported Marci Hirsch, who oversees all productions for Vivid. "There hadn't been a problem for a long time. He thought that the group of talent that's out there now is capable of making their own decisions, and so we decided to go optional. I think there's a pretty responsible group of people that we have in the industry now."

But would the company refuse to hire a performer who wanted to use condoms?

"No, we wouldn't," Hirsch replied. "The truth of the matter is, most of the talent didn't want to wear them [condoms], and there were some people that wouldn't work for us because we had the condom-mandatory [policy]. It was primarily newer talent because I think they weren't really aware of the testing procedures. Just because somebody says to you, 'There's testing every 30 days,' when you're 18, you may not exactly know what that is."

The report further states, "The use of condoms would prevent performers who had acquired HIV and STDs outside the workplace from transmitting these infections to other performers in the workplace. Additionally, condoms would help prevent unwanted pregnancy and the complications of STDs, which include ectopic pregnancy, pelvic inflammatory disease, and infertility. Little is currently known about the prevalence of these diseases in performers."

However, Dr. Mitchell notes that Dr. Kerndt made no effort to contact her or AIM for the preparation of this report, and since AIM tracks the health of most of the performers currently working in the adult industry, such a failure suggests poor research by the authors.

Not content to advocate condom use for all porn performers, the authors clearly hope to use the adult industry to propagandize for the use of condoms for all sexual acts both in and out of the industry.

"The portrayal of unsafe sex in adult films may also influence viewer behavior," the report states. "In the same way that images of smoking in films romanticize tobacco use, viewers of these adult films may idealize unprotected sex. The increasingly high-risk sexual behavior viewed by large audiences on television and the Internet could decrease condom use. Requiring condoms may influence viewers to see them as normative or even sexually appealing, and devalue unsafe sex. With the growing accessibility of adult film to mainstream America, portrayals of condom use onscreen could increase condom use among viewers, thereby promoting public health."

In a country where public school sex education classes generally are barred from even mentioning condoms except to quote statistics about how often they fail to work properly, the Grudzen/Kerndt attempt to create a "nanny state" program through which adult viewers could be influenced to use condoms more often seems too little, too late.

Grudzen and Kerndt attempt to compare the porn industry to Nevada's legal brothel industry, where (tested) prostitutes have sex with untested clients, but they fail to consider the reality of working life within the adult community. For one thing, there are few diseases that adult performers can contract in the course of their work that cannot be treated safely and effectively, and cured. Those include chlamydia, gonorrhea, hepatitis B, trichomoniasis and the little-seen syphilis. As has been noted, since the new procedures have been adopted in the wake of the Darren James incident, there have been no cases of HIV exposure among performers, and all performers have been vaccinated against the most common strains of cancer-causing human papillomavirus (HPV), though studies have shown that teens can easily contract the virus early in their sexual lives, suggesting that some porn stars come into the industry already infected.

The report also quotes an Associated Press article to the effect that, "Brazil boasts an 80% condom usage rate in their adult films, while still maintaining a large share of the international market as the world's second largest adult film industry. This suggests that condom use in adult films does not have to erode profitability."

This is hogwash. While many American companies either do some shooting in Brazil or buy footage shot in Brazil by stringers, almost none of it displays condom usage, including a good segment of the transsexual material, which these days make up the majority of trannie material sold in the U.S..

"It is also possible to use filming techniques to reduce the visual effect of condoms, by using flesh tone–colored condoms or by digitally removing them post-production," the report claims. "Facial ejaculations could be simulated through the use of inert materials such as liquid antacids combined with filming techniques, which would eliminate any health risk to the performer."

While flesh-colored condoms are already the favorites of performers that use condoms, it is ludicrous to claim that condoms can be digitally removed in post-production unless the production company is willing to spend several hundred times the cost of the entire feature to do so. It is equally ridiculous to suppose that "liquid antacids" and (cost-effective) special effects could be used to simulate facial ejaculations. Simply put, the viewing public isn't that easily fooled – and it wants its facials.

Tellingly, the report states, "In contrast to heterosexual adult films, 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 profitable for production companies."

