The Porn Industry Is Rethinking How It Works With HIV Positive Performers

Illustration for article titled The Porn Industry Is Rethinking How It Works With HIV Positive Performers
Image: Angelica Alzona/GMG

In late January, tucked away in a fluorescent-lit conference room at the Hard Rock Hotel in Las Vegas, dozens of porn industry insiders gathered for a panel on the latest in HIV research. In the neighboring exhibit halls, the annual Adult Entertainment Expo was underway, and fans lined up for autographs from performers and poked at the surreal flesh of sex dolls. The expo’s seminars are always a sober affair compared to the raucous exhibit halls, where music thumps and watered-down drinks are poured, and this panel is no exception.


But the panel became a lightning rod for industry debates around HIV, sex worker rights, and homophobia because it raised the possibility of introducing a testing system that meets the needs of performers with HIV. Currently, the industry’s centralized opt-in testing system, Performer Availability Screening Services (PASS), tests performers every 14 days for sexually transmitted infections (STIs). Anyone who tests HIV positive is permanently barred from the system.

The HIV panel, which featured a mix of porn performers and health experts, began by surveying the latest research, including well-documented evidence showing that when antiretroviral treatment lowers an HIV-positive person’s viral load to 200 copies per milliliter of blood—what’s often called an “undetectable” status—they pose “effectively no risk” of sexually transmitting the virus, as the Centers for Disease Control and Prevention has put it. A 2016 statement signed by several dozen major global HIV organizations similarly said that the risk of transmission from someone with an undetectable viral load is “negligible to non-existent.”


Then, partway through, panelist and porn performer Bella Bathory said that the Free Speech Coalition (FSC), the adult industry trade association which manages the adult industry’s centralized bi-weekly testing system for STIs, was considering the creation of a separate and additional testing system that could be used by HIV-positive performers who are undetectable, as well as HIV-negative performers “who are woke and aware and comfortable sleeping with [HIV-positive] performers.” Anyone who opted into the system would get a “drastically discounted testing rate,” she said, garnering a huge round of applause.

In the wake of the panel, rumors started circulating on Twitter, including claims that PASS had been suddenly changed to allow HIV-positive performers into the general talent pool. As one performer tweeted, “Let’s talk about the elephant in the fucking room. Are we just going to let it be ‘okay’ for HIV+ performers to be allowed to perform with in the industry ??” FSC responded with a statement clarifying that the testing system had not actually changed, and that there was no “current plan to change it.”

But the theoretical discussion had fired people up; then the whispers began that HIV-positive performers were already working within the tested talent pool.

This charged debate over undetectable performers has only highlighted the existing division between the so-called “gay side” and “straight side” of the business, and the idea that there are sides, as opposed to a united adult industry. The debate has also tapped into a longstanding stigma around so-called “crossover” performers: cisgender men who work on both “sides” of the industry, and who are seen by some as posing a higher STI transmission risk. (Transgender women are often similarly stigmatized.) This is despite the fact that crossover performers who work in PASS-compliant straight porn go through the same testing protocols as non-crossover performers.


It’s a fresh wound for the industry: In 2017, porn performer August Ames died by suicide following a backlash in response to a tweet announcing that she had declined a shoot after discovering that her co-star was a crossover performer. She wrote, “BS is all I can say... I do my homework for my body.” Many criticized her perspective as homophobic, while others blamed the testing protocols in gay porn. (“Gay porn” and “straight porn” are the imperfect shorthand typically used to signal the sexual orientation of the target audience of a film. For example, a film with two women having sex is often called “straight porn” if it’s made for heterosexual audiences.)

In the late 1990s, amid several cases of on-set HIV transmission, the Adult Industry Medical Healthcare Foundation (AIM) was developed to provide performers with monthly testing for STIs. But in 2011, after a massive leak of performers’ private medical information, AIM closed and FSC created PASS as its replacement. Although FSC doesn’t have the power to enforce compliance with the system, it says that most mainstream producers of straight porn have typically opted to rely on PASS testing and shoot without the use of condoms.


Gay porn, on the other hand, has traditionally used a broader spectrum of safer sex approaches, ranging from condoms with no testing to testing with no condoms. But, historically, the gay porn industry hasn’t heavily relied on PASS’s standardized testing (although some major studios have opted in). That is in part because of its exclusion of HIV-positive performers. This has meant that, in some cases, individually procured tests are printed out and shared on-set, or that results are discussed one-on-one between co-stars.

