As prominent AIDS advocates called Thursday for Los Angeles County officials to require condoms on porn sets or shut down production, more questions arose about why the Public Health Department has not investigated 18 HIV cases reported in the last five years by the clinic that serves the adult film industry.
"L.A. County public health officials have been asleep at the switch with regard to monitoring HIV and STD prevention and testing in the region's porn industry," said Michael Weinstein, president of the AIDS Healthcare Foundation. "It really seems very, very clear that they do have the authority. Why aren't they doing anything?"
Officials from the Public Health Department declined requests for interviews.
The previously unpublicized cases came to light after news last week that a female porn performer had tested HIV positive this month. All 18 were reported to the county by the Adult Industry Medical Healthcare Foundation, a San Fernando Valley-based clinic that serves the porn industry, since a 2004 HIV outbreak shut down production for a month.
AIM clinic officials have said the cases never became public because all were detected in aspiring performers who ended up not entering the business or in non-performers who used their testing services.
In recent days, Dr. Jonathan Fielding, the county's top public health officer, said the county did little investigation into the HIV cases since the 2004 outbreak.
He said the burden of notifying potential partners of people who test positive for HIV rests with the patient's medical clinic or doctor and that the current system and laws do not grant the county health department that kind of authority.
But, according to the California Department of Public Health, local health officers do have the authority to offer partner notification services for HIV, although they are not required to do so.
Many public health experts view notifying partners as key to preventing the spread of sexually transmitted diseases. In November 2008, the U.S. Centers for Disease Control and Prevention issued a report strongly recommending that health departments take an active role in partner notification services of newly diagnosed HIV patients.
Other counties in California already have moved to take on a bigger role in partner notification, which gives health officials the opportunity to better understand who else may have been exposed.
In San Francisco, public health officials review the names of people recently infected with HIV and call the patients' physicians to offer the partner notification services.
In Alameda County, local health officials said they were following the CDC's recommendations and working to take a greater role in offering partner notification in HIV cases, particularly in communities with high rates of infection.
In the latest porn industry case, county and state health officials say they have been stymied by AIM clinic officials.
The clinic has not yet reported the case and has not responded to requests from the county for the name of the production company where the woman worked.
She performed June 5, a day after testing at the AIM clinic, despite lacking a negative HIV test within 30 days, which the industry calls for under its voluntary guidelines. Her test came back HIV positive June 6.
On Wednesday, citing the clinic's slow response, the California Division of Occupational Safety and Health performed a surprise inspection at the clinic and officials said they plan to subpoena medical records.
The AIDS advocacy group praised those efforts, but said neither the county nor the state are doing enough to mandate condom use in the industry. Under state labor laws, employees should be protected from blood and bodily fluids in the workplace.
If condoms aren't used -- and porn producers openly acknowledge that they are rarely used -- the state and county should shut the industry down, Weinstein said.
"If there are roaches in the kitchen, they go out there with the sheriff and close it down," he said. "Why is this different?"
Diane Duke, executive director of the Free Speech Coalition, a porn industry advocacy group, disputed the AIDS Healthcare Foundation's arguments.
"Currently, we are not required to have condoms on sets," she said. "We know that government regulation does not work, and the industry's self-regulation has worked and is working very well. It's frustrating for outside entities to want to regulate our industry without knowing anything about it."
Duke said AIM's past experience has shown that protecting porn performers does work. As for the most recent HIV case, she said the female performer was diagnosed with HIV quickly, and "it was isolated immediately."