Fifth Cal/OSHA Meeting Breaks No New Ground

OAKLAND, Calif.—It's rare that meetings of the Cal/OSHA Subcommittees on Blood Borne Pathogens in the Adult Film Industry (AFI) actually make it through their agendas, which made Tuesday morning's meeting the exception—except that the purpose of the meeting was to finish up the agenda begun in meeting #3, which was the Advisory Subcommittee on Medical Issues.

One reason the meeting was so brief may have been the fact that subcommittee members who might have stoked one or more of the many controversies about adult performers' health—Gail Bolan, former Chief of the STD Control Branch of the state's Department of Public Health; Frank Strona, Chief of the San Francisco Department of Public Health's STD/HIV Unit—STD Prevention & Control Section; Naomi Akers, Executive Director of the St. James Infirmary; and HIV specialist Dr. Aaron Aronow—were absent from the meeting.

Those who were in attendance—Dr. Peter Kerndt, Director of the Los Angeles Department of Public Health's STD Program; Nurse Denise Bleak of Beyond AIDS and APIC; and Dr. Paula Tavrow of the UCLA School of Public Health—had few disagreements regarding their support for mandatory condom use in the adult industry, and two members present by phone—Dr. John Brooks of the Centers for Disease Control (CDC) and Dr. Bruce Bernard of the National Institutes of Occupational Safety and Health (NIOSH)—were also generally in favor of the requirement.

The meeting was chaired once again by Cal/OSHA Senior Safety Engineer Deborah Gold, assisted by District Manager Peter Riley and attorney Amy Martin, and the audience included representatives from a spectrum of interest groups including attorney Brian Chase of AIDS Healthcare Foundation, Diane Duke and attorney Kevin Blank for Free Speech Coalition, attorney Karen Tynan for AIM Medical Associates (formerly AIM Healthcare Foundation), attorney Paul Cambria for various adult companies, Mark Roy McGrath for the L.A. County STD Program, Christina Hart-Rodriguez for UCLA's Reproductive Health Interest Group, Stacey Swimme of St. James Infirmary and several others.

The meeting began with Gold summarizing the proceedings of the previous medical subcommittee meeting, then launching right into a discussion of Agenda Item #3: Assessing the risks of STD and other infections if condoms were or were not used for finger-fucking (not the term they used, of course), blowjobs, vaginal and anal intercourse and "other sexual or parenteral [skin-piercing] contact."

Dr. Kerndt began the discussion by referring to a chart provided at the previous meeting by L.A. County Health Department's Dr. Robert Kim-Farley and noting that he generally agreed with the "hierarchy of risk" set forth in Dr. Kim-Farley's chart titled, "Review of Major AFI HIV/STD Health Risks." That chart places non-condom anal sex as the highest-risk practice for both HIV and STD exposure, followed by vaginal sex, creampies in either the pussy or ass and cum contacting the membranes of the eye. Blowjobs and pussy-licking were considered low-risk for HIV but high for other STDs, while rimming, cumming in the mouth and sharing sex toys were considered low for HIV infection but "moderate" for other STDs, and skin-to-skin contact as "very low" for HIV but still "moderate" for other STDs.

"There is an important need to differentiate between treatable and non-treatable, because it can reduce the risk, mitigate risk through screening and treatment along with barrier protection to reduce it to an acceptable level," Dr. Kerndt added regarding skin-to-skin contact. "But certainly barrier protection for anal, vaginal exposure, and I think the primary exposure for finger and other skin contact would be much less, and those would be probably the non-blood borne pathogens; the fecal-oral risk and also the ATM risk could be mitigated by cleaning the surfaces and protecting the membranes from exposure."

When her turn came, Nurse Bleak referenced Free Speech Coalition's Blood Borne Pathogen Exposure Control Plan, which it had introduced at the subcommittee's first meeting, and began making minor corrections to the document before being reminded by Gold that she should be addressing the question of which (if any) practices put adult performers at risk for infection. She then voiced general agreement with Dr. Kerndt's analysis, as did Dr. Tavrow later.

