Adult film performers, and especially females, are a vulnerable group that is exposed to many health risks that are often cumulative. Occupational risks of the adult film industry that have been described in the literature have been limited to exposure to HIV and other STDs.7,15,16
In this study, we identified other serious health risks among adult film performers, including physical, mental, and social risks that were often severe and sometimes life-threatening. Female performers in particular were especially vulnerable to multiple negative health consequences, including drug addiction, mental health problems, financial hardship, physical trauma, and negative social interactions. Male performers were concerned with and mentioned health risks among female performers more often than they did their own needs. While this study did not set out initially to focus on female performers, it became clear from the initial interviews that women were a particularly vulnerable group.
Tension exists between an individual’s right to make one’s own choices regarding the tradeoff between risks and rewards and a society’s need to protect vulnerable populations. Some industries such as the drug trade are illegal within the US because they are considered too detrimental to health. Other industries such as professional sports have put into place a wide range of mechanisms to minimize risks and make individuals aware of the risks to which they are exposing themselves so they can make more informed choices. To some extent, the adult film industry has attempted to minimize risks to performers through an STD testing program and other means such as allowing females to decline to work with certain performers (“no” lists) or turn down opportunities to perform sexual acts that are higher risk for transmission of STDs. These mechanisms can come from within the industry, such as the STD testing program, or from the outside, such as the government regulation that prohibits performers who are under 18 years old. Clearly, the current mechanisms within the adult film industry are not adequate to prevent many risks to performers, especially young females who are not aware of the breath or degree of health risks. In addition, the high turnover among young female performers makes it difficult to ensure they are adequately informed.
While this work identifies the health risks and potential pathways to these risks in adult film performers, it does not determine the prevalence of these risks, causality, or any comparison to risks associated with other occupations. While many different risks were clearly identified by performers and key informants, the magnitude of each is unknown. The first step, which we have done in this qualitative study, is to document the kinds of risks performers are experiencing. The next step is to systematically assess the rates of exposure to health risks and to determine to what degree entering the industry is likely to result in greater health risks and worse health consequences than not entering the industry. The final step would be to establish mechanisms that would mitigate such risks. Decreasing health risks for this group could involve preventing more women from entering the industry (e.g., by raising the age to 21), decreasing health risks while within the industry (e.g., drug testing), or helping them exit into other careers. Knowing which of these methods would prove most effective depends on learning more about these women’s health, life experiences, and other career options. Nonetheless, certain health risks appear so common that access to certain services can and should begin immediately. These would include substance abuse and mental health services as well as financial and legal assistance. In addition, stakeholders could come together to begin to discuss potential policy changes or interventions.
Our findings suggest that female adult film performers are a vulnerable group that engage in and are exposed to many risks to their physical, mental, and social health. Although a legal industry, health risks among performers are multiple and similar to sex workers in illegal industries (for example, street prostitutes). Interventions to alter their pathways to health risk should be broad and gender specific and should not simply focus on reducing STDs. Their multiple risks related to mental health crises and substance abuse (which have also been associated with risky sexual behavior17,18
), as well as problems in the social and financial realms, make it important to be multi-disciplinary in approach to intervention design. Despite the lack of information on the rates and prevalence of various health risks in performers, it is clear that certain programs such as mental health services should be immediately available and that stakeholders need to come together to debate how and what to change to improve the health of performers.