Los Angeles:
The clinic that for the last decade had monitored the health of those working in the multibillion-dollar pornography industry abruptly shut its doors in December.
Now Los Angeles has moved to fill that role.
Last week, city lawmakers voted unanimously to draft an ordinance that would require condoms to be used on the set of every pornographic movie made here.
The sudden closing of the clinic, coming after a performer tested positive for H.I.V., sent pornography actors to clinics around the San Fernando Valley, north of downtown, where the industry is based. And though the clinic recently reopened, its uncertain status again raised the question of who, if anyone, should be ensuring their safety.
"We can't keep our heads in the sand any longer," City Councilman Bill Rosendahl said. "These people should be using condoms. Period."
The city law would be the first to impose safety standards specifically on the pornographic film industry, which has largely been allowed to police itself.
Until the late 1990s, the industry was unregulated. But after a string of actresses contracted H.I.V. and filed lawsuits against production companies, the industry created the Adult Industry Medical Healthcare Foundation.
Since 1998, the nonprofit clinic, financed by contributions from production companies, has offered health tests to sex-film performers. Producers agreed not to hire performers who had not been tested in the last 30 days, and the clinic investigated the sources of infections, coordinated halts in filming when actors tested positive for H.I.V., and hounded performers who had been exposed to get tested.
Over the years, county health officials had clashed with the clinic, accusing it of failing to cooperate with investigators and of failing to protect industry workers and their sexual partners.
Those in the industry, however, assert that the self-regulating system has worked well, pointing to just five cases of H.I.V. infection among its performers -- none of them definitively tied to on-set exposure -- since a 2004 outbreak shut down the industry for a month.
"This has been working for years," said Steven Hirsch, founder of Vivid Entertainment. "If we saw people getting sick, we would go to mandatory condoms."
Filmmakers also oppose any new regulations because they say that sales drop when performers use condoms and that regulations are difficult to enforce on the set.
Adult Industry Medical, which the county health department shut down because it was not properly licensed, reopened last week under a new name and as a profit-making clinic, now under the oversight of the California Medical Association. On its Web site, the clinic vowed to resume all its services, "relieved from pointless harassment that came with oversight from the county health department."
Even while testing at the clinic ceased for two months, the foundation continued to operate a database that allows producers and talent agents with passwords to see performers' test results from other clinics.
Sexually transmitted infections, however, remain rampant among pornographic film performers. Sexually transmitted disease is diagnosed in a quarter of all performers each year, according to the Los Angeles County Department of Public Health. Rates of chlamydia and gonorrhea infection are seven times higher than those in the general population.
Jan Meza, a performer who contracted herpes and chlamydia before she left the industry in 2007, said the self-regulatory testing system often left her weighing financial needs against concerns for her safety.
"At first, I would ask about condoms, and they told me I'd never be able to find work," Ms. Meza said. "You do worry about the risk, but any girl desperate for money, like I was, is still going to do it."
Health care advocates have long argued that the prevalence of these sexually transmitted diseases highlights the need for government to step in.
"Testing just acts as a fig leaf for producers, who suggest that it is a reasonable substitute for condoms, which it is not," said Michael Weinstein, president of the AIDS Healthcare Foundation. "Syphilis and gonorrhea pose significant health risks, not only to the performers but to the rest of the community."
So far, though, government efforts to impose safety standards have met with little success.
Since 2004, the state Division of Occupational Safety and Health has maintained that existing state workplace safety laws require condoms and other protections for performers in the pornographic film industry. But the agency has issued just a handful of fines for allowing unprotected sex, and they have failed to significantly alter practices.
"It's slow going," said Deborah Gold, a senior safety engineer with the division. "We have a limited number of resources."
Previous efforts to pass legislation that would specifically require condom use -- and make enforcement of the mandate easier -- have also stalled. Los Angeles County health officials say the county lacks the resources to enforce such a requirement. State health regulators have convened a committee to consider a condom mandate, but have not yet drafted a law.
The Los Angeles law would tie the issuing of film permits to on-set condom use. But it is unclear whether the city has jurisdiction over public health issues.
Even if the law is enacted, city regulators may face similar problems of enforcement that have dogged state occupational safety and health officials. And some filmmakers have grumbled about moving their operations, which bring in as much as $13 billion annually, to other states.
"I tried many years ago to get everybody to go to condoms," said Jim South, a longtime talent agent for sex-film performers. "Quite a few companies did, but sales fell severely. The switch would be very difficult."