1. STD Risks to Performers in the Adult Film Industry Katherine M. Stone, MD Medical Epidemiologist Atlanta, GA October 27, 2006 UCLA Think Tank

2. STD Risks to AFI Performers Importance of STD  Common  Preventable by condoms  Almost all are “silent”  no symptoms  identified by screening  Serious consequences  Some are fatal  STDs increase risk of HIV

3. STD Risks to AFI Performers Importance of STD Serious consequences AIDS; often fatal Increased risk of HIV Neonatal infection Cervical, penile, anal cancer Neonatal infection Liver disease, liver cancer Neonatal infection Chlamydia Gonorrhea Trichomoniasis (Trich) Bacterial vaginosis (BV) HIV Hepatitis B virus (HBV) Hepatitis C virus (HCV) Syphilis Herpes simplex virus (HSV) Human papillomavirus (HPV) Increased risk of HIV PID, infertility Pregnancy complications Neonatal infection

4. STD Risks to AFI Performers STDs spread by fluids to mucous membranes  Contact of FLUIDS (pre-ejaculate, semen, penile discharge, cervical/vaginal or anorectal secretions) with MUCOUS MEMBRANES - urethra, cervix/vagina, anus/rectum, mouth/throat, eye  Vaginal, anal, oral sex  Shared sex toys  STDs include:  Chlamydia  Gonorrhea  HIV  Hepatitis B (HBV)  Hepatitis C (HCV)  Trichomoniasis  Bacterial vaginosis (BV)  Easily preventable by condoms  also in blood

5. STD Risks to AFI Performers STDs spread “skin to skin”  Spread by contact of infected skin/mucous membrane with partner’s skin/mucous membrane  Vaginal, anal, oral contact  Shared sex toys  STDs include:  Herpes simplex virus (HSV)  Human papillomavirus (HPV)  Syphilis  Preventable by condoms  also in fluids - also can be in blood (sometimes NONGENITAL skin)

6. STD Risks to AFI Performers  Chlamydia  Gonorrhea  HSV  Syphilis  HIV STDs transmissible to eye  Chlamydia  Gonorrhea  HSV STDs spread by fellatio

7. STD Risks to AFI Performers STDs spread by “fecal-oral” contact  Usually transmitted by contaminated food or water; CAN be transmitted sexually through:  Anilingus  Fellatio immediately after anal sex  Oral contact with sex toys immediately after anal contact  Sexually transmitted enteric infections include:  Hepatitis A (HAV)  Entamoeba histolytica  Giardia lamblia  Shigella  Salmonella  Cryptosporidium  Campylobacter

8. STD Risks to AFI Performers Gonorrhea:20-90% Chlamydia:45% HPV: 40% HSV: 0.05 - 0.2% HIV: 0.05% - 20% Estimated risk of infection from 1 vaginal sex act with an infected partner

9. STD Risks to AFI Performers  Multiple partners over short time periods  increases risk of STD/HIV  increases potential for rapid spread  Prolonged intercourse  inadequate lubrication  anogenital trauma, bleeding  Lack of protective equipment  Condoms, dental dams/barriers, lubricants General AFI practices increase risk:

10. Number of Reported STDs by Year AFI Performers 2000 – 10/2006 *through Oct. 15

11. STD Risks to AFI Performers  Does not prevent infection  Allows prompt identification and treatment of infected persons  Prevents consequences of infections  Prevents further spread to sex partners Screening

12. STD Risks to AFI Performers Curable STDs Preventable by condoms Screening available Chlamydia++ Gonorrhea++ Syphilis++ Trichomoniasis++ BV?+ Enteric infections __

13. STD Risks to AFI Performers Incurable STDs TreatablePersists lifelong Preventable by condoms Screening available HIV++++ HSV++++ HCV+ 55-85% ++ HBV+ 6% ++ HAV+ __ + HPV __ + + * * women only v vaccine-preventable VVVVVV

14. STD Risks to AFI Performers Conclusions  Risks for STDs including HIV are high  STD/HIV can have serious consequences  Most STD/HIV transmission is preventable by condoms