Opinion – Esper Kallás: Pornography, sex and HIV

Last week, a long report by the leaf brought to the discussion the mandatory use of barrier condoms by the Brazilian pornographic industry. The male condom is the best known and most popular of them. Three actresses were diagnosed with HIV infection and suspicion fell on the scenes without the use of condoms.

Although the article brings up an important subject, the approach is reminiscent of debates that took place in the 1990s.

The enormity of the porn industry’s reach is undeniable. Revenues and profits are huge. Although controlled, in significant part, by large production companies, it is also dispersed in small companies and in personal productions, with content disseminated in an amateur way via the internet. The penetration, no pun intended, is extraordinary.

It is estimated that about a third of internet data traffic is driven by erotic or pornographic content. Sex is one of the favorite subjects in the world and the transmission of HIV is one of the concerns that the subject always brings.

In recent years, fortunately, HIV prevention has taken on other contours and has ceased to focus only on the use of condoms. Concepts adopted with different forms of protection make up a more efficient arsenal than isolated measures. A parallel is automobile safety. Despite the importance of wearing a seat belt, the industry continues to invest in vehicles that absorb shock, air bags, anti-lock brakes and several other improvements that reduce injuries and fatalities in accidents.

In HIV transmission, something similar occurs. The concept of combined prevention gained strength with the addition of new weapons: frequent testing, for early diagnosis of possible infection; use of prophylaxis before or after risky sex (PrEP and PEP); the suppression of the virus with the cocktail of antivirals, in people living with HIV, to prevent transmission to the sexual partner (TASP); the adoption of measures to diagnose and treat other sexually transmitted infections, which facilitate the transmission of HIV.

So why did actresses, and actors alike, get infected? Was there a lack of a broader evaluation of prevention to the participants of the filming? Could they also have acquired HIV in situations that were not linked to professional practice?

The various prevention strategies, many listed above, should and must be approached with due balance, considering vulnerabilities.

Making people believe that only the lack of condom use in the scenes was responsible for the transmission disregards current concepts of combined prevention.

Not everyone will be able to adapt to using condoms in every relationship, or to the continued use of medication. Although one method can be added to the others, flexibility allows each one to find the most convenient way to prevent effectively.

Returning to sex scenes in pornographic films, if combined prevention had been applied, condom use might even be optional. This has happened in the American pornographic industry, which even stopped filming in 2011, after identifying an outbreak of HIV transmission. It is important to point out that this was before the implementation of PrEP and the flowering of the TASP concept.

Promoting combination prevention for HIV is the most effective way to face the HIV and AIDS pandemic. Looking at the practice of sex without prejudice, and with pragmatism considering what is available, is the best option.