The 14 doctors and other healthcare professionals who signed onto the study that will appear in Friday's issue of the Center for Disease Control's Mortality and Morbidity Weekly Report (MMWR) seem to give reasonably high marks to AIM Healthcare Foundation's handling of last year's HIV outbreak. The unsigned "Editorial Note" that follows, on the other hand, seems to be doing its best to undo the study's good words.
"The report is typical MMWR stuff, which is always good," noted Dr. Sharon Mitchell, Ph.D., AIM's founder. "They're usually 400 words or less, and they're an accurate depiction with study statistics and attack rates only. There's only so much you can put in there."
Indeed, the report tracks the outbreak from its origins, giving dates of positive and negative HIV tests, the number of primary and secondary contacts with possible HIV carriers, and the steps that were taken to isolate carriers and to test the contacted talent pool. It also notes that the California Occupational Safety and Health Administration (Cal/OSHA) issued two citations (to Evasive Angles and TTB Productions) as a result of an investigation into the situation for "failing to comply with the state’s bloodborne pathogen standard (2), failing to report a serious work-related illness, and failing to prepare and follow a written occupational injury and illness prevention program."
There is still a question as to whether Evasive Angles and TTB were "employers" of the HIV-positive performers under the law, and therefore subject to Cal/OSHA's regulations regarding compliance with the bloodborne pathogen standard (2), filing an illness report and following a prevention program. Those matters will likely be settled in court, and if that ruling finds that the talent were independent contractors, the citations likely would be dismissed.
That question, however, did not seem to trouble the anonymous author of the Editorial Note appended to the CDC report, which takes issue with the adult industry's HIV and STD prevention methodology – and that makes Mitchell angry.
"First of all, it's never been determined, and I think OSHA has admitted this, whether performers are employees or independent contractors; in other words, who is supposed to take responsibility for what," Mitchell listed. "Two, that [performer status] is typically determined by a good-faith meeting between OSHA and the population at risk to discuss issues. Then whoever would take the responsibility for the workplace, whether it be producers or whoever, they would have to determine, thirdly, whether it is workable in the workplace. In other words, is a moon-suit going to work in an adult film? That type of thing. Number four, they need to decide the means to enforce: How, where, who, and where does the money come from? And number five, and I think this is where AIM has a right to state some statistics, from our point of view, this may be a disproportionate response, because last year, there were about 2000 new infections of HIV in Los Angeles County. Four of them were from our industry, so this might be a disproportionate response. To spend all this money and – ultimately, is it going to make things safer? Probably. But is this community going to be able to handle these types of measures, and how can we determine that?"
Mitchell specifically takes issue with the editorial note's mention of industry STD statistics from June 2000–December 2001, which the note admits were "before voluntary monthly STD screening was instituted." The note claims that "prevalences of chlamydial infection and gonorrhea among heterosexual adult film industry workers in California were 5.5 percent for males and 7.7 percent for females for chlamydial infection and 2.0 percent for both males and females for gonorrhea," while "a nationally representative sample of young adults aged 18–26 years during April 2001–May 2002 revealed prevalence of chlamydial infection among males and females to be 3.7 percent and 4.7 percent respectively, and, similarly, prevalence of gonorrhea to be 0.4 percent and 0.4 percent, respectively."
"There was one month in 2001 or 2002 when I called everyone in for a routine screening because we had a spike in our STD rates, and I think they included the spike in their data," Mitchell responds. "Our chlamydia rate is 1.8 to 2.8 percent now since we instituted our monthly screenings, so we're lower than the general population."
AIM also reports its industry STD statistics to the county health department on a regular basis, so it is unclear why the writer of the Editorial Note would not have recent figures available.
The mention of "voluntary" testing also rankles Mitchell.
"These days, everyone looks at everyone else's test, because one girl, if she works for a small company or with somebody that doesn't compare tests, tomorrow she's going to work for Jim South, and Jim South is going to send her across the street to us," Mitchell explains. "Our tests-by-mail is huge. We sometimes get 100 specimens a day to test by mail because even people who do the homegrown stuff are testing. So we get everybody. This is not like any other gig."
Therefore, Mitchell says, to conclude, as the editorial note's author does, that "as demonstrated by the recent incidents of HIV transmission in this industry, screening alone is not adequate to prevent transmission of HIV or other STDs because infected persons can transmit these diseases for a period before their infection can be diagnosed" is to look at the actual situation on the ground "through this very, very fine microscope."
"I think ultimately what they're saying is, 'We understand, being the Los Angeles County Health Department, that we have had 2000 new HIV cases last year, but these four, by golly, we're going to spend a lot of money and a lot of time and look into something that's being voluntarily done with what we think is a high-risk population,'" Mitchell assesses. "The big picture is, I want to know why are these four cases – and I'm so sorry that this had to happen to these people last year, but why are these four cases generating so much time and expense?"
"There's all types of different workers that can be exposed to blood or garbage or bacteria or cleaning fluids or hazardous materials or anything," she continues. "In a way, if this industry wants to be legitimate, a [health] standard is going to have to be set sooner or later, but to target us and to compare our current protocols with something that may not be workable in the workplace, that may drive people underground, that may drive people not to voluntarily come in and test anymore, is purposefully and definitely going to cause more problems by dumping disease into the general population and driving the disease rate up within this [industry] population. So if we're going to come to an agreement, it has to be very gingerly and carefully done, with total and utmost cooperation between producers, directors, talent and the [health services] people that are looking at us right now."
As an example of the county's well-meaning but impractical methodology, Mitchell points to the way county investigators handled some of the performers involved the 2004 outbreak.
"I said to them, 'A mother found out that her daughter did porn because your investigator was sitting in a car in front of her house like a crack dealer, and said he was from the County Health Department. This woman never told her mother what she did, but thanks to you, now her mother knows, and that created a family crisis.'"
"They're looking at AIM's protocols and our wonderful service like it's some horrible violation, when their own system doesn't even work well," Mitchell summarizes. "Am I the only one who sees that?"
Mitchell is looking into discovering the identity of the editorial note writer, since she's certain that it isn't any of the professionals who signed the report itself.
"I know everybody on there," she claims. "We worked with them for this report; that's why it's good."
