Why Did AIDS Healthcare Picket AIM?

VAN NUYS, Calif.—Approximately 15 employees and supporters of AIDS Healthcare Foundation (AHF) picketed the offices of Adult Industry Medical Healthcare Foundation (AIM) this morning, chanting slogans such as, "AIM screws adult actors/Money is a major factor/Withholding info from the county/While collecting quite a bounty," "Shame on AIM" and "Porn clinic is a gimmick," while carrying signs reading, "AIM=death" and "AIM protects porn dollar$"—and AIM founder Dr. Sharon Mitchell has had enough of it.

"Why are they not picketing adult production companies?" Mitchell asked. "What does this have to do with AIM? We love to see people use condoms! By all means, but why the heck is AIM taking the blame for people's personal choices and providing a good service that's been helpful? Why are we the target? I don't know what that has to do with us."

"There were more than a handful of civilian people today that were terrified to come in because these knuckleheads were parading around in their underwear with fake nipples and leaves painted on them, screaming horrible things about their healthcare provider," she continued. "They [patients] were afraid to come in. How many people didn't come in today because they were out there? We had one gentleman who had to be escorted in by the police, who was so shaken, he had to be counseled to calm down. These people freaked out and upset folks, and if they're so concerned about the confidentiality of patients, then why are they parading around with cameras, frightening folks and why are they picking on AIM? We are being of service like anyone else."

But apparently, it wasn't so much that provision of services that AHF claims is the problem, but rather AIM's dealings with the Los Angeles County Department of Public Health.

"Our understanding is that AIM is not being entirely cooperative in terms of giving information in a timely manner to the county to make case reports, particularly when we've got HIV," claimed Whitney Engeran-Cordova, the director of AHF's Public Health Division, "and in the case of this last HIV infection, they got everybody going again, that they're not wanting to provide the information necessary. I want to believe that AIM cares a great deal about their patients and about the people they're taking care of, so I think they need to do everything they can to cooperate with county authorities when they are doing legitimate and legal investigations, case report investigations to help identify partners, to help find and make sure we're able to isolate when there are outbreaks of infection, we're able to isolate those and get those people into treatment and care."

Mitchell is at a loss to understand AHF's position, particularly in the case of "Patient Zero," a person who wishes to remain anonymous, who wanted to return to adult performing after a long absence, and who tested positive for HIV but was reportedly allowed by an adult producer to perform in a scene before the person's test results had been reported.

"For the umpteenth time, AIM does report in a timely manner, because a) we're required to, and b) we of course want to report things as soon as possible," Mitchell responded. "The situation that happened last time, which was months ago, which was a non-industry related exposure, we used the early detection PCR-DNA test. The HIV-positive patient was such a very early borderline detection that we had to have it sent out for verification, to make sure that it actually was positive. It had to be sent from our lab to Specialty Laboratories, which does all the confirmation on very early detection tests. This took, I think, seven days to get the verification back, but the county of Los Angeles doesn't seem to like to accept early detection testing. They want it to be verified. If it were an antibody test, like an Elisa test or something, they would immediately take that, of course, but then this person in question would have had HIV for at least seven weeks to six months, possibly, before that test would have come back positive, and that's why we don't use that specific test: It's inefficient for our population."

The testing that AHF advertises on billboards around Los Angeles as a "10 minute test" is just such an antibody test.

But according to Mitchell, AIM goes several steps further than merely reporting positive STD and HIV cases to the Health Department.

"Oftentimes when we do report STDs, we do specify whether they are industry or civilian, and the reason we do that is because by the time AIM reports them, which is within 36 hours, we typically already have gotten a list of partners and all partners have been medicated and they've either been retested negative or it's a closed case," Mitchell described. "It's not necessary for the county's STD Department to go out and start knocking on doors because when AIM reports an industry case, it's already sewn up; partners have been notified, treatment's been done, they've been medicated and five to six days after that, they've been retested and they're back to work."

"What happens is, oftentimes, people will come in and retest if they've been exposed," Mitchell continued, "and sometimes they will get a second positive test, and if they're in a hurry to get back to work sometimes, they'll test a day or two before the virus has cleared and sometimes they'll have a third positive test, and the county continues to count these as new infections even though it's the same person testing three times in the same few days, and this is how they get these inflated numbers."