"In response to the statement that this would drive the [adult] companies out of country to do their filming," Nurse Bleak said of the possible requirement of condoms for blowjobs, "as well as what's available for college students, where I work in the northern part of Los Angeles County, the San Fernando Valley, great hub of the adult film industry—it's a large economic force there—so I've been told, especially by the Employee Health Services at CalState-Northridge ... that many AFI performers are actually CSUN students; they get income from that to go to college. So it made sense to go to the websites of colleges and look at educational content on those college sites to see what kind of STD prevention they have. There's really no discusson of barrier protection for oral sex there," she noted.

"The adult film industry makes reference in some of their literature to the 'pounding away' at a receptive partner," she continued. "The 'pounding away' phrase would mean repeated vigorous forceful insertion of a penis or other object into an orifice. I believe that's well-known to cause some micro-abrasions... and that would be a portal of entry for a blood borne pathogen."

However, when the subcomittee members were later questioned about whether condom use could cause such micro-abrasions, as actress Nina Hartley had reported at a previous meeting, the consensus was that if sufficient lube were used, and the condoms had not been treated with the anti-HIV chemical non-oxynol-9, that wouldn't happen.

"It's also pretty well known that condoms aren't as disgusting as some people make them seem in the adult film industry," Nurse Bleak added.  "I rather liked them when I was handing them out in my homeless clinic duties and my AIDS Control Clinic duties. I like giving out condoms to people. I'm for them."

Finally, regarding cumshots, she advised, "I just have maybe one term for the adult film industry that's coming to your local theater: CGI. Computer graphics. So if you're ready for computer graphics, then you can simulate that and ... maybe you can consider not putting people at risk with actual secretions when you can simulate fake secretions; maybe make them more interesting."

But Dr. Kerndt was not about to agree that condoms shouldn't be mandatory for blowjobs or dental dams for pussy-licking, and he even had some cautionary words for mere skin-to-skin contact.

"I think there are other factors that aren't knowable in each instance that may increase risk, such as a performer that may be menstruating, so there would be direct contact with blood without barrier protection that would greatly increase the risk," he warned. "Also, any sexually transmitted infection that may be on an unscreened anatomic site or even a screened anatomic site but within the incubation period of that disease but outside of the sensitivity of the diagnostic method, and many of the STDs in the oral pharynx and rectum are known to be asymptomiatic, and when you have that STD, the normal protective mucosal membrane is not present, it increases the risk. Even without an STD, there is substantial risk of exosure to a viral or a bacterial sexually transmitted disease. So it really is about measures that can be taken to reduce that risk to an acceptable level through either screening or barrier protection."

Other relevant factors that Dr. Kerndt noted were increased risks if an extra-large dildo or vibrator were used, or if the performers engaged in double-anal or double-vaginal penetration, which he claimed was the case with some of those infected by "Patient Zero" Darren James in 2004.

There was also lengthy discussion of the difference in risk between those getting blowjobs and those giving them (referred to as "receptors"), and the panel generally agreed that the receptor was more at risk than the the person receiving the stimulus.

"In the 2004 outbreak, where one informer who was infected worked with 13 female performers, infecting three of them, for a 23 percent attack rate," Dr. Kerndt said, "and that individual tested negative using PCR viral load, and he infected the first of those three women four days after his negative test, and worked until he was screened again at about 21, 28 days, and I believe... all three of the women were exposed to double-anal."

However, a review of the movies in which James performed in 2004 indicate that none of the women infected by James participated in double-anal scenes with him.

The subcommittee also discussed whether STD testing such as the AIM testing regimen would be helpful if used with non-condom oral sex and in combination with barrier protections (condoms, dental dams, goggles/face shields, rubber gloves) during vaginal and anal intercourse, and in which types of situations—pre-screening, periodic screening and/or post-exposure screening—it would be most effective?

"If the status of the insertive partner would be known for both the treatable and chronic infections," Dr. Kerndt stated, referring mainly to oral sex, "basically we would support medical monitoring of all workers and treatment of the treatable. The screening would be consistent with the incubation periods of the diseases, and they would be appropriate for the anatomic site of exposure... Currently, I think the expectation for the industry is that there would be barrier protection for oral sex, that there not be exposures to other potentially infectious material, even in cervical secretions, so right now, if the question is [whether] through screening and through limitations based upon chronic infection, whether the level of exposure and risk to the exposed individual could be reduced to an acceptable level, I would say maybe, but it depends on the infection status of some of these individuals and actually what the exposure in fact would be... If condoms were not used for oral sex, I think that there would have to be screening and limitations placed on the individual who had an untreatable condition. It may be a recurrent herpes outbreak, a primary herpes, it may be an HIV-infected insertive partner—I don't think, with or without ejaculation, without protection should that be allowed. There should be a limitation placed on that exposure."