As a centralized database, PASS not only prevents the doctoring of tests, as a recent FSC statement emphasized, but it also clears people for work without revealing any sensitive medical information. If someone tests positive for gonorrhea, for example, it will simply show the performer, producer, or agent who checks the system that said person is not cleared to work. If someone tests positive for HIV, however, they are banned from the PASS system.


Pushing HIV-positive performers either out of the industry entirely, or else excluding them from standardized testing, sits uneasily with some. In the middle of the HIV panel, as the conversation around performers who are undetectable heated up, someone handed a mic to Eric Paul Leue, executive director of FSC, who stood in the back of the room. “As an industry, by excluding people living with HIV from being allowed to have standardized testing protocol, and by shunning and shaming them, we create a social environment that disrupts our community,” he argued, and acknowledged that FSC was working toward a “secondary testing protocol” to address the issue.

This marks a new frontier for an industry that until fairly recently was defending its testing practices and fighting for performers’ right to continue working without condoms. In 2016, the industry successfully defeated the contentious Prop 60, a bill sponsored by the controversial AIDS Healthcare Foundation that would have mandated the use of condoms in all porn filmed in California.


The conversations about testing for undetectable HIV-positive performers has risen in part out of FSC’s broader desire to adapt to a rapidly changing industry. “We have talked about the possibility of creating additional, separate systems for communities that can’t or don’t always use PASS,” said Leue in an email to Jezebel. That could include performers in Europe, where there is no standardized testing system, due in part to regulations around medical record sharing and the “availability of highly-sensitive tests,” says Leue. Just recently, a performer in Europe reportedly tested positive for HIV, triggering a production hold.


Additional testing systems could also address webcam and amateur performers, who comprise a growing demographic in an industry that has moved away from the studio system, and who can find the two-week $150 PASS test prohibitively expensive. “We want to be able to protect as many performers as possible, no matter where they shoot or what they do,” said Leue. Typically, performers pay for their own PASS testing.

But it’s only the discussed possibility of a separate testing system to address “shoots with participants who have HIV but are unable to transmit it,” as Leue puts it, that has sparked controversy. Earlier this month, a statement from the FSC board of directors sought to again dispel the “confusing claims and counterclaims” following the HIV panel.


Longtime porn performer Alana Evans is one of the most vocal critics of such change. She posted video and a partial transcript of the HIV panel online, and wrote, “More proof that they are using performers for ‘their agenda.’” Evans is also the president of the Adult Performers Actors Guild (APAG), a union facing the difficult task of trying to organize workers in a high-turnover industry, and which has come to be known for its explosive Twitter presence, particularly around these issues. Last year, the APAG Twitter account referred to pre-exposure prophylaxis (or PrEP), a groundbreaking tool in the prevention of HIV, as a “party drug.” (PrEP has been shown to reduce the risk of sexual transmission of HIV by more than 90 percent.)

Evans says her main concern with the current conversation is that HIV-negative performers would be—per the theoretical panel conversation—allowed to work in both talent pools, and she believes that this would create a higher transmission risk. “I have no idea what you’ve been doing potentially days before you came working onto my set,” she said.


FSC has previously argued that this is already case, that there is “no way of knowing what performers do outside of PASS.” In other words, anyone within the PASS system can have off-camera sex with people who are not part of any standardized testing system, which is arguably more dangerous than having sex with people who are undetectable and rigorously tested. The testing system is designed to broadly prevent the transmission of HIV during adult shoots, and FSC says it has succeeded in doing so on all PASS-compliant sets since 2004. (The possibility of a waiting period between working within an environment that is open to undetectable performers and then returning to PASS was floated during the panel.)

Evans also worries that it might be possible for an undetectable performer who stops taking their antiretroviral medication to go from undetectable to detectable, and therefore transmittable, within a testing window (although a between-tests window for this theoretical testing system has not been defined). Demetre Daskalakis, an infectious disease physician and the deputy health commissioner for disease control in New York City, says that a viral rebound generally takes two to four weeks. “Most humans who stop their medicine on the day of their test would probably just start [virally] revving up around that second week,” he said. The PASS system currently mandates testing every two weeks.


Carl Dieffenbach, director of the division of AIDS at the National Institute of Allergy and Infectious Diseases, a division of the National Institutes of Health, puts it like so: “Somebody would literally have to stop taking their pills three or four days prior to the test, test, and then actively try to transmit within the window,” he said. “But no self-respecting person who has gone through the trouble of suppressing is going to want to go back to being viremic. The amount of harm that they do to their body every time you go through periods of viremia is profound.”

