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What Truvada means for the future of HIV prevention in porn

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BY BIANCA JARVIS

BDSM porn mogul Peter Acworth recently stirred up controversy when he posted an open letter to Michael Weinstein, President of the AIDS Healthcare Foundation (AHF) on his blog. Acworth’s message: Stop pushing legislation that would force adult performers to wear condoms on set and offer them an HIV-prevention alternative in the form of a PrEP drug called Truvada.

I know you have mixed feelings about PrEP, the new medical regimen that can help prevent HIV transmission. It’s not well-understood yet by performers, but I believe we owe it to the communities we serve to evaluate this on its merits. The fact is, none of the performers you bring to your press conferences would have been protected had AB1576 been passed ten years ago, because no California condom law is going to protect performers during their personal lives, or shooting on unregulated sets overseas. PrEP, if it works as advertised, could do just that. In fact, we’ve recently begun working with HIV and sex worker health organizations to develop an educational program about PrEP specifically targeting adult performers—it would be great if you could be a part of it.

While I have my qualms about Acworth as an individual, I think his advocacy for Truvada makes a lot of sense from the perspective of a sexual health educator. Truvada is an anti-retroviral medication that was approved by the FDA in 2012 for HIV PrEP, which stands for pre-exposure prophylaxis. Studies have shown that when taken consistently, Truvada can reduce HIV transmission as much as 92 percent, findings comparable to perfect condom use.

That said, Truvada is typically recommended as a supplement to condoms and regular testing in high risk populations, not a replacement or a general panacea for HIV prevention. While Truvada for PrEP has been a hot topic within the gay male community, there has been little discussion of how the drug might help other high risk populations, such as adult performers and other sex workers.

Chicago-based pro-domme Erin Black is one sex worker who uses Truvada to reduce her risk of HIV infection, but she says her reasons her partly political. “So few sex-workers know about Truvada, and those that are aware of it are undereducated about the drug, or have completely bought in to lies and misinformation that surround the blue pill,” Black said. “I try to educate them whenever I get the chance.”

With a recent spate of HIV infections leading to multiple moratoriums in the adult film industry, improving Truvada education and accessibility (in addition to biweekly testing and optional condoms), is a logical public health strategy for minimizing the incidence of HIV in adult performers.

One of Truvada’s greatest barriers to general acceptance is fear that the drug will promote reckless promiscuity, in spite of evidence to the contrary. This is a common issue in the world of sexual health promotion—the prudish fantasy that denying access to sexual health education and services will magically prevent people from engaging in high risk behaviors (see: HPV vaccination and comprehensive sex education in schools).

With Weinstein’s callous dismissal of Truvada as a “party drug” for gay men, it’s unlikely that he will be receptive to Acworth’s advocacy of PrEP as a public health strategy for porn stars. Weinstein’s statement sends a dangerous message that people who use Truvada are irresponsibly promiscuous, fostering an atmosphere of stigma and shame that may deter high-risk individuals from seeking treatment. Adult performers are a highly stigmatized population, and there may be a concern relying that on Truvada and testing alone is an irresponsible choice compared to using condoms.

Weinstein’s AHF is the driving force behind AB 1567, a bill that would mandate that adult performers in the state of California wear condoms on set, or face criminal penalties. Although requiring condoms on porn sets seems like a logical STI prevention strategy, many performers and directors have spoken out against AB 1567, arguing that wearing condoms during prolonged sex scenes can result in genital abrasions that make performers more susceptible to STIs.

Others are concerned that the bill will force porn production underground or out of state, where there are fewer regulations to protect performers. While condoms are a highly effective barrier against HIV and other STIs, they can slip or break, especially if used incorrectly. Truvada would offer an effective alternative to condoms for performers who prefer to go without, and offers additional protection to those who do use condoms.

Acworth’s most effective selling point for Truvada in porn is the protection it offers off-set. Legislature like AB 1567 doesn’t guarantee that the performers will practice safer sex in their personal lives. Truvada offers protection against HIV both at work as well as in their off-screen relationships. In my interview with Erin Black, she expressed that Truvada offers her greater protection for enjoying sex with her fluid-bonded partner. “Truvada allowed me to maintain my sexual relationship with my partner regardless of my work,” she argued.

Truvada is not a perfect solution for HIV prevention, nor does it offer protection against other STIs. There are many persuasive arguments for why Truvada should not be used, but ultimately it is a personal decision. Nevertheless it is an FDA-approved strategy for HIV prevention that has been shown to be highly effective when used as directed. “Inform, educate, and empower” is one of the ten essential functions of public health, and I believe that Truvada education is an essential component for HIV prevention in the world of porn and beyond. 

Bianca Jarvis, MPH, is blogger and sex educator at Indiana University's Kinsey Institute, based in Bloomington, IN. She is also executive editor of Msbehaved.com, "a sex-positive lifestyle site with a fierce femme sensibility."  Read more at Kinsey Confidential and on Twitter at @BiancaJarvisMPH.

Photo via felix.castor/Flickr (CC BY 2.0)