"Certainly, if there was exposure," he continued, "if there was a breach in the barrier method that exposed that worker, then I think that exposed individual should be screened."

The subcommittee spent several minutes discussing what steps should be taken regarding contact in sex scenes with a known HIV-positive individual, even though there has never been any such reported incident in the hetero adult moviemaking community.

Dr. Kerndt challenged the frequency of talent testing by AIM.

"Certainly in a one-month interval, we've seen several examples where that interval has been insufficient to protect workers in this industry," he said. "In the 2004 outbreak, the individual was screened, faithfully, monthly for four to seven years, and it worked during that period—or may have; we don't know, really, how many exposures—but then this individual tested negative, and three days later infected the first of three of 13 women he worked with, and 23 days later when he was tested, it was found that he was infected, and during that 23 day window, 61 first- and second-generation persons were exposed. So the one month interval ... is not going to exclude everything, but clearly if condoms had been used in those shoots, three fewer women would be infected with HIV."

Dr. Kerndt also referenced the recent infection of gay performer Derrick Burts (who allegedly contracted HIV during an all-condom shoot), then claimed, "I think we can expect this is going to occur consistently in the industry, and I think another really important part is, maybe we don't know all the answers, but we have to have the information as to the industry and the cooperation of the industry to really fully characterize the risk from these risks [sic] and really determine how the infections entered the industry and whether they're acquired or transmitted in the workplace. Because there is a source for all of these infections; they're person to person; they don't spontaneously generate in an individual; they're all person to person contact, and it's either exposure in the workplace or exposures out of the workplace brought into the workplace. And obviously we can't control everythign that occurs in the sexual context outside of the workplace."

"It sounds to me that what you're saying is, there's an unacceptable risk to anything but full barrier protection?" asked Gold.

"Yeah, I think that if there is full barrier protection, the screening is less of an issue, the pre-screening," Dr. Kerndt replied.

But when Gold asked if there were any point to screening (testing) in situations where "full barrier protection" were used in sex scenes, Dr. Kerndt equivocated, admitting that there might be.

"I think you could have oral exposures unprotected with appropriate screening," he said.

In the end, all of the subcommittee members agreed that testing of some sort would be useful, even if condoms and other barriers were used for all on-camera sex acts, if for no other reason than to help gather statistics on STD infections rates in the industry.

Gold also noted that the CDC recommends that performers obtain all of the available anti-STD vaccinations, including those to counter Hepatitis A and B infections, as well as the recently-recommended HPV vaccines.

The hearing concluded just after noon, with Gold stating that the next meeting of the subcommittees would take place in March in Van Nuys, Calif., and will be a "business meeting" of the Cal/OSHA Standards Board, during which no public comments will be allowed. However, she said, prior to the commencement of the business meeting, audience members would be allowed to comment on the subcommittee recommendations (if any), but that no rule-making would take place at that meeting.

"Our chief, right now, is interested in possibly making a rule-making proposal," she said. "In addition to that, the petitioner [AIDS Healthcare Foundation] or anybody else can still go back to the Standards Board. So we can propose something, Cal/OSHA can propose something; based on this record, the petitioner can go back and say, 'Even though the division didn't propose something we think you should act on, here is our modified petition.' The Free Speech Coalition or any other person sitting here or not sitting here in this room can go to the Standards Board and say, 'Look, a record has been created, and this is what we think you should do about it.' Anybody can go to the Standards Board and say, 'This is what we think you should do now.'"

Gold further stated that if any rule is proposed, that there would be a public hearing on it and "a lengthy public comment period, and that may modify the proposal."

While neither Gold nor any other participant at Tuesday's hearing indicated that they would definitely propose a new rule to modify the current California Health Code requirements, certainly the medical subcommittee seemed poised to advise the board that condom (and possibly other barrier) use be required for sex scenes in all adult movies shot in California, though the subcommittee's view on requiring condoms for blowjobs appeared unresolved.

Keep checking back with for information and analysis of Cal/OSHA's continuing fight to force the adult industry to be "condom only."