The Adult Film Industry: Time to Regulate?

T he United States adult fi lm industry produces 4,000–11,000 fi lms and earns an estimated $9– $13 billion in gross revenues annually [1]. An estimated 200 production companies employ 1,200–1,500 performers [2]. Performers typically earn $400–$1,000 per shoot and are not compensated based on distribution or sales. Los Angeles County is the largest center for adult fi lm production worldwide. In 1988 the California Supreme Court, in People v. Freeman, found adult fi lm production to be protected as free speech under the First Amendment, since such fi lms were not considered obscene based on prevailing community standards. Unlike other legal but highly regulated activities such as gambling and commercial sex work in Nevada, the adult fi lm industry was legalized in California through case law, not by statute, and has for the most part escaped governmental oversight. Regulation of the industry has been limited to prevention of child pornography. Title 18, Section 2257 of the United States Code of Regulations explicitly prohibits performers under age 18 and provides for civil and criminal prosecutions for any violation [3]. Adult fi lm production companies are required to have a Custodian of Records to document and retain records of the age of all performers, to enforce the age entry restriction. Adult fi lm performers engage in prolonged and repeated sexual acts with multiple sexual partners over short periods of time, creating ideal conditions for transmission of HIV and other sexually transmitted diseases (STDs). All the more concerning, high-risk practices are on the rise [4]. These practices include sex acts that involve simultaneous double penetration (double-anal and vaginal– anal intercourse) and repeated facial ejaculations. At the same time, condom use is reportedly low in heterosexual adult fi lms—approximately 17% for adult performers [5]. In 2004, only two of the 200 adult fi lm companies required the use of condoms for all penile–anal and penile–vaginal penetration [2]. Performers report that they are required to work without condoms to maintain employment. These practices lead to high transmission rates of STDs and occasionally HIV among performers. After four performers contracted HIV in 1998, Sharon Mitchell, a former adult fi lm performer, founded Adult Industry Medical (http:⁄⁄www.aim-med. org), a clinic to counsel and screen performers monthly for HIV using a PCR test (Figure 1). It was expanded later to include other STD testing. The testing program began as an effort to reduce transmission of infections through …