Supplementary Information

Undetectable = Untransmittable
The aim of treating someone living with HIV is to achieve viral suppression. When the amount of HIV is suppressed too low for tests to measure this is known as being ‘undetectable’. People living with HIV who maintain undetectable levels of the virus are unable to pass HIV to sexual partners. Being undetectable is no prevention for contracting or transmitting other STIs.

PrEP 
A medication for people that don’t have HIV that, if taken correctly as part of a regime before and after exposure, can prevent them acquiring HIV. PrEP is not required following sex with someone who is undetectable on treatment. PrEP is no prevention for other STIs.

PEP 
A month long course of emergency medication that needs to be started within 72 hours of HIV exposure that can stop HIV transmission. PEP is not required following sex with someone who is undetectable on treatment. PEP is not an emergency response for other STIs.

Status Disclosure 
All models should be aware which status disclosure strategy a studio has them assigned to. Performers can always withdraw consent to work with an individual scene partner or change which status disclosure strategy they consent to.

Serosorted – Each model shows each other their most recent sexual health test results. In principle performers are separated by HIV status (serostatus), only working with others of the same status. It has flaws as HIV testing has ‘window periods’ when recently acquired HIV may not be detected; this means true separation by HIV status is currently impossible no matter how frequent they test. Serosorting is commonly used in straight porn in USA and Europe.                 

Open Disclosure – Each model shows each other their most recent sexual health test results but models can work with performers of another status as long as prevention strategies are used such as U=U and/or PrEP. Performers using this method are usually completely public about their HIV status; this can be because they accept their HIV status could end up public knowledge eventually when studio staff or scene partners know it. Non-disclosure agreements are hard to make enforceable, especially while also protecting the anonymity around a performer’s legal name. Open disclosure happens in all sexualities of porn to differing degrees.

Status Privacy – Apart from HIV results, each model may show each other their most recent sexual health test result. Studios vet that a performer either has a recent HIV negative test result or, if HIV positive, an undetectable viral load result.

This strategy can protect performers who want privacy or are in a situation where they are unable to work in open disclosure. A performer may choose this if they want to avoid the following scenario: two scene partners fall out after a scene and one publicly discloses the other’s HIV status without permission. Ignorant public may then send hate mail or make life difficult for the performer or their family.            
Status Privacy means a model knows their scene partner may or may not tell them their HIV status, and they themselves are consenting to work with that scene partner with the knowledge they either hold a recent HIV negative result or have an undetectable viral load.

Status Privacy began in gay porn in Europe because of personal medical data privacy laws. Many performers taking PrEP have chosen this approach to support the privacy of those living with HIV. This approach supports the use of HIV prevention techniques such as PrEP and U=U over mandatory status disclosure. Mandatory disclosure can result in harm to people living with HIV via stigma. It also has poor efficiency as most people with HIV catch it from someone who didn’t know they had it as new HIV transmissions can occur in the window period of a recent test or from someone who has not tested recently.

Testing 
Studios have different protocols, and different tests are used around the world. Models should be aware of which testing approach a studio has. To learn more about the types of HIV test used see the table named ‘Types of HIV test’.

Centralised Database – In the USA performers test results can be directly uploaded into large databases; the aim is to avoid tampered results. In Europe medical data privacy laws prevented these databases being developed.

Independent Testing – Porn producers have tried owning testing companies, but potential bias and conflicts of interest has meant impartial testing was seen to be safer. Some organisations contribute to the cost of a model being tested, others do not. Many access testing through national health services where they are available. Some clinics will charge a small fee when a model says they need the test result on a signed certificate for them to use at work. On the certificate there should be an indication that the medical staff saw the performer’s legal photo ID, so studios know the test is for that person.

Studio Testing – This is limited to HIV tests but is usually fingerpick or other rapid testing as it gives instant results and requires little training. However, this testing has a longer window period where results may not show a recent HIV acquisition.

14-Day Testing or 28-Day Testing – Some studios are requiring performers to test every 14 days and show the 3 most recent tests in order to film. However, many publicly funded healthcare services like the NHS in the UK don’t find this testing frequency viable or practical. The NHS finds testing every 28 days works well alongside a focus on prevention tools such as PrEP, U=U and condoms.

No Testing – Some productions have a formal position saying performer’s sexual health is in their own hands. They do not require recent sexual health tests, but this almost only occurs for condom scenes now. The studio should still make an effort to educate performers about condom failures and STIs transmitted via oral sex where condoms are less frequently used.

Window Period – Each type of HIV test has a different ‘window period’ so it is important to know what HIV test is used and when. With an HIV finger-prick test there is a 3-month period following exposure where the test may not identify that you have acquired HIV.
E.g. If you acquired HIV in January, it may not give a positive result on a finger-prick test until April.

To work in porn, performers usually have a certificate signed by a medical professional. The certificate comes from a 4th or 5th generation HIV test and/or PCR test, depending on where in the world you are. Performers should keep ‘window periods’ in mind with anyone who presents an HIV negative test result and still consider prevention options like condoms and/or PrEP as there is no way to have test results without potential risks from a window period.

Types of HIV Test:

There are many names for HIV test like ‘Elisa’, ‘Combination’ or ‘Western Blot’ and it can be confusing as these names describe components within a number of the standard tests listed below. These tests are sorted by the window period you should be aware of. When in doubt, if a test is not sent to a laboratory for testing, it has a three-month window period.

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