Daskalakis does note that science backing up the concept of “undetectable equals untransmittable” is based on research subjects who have been virally suppressed for six months. “If you follow that notion, then you probably want to say if someone is newly diagnosed with HIV they need to be undetectable for six months prior to being able to enter that pool,” he said.


In the past, Evans focused less on the nitty-gritty of HIV science and more on the general subject of crossover performers. In 2014, she argued that crossover performers “cross over and infect.” A year earlier, she tweeted, “My problem IS CROSSOVER GAY MALE TALENT.Stop double dippin.” Many see this kind of anxiety on the straight side of the industry around crossover and gay performers as homophobic. Evans has defended herself against these allegations in part by arguing that she’s had lesbian relationships and thinks “most gay men are hot.” She’s also argued on Twitter that FSC treats any performer who doesn’t “agree with infiltrating our performer pool with HIV” as “a bigot, a bully, and discriminatory.”

Evans believes that this “infiltration” has already happened. That’s because the PASS system mandates the use of the highly-sensitive Aptima Qualitative RNA test, which can rapidly detect HIV after transmission. The test has a high detection rate for people with as few as 30 copies of HIV RNA per milliliter of blood (anything under 200 is considered undetectable) and can detect as little as 1 copy per milliliter, although far less reliably.


So, it is possible for someone who is HIV-positive and undetectable to have a non-reactive Aptima RNA test, according to several HIV experts who spoke with Jezebel. “Yep, absolutely,” is how Daskalakis put it. But, again, someone who is undetectable poses “effectively no risk” of transmission.

Since 2017, Evans has called for FSC to mandate an additional antibody test, which can detect HIV regardless of viral load, but which has a greater window from transmission to detection. Leue emphasizes that the PASS system “was originally designed to exclude anyone who was HIV-positive, regardless of ability to transmit.” In an email to Jezebel, he underscored that participation in the system requires “a statement affirming that you have never tested positive.” It is technically possible for someone who is undetectable to have worked within the PASS system, but only if they had a vanishingly low viral load and were willing to falsely claim that they have never tested positive.


The post-panel Twitter noise about the possibility of undetectable performers in the talent pool grew loud enough that Talent Testing Services and Cutting Edge Testing, the two outside clinics that test for the PASS system, decided independently of FSC to add the antibody test to their performer panel free of charge. Previously, FSC had announced that it had decided against adding the antibody test to its protocol because it “offered no additional risk reduction... while increasing costs for performers by at least $15.”

While the PASS system does not mandate the antibody test, those test results are nonetheless now being fed into it. As a result, Leue says anyone who tests positive on an antibody test will now be prohibited from working within the PASS system. In other words, it is now virtually impossible for performers who are undetectable to enter PASS. Which, from certain perspectives, only greater underscores the need for an additional testing system that addresses these performers.


Ty Mitchell, who has performed in gay porn for over two years, feels that undetectable performers “should have the ability to work, if their scene partner is comfortable with working with them.” Excluding these performers from the industry, he argues, “demonstrates a real failure to understand how HIV has impacted the gay community, and how HIV-positive people currently live.” Mitchell points to stigma, discrimination, and even criminalization around HIV. (It was only in 2017 that California made it a misdemeanor, instead of a felony, to fail to disclose one’s HIV status to a sexual partner.) One of the concerns aired at the HIV panel is that the current PASS protocol might actually run afoul of anti-discrimination laws by entirely excluding HIV-positive performers from the industry.


“This marginalization exacerbates the HIV crisis by making people too ashamed or depressed to communicate with partners, to get tested, to take their meds, and to work with their medical provider,” he said in an email. “I think there’s an ethical imperative to demonstrate to people that it is possible to have sex with HIV-positive people safely and satisfyingly.”

Longtime porn performer Lance Hart runs the site, which bills itself as “films with men getting weird.” Typically, he relies on PASS testing, but whenever he books a performer who is HIV-positive and undetectable, he has to pair that performer with a co-star who is also undetectable, and typically formal testing is then forgone. That’s because the PASS system is specifically designed to exclude HIV-positive performers, he says. He argues that there are no feasible testing alternatives for performers because of issues around accessibility, turnaround times, standardization, and healthcare coverage.