Mitchell was referring to the number of HIV, chlamydia, syphillis, gonorrhea and hepatitis cases which the Health Department has claimed have been generated by adult performers, and which have been reported in the Los Angeles Times and in AHF press releases—numbers which the department has been forced to retract as not necessarily accurate.

As for Engeran-Cordova's contention that AIM may not be cooperating fully with the Health Department to identify partners of AIM clients who have tested positive for HIV or another sexually transmitted disease, Mitchell points out that while such disclosure of partners' names in not required, AIM has done so in a limited number of situations.

"For instance, with this last [HIV case], we were 99 percent certain that no exposure took place," Mitchell explained. "This was not a workplace exposure. We knew this person in question had only worked once or twice, and when we interviewed this person, we realized that the exposure did not take place in the industry, and indeed, they had not worked to expose anyone afterwards in the industry, so we had tested the partners that could have been exposed, just to be on the safe side, as we always do when we put people on quarantine. We ask them, please, routinely test, which we do by many different means. We test for a full panel of STDs when someone's been exposed to HIV, and we test by three or four different methods of early detection of HIV, and in this case, there was nothing to report. I really am unclear as to why we are being persecuted for doing a thorough job and having such a low amount of positives."

But according to Engeran-Cordova, today's protest wasn't really about First Amendment issues or the adult industry at all.

"What I really want to say to you and especially to your readers, this is not about porn; this is not about adult films themselves and whether people should or can be viewing adult films or enjoying adult films," he claimed. "I don't have any problem with any of that. What I have a problem with is people working in a field in their job, having insertive sex and having no protection against what can be debilitating diseases, so all I really hope, and I really wish that your readers would hear, that our interest is in people being protected and in people who are working in this industry being protected from disease and infection. It's not about stopping people from enjoying, making or producing adult films."

"Then why would they be in front of our facility saying AIM equals death and porn-funded and all of this stuff? They're directly linking one with the other," Mitchell retorted, referring to the protesters' chants and some of the slogans on their signs.

"I understand that we're talking about California, and that adult films are not only produced in California," Engeran-Cordova continued, "so if people don't want to see condoms, then at least in the legislation that we're proposing in Sacramento they can be digitally removed. This is really about the workers and what I would say about that is ... in gay porn, people are still watching gay porn and most gay porn has people who use condoms and they make their way into the scene; people aren't fumbling to put them on, they magically show up and people are protected. I don't understand why there's a double standard in that regard. HIV affects more heterosexual people on this planet than gay people by far, by leaps and bounds, so I'm at a loss as to why there's a double standard. But the disadvantage that I can envision is people saying that people aren't going to buy it because there's condoms there."

While AVN is unaware of the wording of the mandatory-condom legislation AHF is supporting in the California legislature, AVN has already reported on the financial impossibility of digitally removing condoms from sex scenes.

"This is not Disney," Mitchell added. "There is not a gigantic computer-graphics house out there where these things can be digitally removed. These [adult movies] have various and sundry budgets of different companies, and many times people work in productions of less than $10,000, and where would that money come from to digitally remove those?"

Moreover, Mitchell bristles at the suggestion that AIM does not provide a valuable service to both performers and to the public health system.

"It's tremendous protection!" Mirtchell exclaimed. "In fact, I think the actual statistics show that it's probably safer to work in this adult industry without 'barrier protection' than it is to go to your local pub and have at it. Now, let's not deny that just inside of our door is a gigantic bowl of condoms—condoms which by the way are no longer provided free by the county or any other entity. Where we used to get condoms for free, AIM now continues to pay and pay handsomely to provide condoms. People use those condoms; they have the option to use those condoms with or without testing. We are not stating that we are an anti-condom facility; we are stating that people have the choice to utilize the toolbox that AIM provides. If you wish to use our toolbox, you can use the condoms, you can utilize testing, you can ask your partners to test, you can share results, you can utilize everything AIM provides, and it's been proven effective I think over the last 13 years, given our track record, that this system does work and it works quite well, and these horrible accusations that we are making a fortune somehow when we clearly are not—our books are open just like anyone else's are, and actually I'm quite embarrassed for them and their behavior to actually go in front of another healthcare provider and act the way they did today. We felt quite sorry for them."

