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The Dignity of a Porn Star

The views expressed are those of the author and are not necessarily those of Scientific American.


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Porn stars all across San Fernando were told to put their clothes back on and go home a couple of weeks ago on the news that a 29 year-old adult actress named Cameron Bay tested positive for HIV.

Shortly thereafter, the Internet lit up. News, judgments, and jokes shot left and right in newsrooms as freely as bodily fluids fly on set. Countless reporters and pundits surely worked overtime to do the deep background: who were Ms. Bay’s co-actors, who did what to whom, and inquiring minds want to know: were condoms used? Imagine the frenzied speculation, all those sticky keystrokes.

Don’t get me wrong: the details of the whodunit have medical import. Public health workers need to find who is at risk. Those who are at risk need testing and education including reminders that early tests can be falsely negative and must be repeated. Since this isn’t the first case of HIV among the scantily clad actors of San Fernando, CA, Ms. Bay’s diagnosis demands we try again to get porn stars to practice safer sex. My guess is legal maneuvers will never do much to affect the sex lives of the nude and infamous, but if porn viewers could learn to have fun even with a condom on set there might be a hope.

Twitter captured all this and more. It showed the diversity of our reactions to Ms. Bay and people like her. Some tweets expressed a sense of inevitability:

Some were judgmental:



Others were pragmatic:

Many were unprintable.

Something important is lacking though: concern for Ms. Bay. This young woman just learned that she has an incurable and potentially lethal disease. Our first emotion, I think, should be concern. We should commiserate. We should be grateful for our health and hopeful for hers. Here’s a rare example:

Undoubtedly, it was Ms. Bay’s responsibility to protect herself. Abstinence, Being faithful and Condoms are the ABC’s of HIV prevention. But since millions contract HIV every year despite knowing their ABC’s, I’m going to go out on a limb and say it’s not always that simple. Sex is complicated, and not fully encompassed by logic, willpower, commonsensical public health messaging or a few square inches of latex.

Porn stars, too, are easy to oversimplify. Dressed (at least temporarily) in garish or stereotypical costumes, they have sex on camera, they say things most can’t imagine saying, and they behave on screen like simplified primal versions of the complicated people of ordinary life. We project a mixture of desire, disdain, and pity on them, and often we forget to consider the person under all that exposed skin.

I learned this from Jose*, a patient in my HIV clinic. Jose was a muscular guy who wore tight black shirts and a jet-black goatee. The list of movies in which Jose engaged in unprotected anal sex was long. Very long. None of the titles can be repeated here so let’s just say somebody is making good money dreaming up new variations on the Bareback Mountain theme. I asked Jose once how many men he’d had sex with in his life, and he said, “Gosh, I really have no idea,” as if it had never occurred to him to count. He estimated several hundred with a shrug.

I met Jose when he left California to be closer to his family, and “to escape the crazy life” of adult entertainment. Despite a grocery bag full of pill bottles, Jose’s immune system was gone. HIV ran freely now. Jose said he was taking his medications at first but then, months later, admitted his adherence was haphazard at best. One day he confessed he had stopped altogether.

Jose seemed as mystified by his cessation of treatment as I was. But he confessed that his identity was so wrapped up in virility and the desire of men and women alike that taking pills for a deadly illness was intolerably antithetical to who he was.

He lived life in the moment. He hung out with his sister and visited her two young daughters after school. He moderated family squabbles and tried to keep a nephew out of jail. He worked as a patient transporter at a local hospital. He dreamed of becoming a chef. And he waited. Jose knew AIDS would get him, soon.

Periodically I treated the advancing horsemen of the AIDS apocalypse: the warts that blossomed on his fingers and genitals, a case of pneumonia, a skin infection from a fish tank. I also listened to him as he faced death.

One day he showed me a dark purple spot on his leg. We both knew what it was even before the biopsy results came back: Kaposi sarcoma (KS). At first the KS was a painless purple memento mori, but more spots appeared higher up his leg and soon came to clog the lymph channels that drained that leg. Soon, his leg had swollen so badly he could no longer fit his foot into shoes.

The KS marched on. By the time KS filled up the lymph nodes in Jose’s chest and crept into his lungs, Jose’s face was thinning and his enviable physique had begun to waste away. When breathing became difficult, Jose cut back to part time work. He didn’t want to quit entirely; he said he liked helping patients get oriented to the hospital, especially the ones who were there for the first time. He knew it could be a scary place. Throughout, Jose was resolute and cheerful. He enjoyed board games with his nieces. He traveled. He slept. And he waited.

