LOS ANGELES — As states and employers furiously develop plans to safely reopen workplaces in the midst of the coronavirus pandemic, they’re grappling with what seems like an endless list of questions: where to test, who to test, and how often to test for the virus? Further complicating matters are issues of workers’ privacy, geography, politics, science, and cost. It’s a difficult mandate. But there is one place to look for guidance — the adult film industry.

Since the late 1990s, when an outbreak of HIV infections threatened to shutter the multibillion-dollar industry, the mainstream porn community has implemented procedures that require all performers to be tested for HIV and a host of other sexually transmitted infections every 14 days before they can be cleared to work. Any HIV-positive test leads to an immediate shutdown of all U.S. sets, followed by detailed contact tracing before sets can reopen. While not perfect, those in the industry say the nationwide PASS program works to protect thousands of performers, ensures safer workplaces, and curtails the spread of disease.

“I don’t think I could be in this industry without it. That would be insane. Bareback sex with strangers 20 times a month? It would be like the most dangerous job in the world,” said Lance Hart, a gay and straight adult film performer and independent pornographer in Las Vegas who runs the production companies Sweet Femdom and Man Up Films.

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In the 20 years it has been in place, PASS has met, and overcome, many of the same challenges that any large-scale coronavirus testing program might encounter, from issues of keeping databases of private medical information secure, preventing the forging of test results, dealing with false positive results, and educating workers about the need for repeated testing to keep workplaces safe. Those devising strategies to reopen workplaces and the larger economy during the coronavirus pandemic say their plans would involve, at their core, processes of rigorous testing, isolation, and contact tracing similar to those used in the adult film industry.

“In many ways, what they are doing is a model for what we are trying to do with Covid,” said Ashish Jha, a physician who directs Harvard University’s Global Health Institute and has been calling for widespread national testing to contain the coronavirus. “The adult film industry teaches us that as a proof of concept, this can work. We just have to scale it up.”

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Lance Hart
Lance Hart, an adult film performer who also runs two production companies. Nikki Hearts

Jha said he could envision a program similar to PASS where Covid-19 test results are put into a secure database that could be checked to verify whether people had recently tested negative for the virus. “You could imagine TSA verifying someone had tested negative before they were allowed on a flight,” he said. “Testing is particularly important for areas that are high risk, like airplanes or meatpacking plants.”

While it did not cite the adult film industry, a “National Covid-19 Testing Action Plan” released by the Rockefeller Foundation last month included the creation of an “infection database” that could be accessed by employers, schools, TSA, and those scanning tickets for entry into sports or music venues.

“What the adult film industry has produced has worked, and really could be the kind of tool we need,” Jha said. “People can’t get distracted because it’s from a business they don’t approve of.”

Mike Stabile, communications director for the Free Speech Coalition, the adult entertainment trade association that runs PASS, said the adult film industry understands “better than most the discussion that has to happen for businesses to reopen.”

Yet for all of that expertise, it would be hard to imagine the Trump administration, or state politicians, reaching out to the porn industry for guidance. Stabile said that while he has not been contacted by any government officials, he would have plenty of advice to share. “It’s going to be an ongoing process. It’s not going to be a binary open or shut,” he said. “But it’s not as heavy a lift as people think. This is something that’s doable.”

Stabile, who is closely following coronavirus news, feels most people are unaware of the need for repeat testing that is standard in his industry. “When you look at the world at large, there’s an idea you’ll be tested once and then go back to work, but with coronavirus, it’s not that simple. We’re looking at a series of regular tests until this gets under control,” he said.

Repeat testing will be necessary for the coronavirus, too, because — like with HIV — there is so much asymptomatic spread of the coronavirus, said Elizabeth “Betz” Halloran, a professor of biostatistics at the University of Washington who directs the Center for Inference and Dynamics of Infectious Diseases at the Fred Hutchinson Cancer Research Center in Seattle.

“You’ll have to keep testing, maybe every 10 days. We need simpler tests that people can just do at home,” said Halloran, who envisions a low-cost “10-pack” of tests for home use.

“We can’t sit around for 18 months waiting for a vaccine. We have to find a way out without pharmaceuticals, and that’s repeat testing, taking people out of circulation, and then contact tracing, so it’s an interesting analogy,” said Halloran, who is working with colleagues to model a plan where the disease could be kept at levels that would not exceed health care capacity and that would require quarantining less than 10% of people.

Performers say they have a lot to teach the rest of the post-Covid-19 world. “We’re already used to working in an environment of risk. That’s something the rest of the normal world is just learning to do,” said Lotus Lain, a bisexual adult film actress who works with Stabile’s group as an advocate for other performers.

Lain said the porn sets she works on are extremely clean and precautions are taken to limit infectious-disease risk. “All of the things people are looking for right now — gloves, masks, alcohol wipes — we have all those things on sets. It’s standard operating procedure,” she said. “I hope other industries look to our industry not just to learn, but to credit us as well.”

Lotus Lain
Adult-film actress Lotus Lain LegendOne

AIDS experts say the testing program within the adult film industry provides insight into how we might build national testing programs to safeguard workplaces, but also helps illustrate the many challenges that lie ahead, in part because the coronavirus has proved so contagious.

