February 15, 2016
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Testing insufficient to prevent HIV spread in adult film industry

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Testing alone is insufficient to prevent HIV transmission among adult film actors, according to researchers who studied a recent case of a male performer who infected a co-worker and found the industry’s prevention approach lacking.

The industry should enhance its HIV prevention strategy to include pre-exposure prophylaxis, or PrEP, the researchers wrote in MMWR, noting that such a plan would likely have obstacles.

“Unlike condoms, PrEP is not an HIV prevention modality with which employers can ensure compliance because of the requirement for daily use outside of the workplace, with no methods of tracking; PrEP also does not prevent other [sexually transmitted infections],” the researchers wrote. “However, combined with condoms, PrEP remains an important approach for preventing HIV infection among persons at high risk for HIV infection, including adult film industry performers who might be at risk in both their professional and personal lives.”

The study analyzed the 2014 case of a California adult film performer aged 25 years who tested positive for HIV infection and rectal gonorrhea after presenting with rash, fever and a sore throat. It found the performer was likely infected by a male sexual partner outside of work and transmitted the virus to a male co-worker during a film shoot, as well as a nonwork-related partner, during a 22-day period between a negative HIV-1 RNA qualitative nucleic acid amplification test (NAAT) and his positive HIV test result.

During that period, two production companies directed the patient to have condomless sex with 12 male performers. Neither the patient nor any of his 17 interviewed sexual partners during that time — 12 co-workers and five partners outside of work, living in seven states and four foreign countries — reported taking PrEP.

The four infected individuals — the performer, his co-worker, the nonwork-related partner and the person suspected of being the source of his HIV infection — were found to have subtype B sequences that clustered tightly, suggesting high genetic relatedness of their HIV sequences, the researchers said. Pairwise nucleotide identities (99.1% in gag and 99.6% in pol) were high and none of the pol sequences had any major drug resistance mutations.

The adult film industry’s current HIV prevention methods rely mostly on NAAT testing, the results of which are stored in a database that can be checked by production companies before filming. The male performer who infected his co-worker began experiencing symptoms 10 days after his negative NAAT, and 1 day before the start of the film shoot during which he infected his co-worker while engaging in condomless sex.

Because follow-up testing was not reported for some of the performer’s sexual partners, and because he did not provide names for all of his sexual contacts, the extent of this particular HIV cluster might be underestimated, the researchers wrote. Seven of the 10 sexual partners at risk for infection by the performer engaged in condomless receptive anal sex with him and two became infected — a 29% attack rate comparable to the 23% rate seen in a 2004 case in which HIV was transmitted between heterosexual adult film performers.

The adult film industry is well-suited to implement better HIV prevention strategies, including PrEP and the consistent and proper use of condoms, the researchers wrote. Further, federal and state laws ensure the right to safe working conditions for adult film performers, as for all employees. However, the researchers wrote that a wide geographic distribution of adult performers, filming locations, and production companies makes it challenging to develop regulations and disseminate prevention information in the industry.

“Because the adult film industry recruits workers from numerous states and countries, documenting future disease transmission associated with filming sexual acts might, as this investigation did, require substantial resources and coordination between local, state, and federal agencies,” the researchers wrote. – by Gerard Gallagher

Disclosure: The researchers report no relevant financial disclosures.