Here Come the Condom Police

Some prominent adult filmmakers agree. Popular porn producer Tristan Taormino argued the porn industry itself should require condoms and said she was skeptical that industry profits would suffer as much as naysayers predict. Porn director Nica Noelle wrote in Salon that she has had a change of heart: after years of looking the other way she will now require condoms on set.

HIV transmission among adult film actors is, of course, a miniscule proportion of the total HIV transmission around the world. Two million people will be infected with HIV this year whether or not we are able to stop HIV transmission among the uninhibited thespians of the San Fernando Valley. But the way we contain HIV transmission among porn stars reflects how we contain the whole HIV epidemic. And the visibility of porn stars sets them up as exemplars of our HIV prevention efforts in general.

I fear that condom laws will hoodwink us into thinking that we have addressed HIV transmission with the stroke of a legislative pen when in fact the work of HIV prevention remains undone. The real road to epidemic containment requires more challenging interventions like personal empowerment, sex education, and global scale-up of effective HIV treatment.

I learned this in part from Roger. At 45 years old and 200 pounds, Roger was not a typical lothario. When we first met in my HIV clinic, he was having sex with more than 100 men a year. Most days he logged onto Manhunt.com or another hook-up site to arrange same-day rendezvous with men whose names he rarely learned.

“Condoms?” Roger laughed. “I’m fine with condoms. I use a condom if the guys ask for one.” They rarely did. Roger also never disclosed that he was HIV positive to the men he met in the clubs and bathhouses outside of Boston. “Bringing up HIV isn’t very romantic,” he said. “Plus, these are grown men. They’d be stupid not to know about condoms. It’s their funeral.”

I asked if he thought some men might be unaware of the risk of HIV, or assume he was uninfected. “What if they are being naïve?” I asked, “Is that fair, to get HIV for being naïve?” He shrugged his shoulders and said he needed to think about it. Later Roger confessed he had been infected in exactly that way: as a young man, half in and half out of the closet, he frequented the bathhouses for months before learning about safer sex from a doctor who also diagnosed him with HIV.

Each time Roger visited my HIV clinic, we discussed what he called his “extracurricular activities,” and we brainstormed about how he might feel more comfortable mentioning condoms and his HIV status beforehand. I sympathized with his reticence on the topics, and said I hoped we could find a more comfortable way for him to bring them up. Roger seemed genuinely interested. “I’d hate to hurt someone,” he said eventually. In time, Roger started HIV therapy and responded well.

Slowly, he changed his behavior too. He continued to have sex with anonymous men, but he shifted to sex acts less likely to transmit HIV. He selected “Ask me” next to his HIV status on Manhunt.com. Recently one of his dates took him up on the offer, and asked him. “I took a deep breath, and I told the truth,” Roger said. And then they had sex. With a condom.

This is the key. People will have sex, but they can learn to be safer. To get there, they need strong internal motivation, not a doctor’s wagging finger or the threat of being busted by the condom police. Generating internal motivation to prevent HIV transmission is difficult. Much like getting bathhouses to support safer sex among their patrons or adult filmmakers to encourage their actors to wear condoms, HIV transmission prevention requires education, collaboration, buy in, and time. These are imperfect and time-consuming tools, but they are the best we have. 

Presented by

Tim Lahey, MD, is an infectious diseases specialist and associate professor of medicine at Dartmouth's Geisel School of Medicine. He writes regularly at MedMurmurs.

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