“HIV is our prior pandemic. Surely we can learn from that,” said Robert Gallo, the virologist who co-discovered HIV and now directs the Institute of Human Virology at the University of Maryland School of Medicine. But Gallo said preventing the spread of HIV in the film industry is a far more tractable problem than reining in the novel coronavirus.

“You have to deal with every virus differently,” said Gallo, who in 2011 co-founded the Global Virus Network, a consortium working to prevent and eradicate viral disease. HIV, he said, was difficult to contain because symptoms don’t occur for years, but it was also harder to transmit. “This virus is viciously infectious,” he said. “It’s as infectious as anything I’ve ever heard of.” One key to containment, he added, would be to take time now, before widespread testing begins, to ensure tests are highly accurate and avoid the false positive results caused by cross reactions with other common coronaviruses.

Pamina Gorbach, a professor of infectious disease epidemiology at UCLA’s Fielding School of Public Health, has studied the spread of sexually transmitted diseases in the adult film industry. She says the testing program is a step in the right direction to protect the health of performers, but thinks there is room for improvement.

Gorbach’s 2017 study of 360 adult film workers showed 24% of performers were infected with either chlamydia or gonorrhea. One-third of those infections were found in the throat or rectum, she said, undetectable by the urine tests the industry uses to screen for sexually transmitted infections and serving as reservoirs for ongoing transmission. The findings show that testing protocols need to be carefully thought through, she said. (Chlamydia and gonorrhea, for example, can be transmitted within the 14-day repeat testing window that was chosen because it works to prevent HIV transmission.)

The film industry does not think Gorbach’s study accurately assesses the effectiveness of its testing program because the study enrolled a wide variety of performers, including those who do not participate in routine testing, and also recruited from a pool of performers who were actively seeking treatment for infections.

The study also found more than 20% of film workers were self-treating without medical advice when they had symptoms, hoping to shorten the time they might miss work. Gorbach said she feared the same thing could happen with Covid-19, with people misusing or overusing inappropriate treatments in an attempt to cure themselves or mask symptoms so they won’t miss work. (Porn performers don’t get paid when they can’t get to sets, just like other workers without paid sick leave.)

Gorbach said she did see clear lessons that coronavirus testing programs could take from the film industry, including thinking about how to address people who “float,” or work at multiple locations that have vastly different standards for screening or protection. “People in nursing homes float, just like the adult film industry. They float, they work at multiple places with different rules and standards,” she said. “If one place they work screens for infection and one doesn’t, they can take the infection from one place to another.”

The film industry deals with this through frequent testing, and Stabile said most performers won’t work with untested partners. While the testing program is voluntary, Stabile said clear test results are a requirement on most mainstream sets.

Who would pay for tests is also an issue. In the film industry, performers generally pay the roughly $150 testing fee to be cleared to work. Public health officials argue that workers, especially low-wage workers, should not bear the brunt of coronavirus-testing costs. “In public health, we try to reduce barriers to prevent the spread of disease, especially economic barriers,” said Angela Bazzi, an assistant professor of community health sciences at Boston University School of Public Health who has studied the health of sex workers in Mexico, Kenya, Ghana, and Boston. “If we place this burden on individuals, that’s worrisome.”

The geography of testing is also a concern; when permits and condoms were required on film sets in Los Angeles, many producers moved filming to less restrictive locations. Employers might do the same, experts said, to avoid coronavirus testing programs they deem costly or onerous.

Bazzi said it was fascinating to think about what could be learned from a program that increased safety for actors in the adult film industry. “It’s informative,” she said. “They’ve clearly gone through a decision-making process.” But she added that coronavirus testing would likely be far trickier for practical reasons. Adult film testing started more than a decade after the HIV outbreak, and only after years of research to improve HIV tests. Coronavirus tests are still a work in progress.

“In HIV, we saw this progression of tests that took decades, and there are still new tests being developed,” Bazzi said. “With coronavirus, there are still a lot of unknowns with testing.”

Politics will also likely play a role in coronavirus testing programs, if the film industry is an indicator. The testing program continually comes under fire from the AIDS Healthcare Foundation, whose leaders think testing does not do enough to prevent on-set HIV transmission and that condoms should be required. Another issue has been a simmering argument over whether HIV-positive performers who have such low levels of the virus that they cannot transmit it should be allowed to participate in filming. For now, any HIV-positive result, regardless of viral titre, disqualifies a performer from being cleared to film in the PASS program.

Now, fears about sexually transmitted infections have faded into the background as those in the film industry grapple with the coronavirus. Performers can obtain the tests they need to be cleared to work because medical clinics remain open, but Stabile said few were participating, mainly because production is on hold due to the coronavirus. (People can still shoot solo videos, or videos with people they are quarantining with.)

Like many industries, Stabile’s group is trying to determine when and how it could safely resume work. Like workers across the country, those in the film industry are feeling the economic pain of loss of work — although those who run subscription porn sites say their business is booming during quarantine. “My revenue is through the roof,” said Hart, who, while at home with his wife and four cats, is raising money for makeup artists, production assistants, and other set workers who are struggling.

A Free Speech Coalition task force is meeting twice a week by Zoom, grappling with questions like whether they can incorporate Covid-19 in their testing protocols and how to protect camera operators, makeup artists, and other on-set employees that did not require testing before. “We’re asking questions like whether directors and camera people can shoot with N95 masks on,” Stabile said. “We are actively trying to figure out how to make sets safe, and that means coronavirus as well as HIV.”

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