Ultimately, this means that in order to shoot with HIV-positive and undetectable performers, he has to do so without the safety measure of any kind of standardized STI testing. “It’s fucked up, because I’m like, ‘I hope one of you guys isn’t giving the other one gono,’” he said. “It’s not cool. It’s ultimately their choice, but I don’t feel great about that.” That’s one of the reasons that he feels an addition to the PASS system is necessary. “We need this so bad,” he said. “It absolutely has to happen. We just need a system to keep us safe.”

For these reasons, the Adult Performer Advocacy Committee (APAC), a non-profit centered around protecting performers’ rights, and which is unrelated to APAG, is in theoretical support of the concept of adding a parallel testing system to PASS. “At this time, a lot of gay sets are operating using no tests or printed out tests from their separate doctors, because they’re not eligible for the PASS system if they’ve ever tested HIV positive,” said Riley Reyes, president of APAC. “We would love to see a testing system available to help make our gay performers safer.”


Hart has worked as a “crossover” performer for over a decade and says he has seen the norm within gay porn shift from condom-only to condom-less. “I don’t even shoot condom stuff anymore. It’s not gonna sell,” he said. “That’s how much it’s changed.” Now he demands a PASS test from all co-stars. “Gonorrhea, syphilis, and hep c are huge concerns for me,” he said. “I don’t want that. Within a day I’m gonna give it to my wife and then she’s fucked.” Part of his concern is that his wife, porn performer Charlotte Sartre, would lose work if she contracted an STI.

“The people who say, ‘We can’t have this,’ I’d be curious to hear how it actually affects them,” he said. “I don’t get it. Why would you not want this?” He suggested that those performers simply not opt-in.


Similarly, Wolf Hudson, who has worked as a bisexual performer for 12 years, says, “I don’t think anybody should dictate how anybody performs. So if someone who is negative doesn’t want to perform with an HIV-positive performer, that’s their prerogative and I’m not passing judgment.” But Hudson, who says he is comfortable performing with co-stars who are HIV positive and undetectable, adds, “I would personally hope that they come to that conclusion based on facts. If they understood the facts, that fear would not be there. A lot of it just comes straight from stigma.”

In fact, despite his enthusiasm about expanding the testing system, Hart questions whether he’ll be able to opt into such a testing pool himself, because he fears that anyone who does will be stigmatized as posing an added risk within the industry. In other words, it could damage his ability to continue performing in straight porn. As it is, Hart says he’s already been blacklisted four times by major talent agencies as a result of his doing crossover work.


The conversation around a separate testing system for undetectable performers may be controversial within the adult industry, but leading HIV researchers and experts are excited by the idea.


“Why wouldn’t we encourage the industry to do this?” asks Carl Dieffenbach of the National Institute of Allergy and Infectious Diseases. “If you think about this, this is a really good message that people can pursue their livelihood even though they’re HIV-positive because the industry has listened to the science.”

He adds, “I think this is a big victory for people with HIV and it’s a big victory for this community that they’re being inclusive, they’re being open, and it’s a model for what the rest of society should be doing.” Dieffenbach continued, “We have to wrap our heads around that ‘undetectable truly means untransmittable,’” he said. “The industry is modeling the best behavior for all the people who watch and participate vicariously in porn by getting it on their computers.”


Similarly, Bruce Richman, the founding executive director of Prevention Access Campaign, which targets the “dual epidemics of HIV and HIV-related stigma,” says, “I think it would be a wonderful step forward for the adult entertainment industry to stand with science, to stand with social and reproductive justice, and to integrate the science into their testing process so that people living with HIV who are undetectable have the opportunity to participate in the field just like anyone else and are seen as safe.”

But Richman, creator of a recent “undetectable equals untransmittable” social media campaign, notes that the barrier to acceptance is significant. “Culturally, we’re up against over 35 years of fear of HIV and people living with HIV, and people are resistant to change.”


Correction: An earlier version of this story stated that Lance Hart’s wife was named Charlotte Cross. Her name is Charlotte Sartre. Jezebel regrets the error.

Correction: This article has been corrected to reflect that Wolf Hudson identifies as a bisexual performer.

Senior Staff Writer, Jezebel

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The Hate Watcher

Firmly of the belief that failure to disclose HIV status should be a felony. It's a gross violation of the other person involved and frankly I can't really see a good argument aside from "I wanted to get laid" that tracks morally.