When Jose went on hospice I had been a physician for ten years. I had seen many people die. But I had never seen someone face death so unflinchingly, so calmly. Jose was afraid, absolutely. But Jose was also courageous and determined to hold his head high to the end.

Jose made it impossible to oversimplify him. He died nearly six years ago, but I thought of Jose immediately when I heard about Cameron Bay’s HIV diagnosis. Without the memory of Jose, I might have dismissed Ms. Bay as a fool and a degenerate. What was she thinking?! But Jose taught me not to reduce her to a character on a stage, and not to pretend I know very much at all about Ms. Bay and the complicated life she leads.

Soon after Ms. Bay revealed her HIV diagnosis, her boyfriend Rod Daily announced he too was infected with HIV. Sigh. It turns out Ms. Bay might have been infected the old fashioned way after all: by living life and having sex in the midst of an HIV epidemic. This week a third porn star tested positive for HIV, and another porn set was shut down. Temporarily.

Not only is it tempting to have an oversimplified view of how porn stars get HIV, it is also easy to oversimplify the relationship between HIV in porn stars and the worldwide HIV epidemic. Porn stars are not the cause of the HIV epidemic. They are its public face (et cetera). We could arrest HIV transmission entirely in the porn community, yet HIV would rage on around them. Porn stars, like all of us, make bad decisions and suffer hard consequences. They deserve our compassion, and I hope they get it.

—–

* Not his real name.

Photos: D Sharon Pruitt and Josep Ma. Rosell.

Tim Lahey About the Author: Tim Lahey, MD MMSc, is an HIV doctor, an associate professor at the Geisel School of Medicine at Dartmouth, and chair of the bioethics committee at the Dartmouth-Hitchcock Medical Center. Follow on Twitter @TimLaheyMD.

The views expressed are those of the author and are not necessarily those of Scientific American.






Comments 12 Comments

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  1. 1. Chris Clarke 12:11 pm 09/8/2013

    Unmentioned elephant in the room: these people contracted a fatal disease in their place of work, in an industry that has fought worker safety laws tooth and nail.

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  2. 2. vmfenimore 12:47 pm 09/8/2013

    This article is not about HIV. It is about how we treat people who caught a fatal disease that has a stigma attached to it.

    People are still treating the disease as judgment against the victim. Yes people do stupid things all the time. However when a person has a disease the kind thing to do would be to offer them compassion instead of judgment. I myself will endeavor to offer kindness.

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  3. 3. slundgren 1:01 pm 09/8/2013

    Chris Clarke – There is no evidence that any or all of these individuals contracted HIV on an adult film set, rather than through high-risk behaviors (unprotected sex, drug use, etc.) outside of their workplace. It may never be known when and where they contracted it.

    But I agree with vmfenimore – this article is not about the disease itself, or the porn industry. It’s about the fact that the people who contract HIV are real people dealing with a scary, incurable disease that will change the rest of their lives.

    And honestly, people are cruel and judgmental towards people with HIV regardless of whether they are adult actors. Culturally, there’s a lot of victim-blaming associated with HIV, and it does nothing to help the situation.

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  4. 4. gocog 2:34 pm 09/8/2013

    Porn stars in Fresno would be told to put their clothes back on because there’s no porn industry there. Do you mean the San Fernando Valley?

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  5. 5. RSchmidt 4:18 pm 09/8/2013

    Not surprising. We blame people who smoke for their lung cancer and people who drink for their damaged livers and obese people for their heart disease. I agree that once someone is given a death sentence they deserve compassion regardless of the role they played in causing it. Their death is punishment enough. They don’t need our smug judgement on top if it. If you seriously believe that someone deserves to die because of a few bad choice they made perhaps you need to examine your own personality flaws.

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  6. 6. notmebug 7:02 pm 09/8/2013

    Chris Clarke: “Unmentioned elephant in the room: these people contracted a fatal disease in their place of work”

    No. It takes time before a test will come back positive. Ms. Bay is regularly tested for work, and JUST came up positive. None of Ms. Bay’s coworkers tested positive, so she couldn’t have caught it from them. Her boyfriend did test positive… and if he caught it from her then he almost certainly wouldn’t show as positive yet. So the facts indicate that she almost certainly caught it from her boyfriend.

    RSchmidt: “Not surprising.”

    Considering that 50,000 people contract HIV in the U.S. each year, no it’s not surprising that sooner or later some performer would catch it from their boyfriend or girlfriend or husband or wife. But that’s obviously not what YOU meant by “Not surprising”.