When asked if he could think of any situation in adult movie production where he could understand performers or producers not wanting to use condoms in a sex scene, Engeran-Cordova responded, "I'll give you the example from the gay porn industry of Christian Bjorn, who films partners, people who are together and are in monogamous relationships having sex without condoms. That's a little bit different; you're talking about monogamous partners who are claiming their monogamy and filming that. That's what makes them sensible."

However, Mitchell, a veteran with more than 40 years in the adult industry, found Engeran-Cordova's naivete saddening.

"How does he know they're monogamous?" Mitchell retorted. "How the heck does he know? They're quoted that way, they say they're a couple, but for goodness sake, it's show business! Who knows?"

"I've worked on many gay film projects," she continued, "and there are a good amount [of 'condom-only' productions] where the tips of those condoms are cut off so it appears as if the person is wearing a condom, and they are on the bottom half of their penis, but the tips are cut off. So those people are not reallly being protected., And we do not have a baseline of who's HIV-positive because the gay industry feels this [condoms] is just sort of a golden band-aid. If I had a baseline, I'd bet there's between 30 and 80 percent HIV rate of gay actors. This is a crazy argument that has nothing to do with anything concrete or any statistics; it's just another attack at AIM."

But while Mitchell said that AIM would support performers who are HIV-positive and whose viral loads are low and being managed with medication working together with or without condoms, she didn't think such a situation would be workable on the hetero side of adult.

"I think, if people were told that they'd be using condoms and working with other performers who had not been tested, they'd be shocked and mortified," Mitchell observed. "I don't think they'd agree to do the movie, and they would go, 'What the heck is going on with the system that we already have? If we have to use condoms, why can't we test as well?' I don't think people like to be told that they have to do anything, number one. Number two, I feel that we provide a service. We are not pro or con condoms or testing; we just provide a toolbox that we hope people utilize to make sure that they are as safe as they possibly can be, and our follow-up is so much more effective due to the fact that we use early detection testing and we have a closed-ended system of folks who are willing to share results. This is not broken; do not attempt to fix it."

Another long-standing dispute between AHF and AIM is over the issue of patient privacy. AHF supported the county Health Department and the California Department of Occupational Safety and Health (CalOSHA) when it went into court over the summer to attempt to force AIM to disclose the identity of 'Patient Zero' and other personal information about the patient, and Engeran-Cordova admitted today that AHF was behind California Assembly Member Bonnie Lowenthal's recently introduced bill, AB 2590, which would change the state's Health and Safety Code to allow disclosure of such information to "an agent or contractor of the state that, by contract with the state, is authorized to provide medical care and treatment to the subject of the test"—apparently whether the patient wants that information disclosed or not.

"The Lowenthal bill, which we did in fact sponsor," he said, "is really a bill that's intended to help move information from legitimate and authorized healthcare entities to other healthcare entities, that is authorized and consistent with HIPAA, so it's not in any way in contradiction to HIPAA. It doesn't have anything to do with this issue; it doesn't have anything to do with porn, doesn't have anything to do with the adult industry whatsoever."

But while Engeran-Cordova suggested that the Lowenthal bill would not have the effect of reducing patient medical privacy, Mitchell is less than certain of AHF's motives in sponsoring the bill.

"If they're so concerned with HIV patients' privacy, why are they supporting a bill that would allow the state to tell them who's positive, and why are they out here in front of a clinic that tests for whether a person is HIV-positive?" she asked. "If AHF were really concerned with something other than cheap publicity stunts, this press conference would not be in front of a healthcare facility where it endangers patient privacy."

For his part, Engeran-Cordova told AVN that AHF "would like to have some genuine conversations with folks about this. It's not about denigrating the industry; it's about protecting people and, frankly, the public's purse from a whole lot of expense."

Mitchell's response? "That's exactly what AIM already does."