Adult Film Performers Transmission Behaviors and STI Prevalence

Background: Adult film work involves multiple sex partners, unprotected intercourse and frequent oral/rectal contact.  Data on sexual networks and sexual behaviors of adult film performers (AFPs) are limited. 

Methods: From August 2012-May 2013, AFPs in Los Angeles, CA seeking care at two clinics that provide STD testing to performers were offered urogenital, pharyngeal and rectal Chlamydia/gonorrhea NAAT testing.  A web-based survey was used to collect demographics, type of sexual practices on-set and off-set, substance use, and sexual network characteristics.  Participants were at least 18 years of age and performed in at least one adult film within the past year.

Results: A total of 366 AFPs were enrolled; 75% (n=274) were female, 62% (n=219) were white and the median age was 25 years (IQR: 22-31 years).  Most reported a main partner (74%), 23% reported non-film transactional partners, and 26% reported sex with an AFP off–set;  only 6% reported always using condoms on-set and 13% off-set.  Overall, 24% (n=86) tested positive for Chlamydia (15%, n=54) or gonorrhea (11%, n=41).  The most common site of infection for Chlamydia was urogenital (43/54) and pharyngeal for gonorrhea (33/41).  Prevalence of Chlamydia/gonorrhea varied by age (median 23 vs. 26 years; p-value<.01), time as a performer (median years 2 vs. 3; p-value=0.06), and days of adult film-work in the past 30 days (median 6 vs. 4 days; p-value=0.02). In multivariable analyses, age (adjusted odds ratio [AOR]=0.90; 95% confidence interval [CI] 0.85-0.96) and type of scene (AOR for double vaginal=2.89; 95% CI 1.29-6.48) were associated with Chlamydia/gonorrhea.

Conclusions: AFPs had a high burden of STIs at all anatomic sites and reported inconsistent condom use within the context of any occupational or other sexual partnerships. Targeted intervention strategies - both in and outside the workplace - are needed to limit the spread of STIs.