    RSchmidt: “We blame people who smoke for their lung cancer:

    You’re BLAMING someone for catching HIV from their boyfriend/girlfriend? I’ll have to remember to blame you if you catch HIV from your boyfriend/girlfriend/husband/wife.

    RSchmid: “Their death is punishment enough.”

    You are a seriously ill individual. You believe someone deserves “punishment” for having sex with their boyfriend/girlfriend? You consider DEATH to be “enough” punishment? For having a boyfriend/girlfriend? What the HELL is wrong with you?

    RSchmid: “They don’t need our smug judgement on top if it.”

    You’re right they don’t need it…. but you went ahead anyway and posted your smug perverted judgement anyway.

    RSchmid: “If you seriously believe that someone deserves to die because of a few bad choice they made perhaps you need to examine your own personality flaws.”

    You’re the one who called it a “punishment”, and implied that it was a deserved punishment. So yeah, you seriously do need to examine your own personality flaws.

    And the only supposed “bad choice” she made was having a boyfriend.

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  7. 7. RSchmidt 8:29 pm 09/8/2013

    @notmebug, you completely misunderstood my post but instead of looking for clarification you went ahead and judged me based on your ignorance. Thanks for proving my point.

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  8. 8. tlahey 9:30 pm 09/8/2013

    @Chris Clarke @vmfenimore, @slundgren – Well said.

    @Gocog – Thanks for the tip. I fixed the error. Note to self: must get porn capitals starting with the letter “F” straight. ;)

    @Rschmidt, @notmebug – Thanks for reading. I was glad each of you wrote about how blame and accusation are unproductive. So easy to do, particularly lacking personal context, but a huge problem.

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  9. 9. allanz1844 10:18 am 09/9/2013

    The real issue is the blatant hypocrisy of this writer and the media in general. In SF, NYC, DC and many other cities the gay men have HIV infection rates between 15-25%. This is a massive epidemic yet it’s completely ignored due to political correctness. So please tell me why it’s a big crisis that a few porn stars have contracted HIV which requires a quarantine and immediate intervention by the health dept. but the situation in SF where a full 25% of the gay men are HIV positive is treated as non-news worthy. Now before the haters come out in full force this is not an attack on gay men but the treatment of medical illness should be treated the same by the gov’t authorities. A 25% HIV rate is a massive epidemic and ignoring it is a public health disgrace.

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  10. 10. dawson54 4:44 am 09/10/2013

    Just wanted to offer thanks to Dr Lahey for a necessary reminder that compassion is the best option when anybody becomes seriously ill for any reason. I am troubled by the way our society seems to be blaming victims for their illnesses. While I don’t doubt that unhealthy behavior can lead to catastrophic, perhaps fatal illness, are we becoming so arrogant as a society that we now feel the need to blame the victims? I hope not. I hope that we will not forget that victims of such illness are foremost human beings who are frightened, suffering, and in need of our most dignified attention. Dr Lahey and Scientific American are to be commended for reminding us of our common humanity, and its inevitable brevity. As the poet reminded us some 400 years ago, the bell tolls for us all.

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  11. 11. geowiz875 1:27 pm 09/11/2013

    OK, time for a little confessional. I have noted that the male actors for the kink.com stable of porn videos do use condoms and that is clearly shown in close-ups!
    All the studios should be asked to show this. After all, porn is bigger than Hollywood so there must be so many people watching.
    Also, let us get some science into this. Invent a condom that lubricates, heats and vibrates all at once and it will fly out of the vending machines in the loos at the pubs, bars, nightclubs every Friday night. (And Betty and Bob will bring it home to ‘surprise for your big 5oh birthday’
    Apple, are you listening?

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  12. 12. tlahey 6:50 am 09/13/2013

    Many thanks for reading, and for your comments.

    @dawson54, you are most welcome, very much appreciate your understanding that this was an article about compassion.

    @allanz184, “blatant hypocrisy” is pretty strong wording. I’ll try not to take offense. I agree that HIV in men who have sex with men is a huge problem. Notably, in this story I depict HIV and dignity in Jose, a man who had sex with men. Even if I had not told exactly the kind of story you suggested, I would submit to you there is room for all of the stories of people with HIV. If we are respectful of all of these stories – and the folks who write them, sheesh! – we will be more effective against this plague than if we lapse into recrimination and fractiousness.

    @geowiz875, totally agree there should be a way to make condoms more acceptable in porn. The Gates Grand Challenges group is funding proposals for exactly that. I think this is important because I wonder if resistance to condoms in porn comes from a similar place as resistance to condoms in the bedroom.

    Link to this

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