Tuesday, June 16, 2009

HIV in the porn industry: time for regulation

I know, it seems like a strange cause to take up.

But the fact is, being a porn actor puts one at huge risk for STIs including HIV. I wish I had a good and shocking comparison, along the lines of, "being an average porn star for one year is equivalent to riding a motorcycle on a crowded indie speedway without a helmet for a month without stopping", but I don't have any statistics. (And someone should really look into calculating that risk!)

You get the idea, though; being in pornography with the very limited regulation currently in effect is running a huge health risk, and no one should be required to do that to keep his or her job. The recent revelation that a porn actress had tested positive for HIV and possibly infected a costar and her boyfriend prompted the apparently hushed-up fact that several others in the industry have become infected with HIV in the last 5 years. Thousands have tested positive for Gonorrhea and Chlamydia.

The heterosexual porn industry has rejected suggestions that regulation include mandatory condom use, and actors who demand condom use are often not asked back for further work. (Meanwhile, because HIV is so prevalent in the gay community, gay porn studios generally require condom use.) The current regulation around safety in the industry is that actors must arrive on set with the results of an HIV PCR test. However, HIV testing is not flawless, as a cluster of cases in the porn industry in 2004 showed; further, requiring that actors pay for testing on their own, and dismissing anyone who is HIV-positive, is illegal.

As this article (which you can download for free! I love Plos Medicine!) argues, regulation of the porn industry must involve condoms, which will lower risk of STIs and HIV significantly -- and carry the added bonus of normalizing condom use for viewers. The industry apparently thinks that people will stop watching porn if actors are wearing condoms, something that hasn't played out in the gay porn industry. State regulators need to show some backbone and stand up to the industry in order to protect porn actors and their partners.

(On a side note: is this blog getting too soapboxy? I figured that if there was anyone reading this blog, a good use of it might be to write persuasive arguments about issues arising in medicine and public health... but if no one reads it because it's too preachy, it defeats itself.)

Thursday, June 11, 2009

F*@# the AMA

This is making me so angry I can hardly even think. The American Medical Association has a stated mission "to promote the art and science of medicine and the betterment of public health." How an organization with this mission, composed of supposedly human beings who have taken the Hippocratic Oath (or the Lasagna Oath, which we know I love!) to "do no harm" can oppose a system that would improve health coverage to Americans is beyond me.

They say that having a public insurance provider would "restrict patient choice" by driving out private insurers, a logic I'm not even sure I understand. But let's look at the "patient choice" available right now: how many people, even those lucky few with good private coverage, can say they have the choice they'd like in providers? And as this blogger points out, the private insurers enjoy such hegemony over the industry right now that they can raise premiums as they wish, padding the pockets of their wealthy CEOs, thus often driving individuals and businesses into bankruptcy. (Health care costs are the main cost of individual bankruptcy filings in the U.S.) In a free market system, which the AMA seems to tout as king, supply and demand are in communication -- they aren't mediated by HMOs with price-setting behind closed doors in a mysterious, non-transparent process probably influenced by big Pharma and big Insurance.

I guess the AMA's stance shouldn't surprise anyone, because it seems that it has a long history of opposing plans that help people, including Medicare. I honestly don't think the AMA is an evil cabal of specialists trying to make sure they can easily afford next year's timeshare in the Hamptons, although there's probably some of that too. I think most of it is a subconsious reaction that many Americans have that equates "government-controlled" with "inefficient". What Americans must realize is that health is not a commodity like any other, and that American health and productivity do not benefit when health insurance companies make money. Sure, government can be inefficient; it would be the responsibility of the overseeing agencies to make sure that it is run well and makes use of all the current technologies and strategies for maximizing service output. But the current system of armies of actuarial specialists setting premiums based on risk is far more inefficient. A public system has the potential to make Americans healthier than they've been for decades, at lower costs. Under the current, privatized system, there will always be people slipping through the cracks. Anyone who wants to get as angry as I am should just visit a community free clinic and chat for awhile with its clients.

Physicians for a National Health Program is an organization that advocates for single-payer healthcare -- care provided to all Americans by government agencies, with provision of care managed privately. This is the only way to give Americans real choice in their care, and real coverage for their health problems. Obama's plan doesn't go far enough, but it's a step in the right direction. The AMA's stance is 50 steps back.