Sadly, that conclusion is wishful thinking on the authors' part. At least half a dozen gay American production companies make bareback videos, and according to Wikipedia, "A number of Eastern European studios supply the increasing demand from homosexual men in North America and Western Europe for bareback pornography." Moreover, within the last few days, there's been news from England of three UK-based actors having contracted HIV, having been infected by a fourth man that the three worked with in a bareback video. Hence, it is not possible to evaluate the authors' statement that, "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." We know that in a growing portion of the gay community, this statement is untrue.

"Although some companies may voluntarily decide to be condom-only, it is unlikely that this industry will establish safer working conditions for employees without external regulation," the report concludes. "A state or national mandate would level the playing field for all companies and not give an unfair advantage to those who decide to produce films without condoms."

It's an old argument: "If all bars and restaurants are required to be smoke-free, then none will have an unfair advantage over another." Ask that regulated industry whether business has been affected by that regulation!

The basic problem remains that an unquantifiable but apparently substantial segment of the viewing public does not want to see condoms on performers of sexually explicit material, and that despite the fact that, according to the report, "Distributors and production companies have become so entrenched in Southern California that it seems unlikely that they would move to another location or go clandestine," if an across-the-board condom-mandatory regulation were shown to affect sales, at least some production would move back "underground," from whence it sprang, in some cases, less than 20 years ago.

Were that to happen, Dr. Mitchell fears, it would be much more difficult, if not impossible, to assure that all performers were being tested for STDs, and more importantly, much more difficult to spread the word among performers if an actual incident of STD infection, much less an HIV infection, on a set did occur.

Towards the end of the report, the authors reference a multi-stakeholder meeting" at UCLA in October, 2006 to "readdress the issue of worker safety," and they do note that "Concerns were raised about the industry going underground or moving out of state should there be a state but no national requirement." This author attended that symposium, and it is incorrect to say that the policy changes Grudzen and Kerndt recommend were widely-held conclusions of that gathering.

In particular, almost none of the adult industry attendees at the symposium – in other words, those with the most knowledge of the needs and practices of the adult industry – agreed that there should be "National legislation that includes regulation of internet-based adult films," "Mandatory condom use with condom seal of approval" (although several did support labeling product containing extensive condom use with a "condom seal of approval"), "Film rating system based on set safety criteria" or "Licensure of performers."

There was, however, better support for "STD testing paid for by the industry" (which some companies already do) and "Vaccinations against human papillomavirus and hepatitis B and post-exposure prophylaxis paid for by the industry" (the vaccinations already occur, but paid for by talent). Few supported raising the legal age of performers from 18 to 21, and drug testing of performers was (rightly) thought to be an invasion of their privacy.

In its final section, the report concludes, "Short of legislation mandating performer protection, restricting distribution of adult movies to condom-only films may be the one way to have an impact on the industry."

That would indeed have an effect on the industry: It would turn back the clock on performer protection to the era prior to 1975, when performers were hired by phone and the production company assembled in supermarket parking lots and caravanned to the filming location; when productions were shot in remote areas of the desert or forested mountains ... and when few cared what happened to performers once they completed their work and left the set.

"Unfortunately, the growing popularity of adult film has not translated into safer working conditions for performers," the report claims, ignoring the rise of AIM and the various companies that offer health insurance to performers. "It is unethical for industry executives, legislators, and consumers to continue to enjoy the profits, tax revenues, and gratification of adult film without ensuring the safety of performers."

Apparently Grudzen and Kerndt imagine some world when adult productions compete in the same marketplace as Hollywood features; where the federal government does not routinely target producers of sexually explicit material for prosecution that could result in multi-year prison sentences, huge fines and even the forfeiture of entire businesses; and where communities do not attempt to relegate sales of adult material to swamps and industrial areas far from consumers. Perhaps when the very government that wants to regulate adult material out of existence changes course and allows the industry to sell its wares on the same basis and with the same protections as the multi-million dollar productions coming out of Hollywood, then it can talk less hypocritically about adult producers' obligations to the performer community.