Female performers in the adult film industry: What and where is the risk?

Background: The adult film industry (AFI) is larger than Hollywood and produces 4,000-11,000 films and $9-13 billion annually. They employ 1,200-1,500 performers, 75% of whom are female. Performers engage in high-risk sexual acts for prolonged periods. Condoms are rarely used.

Objective: To understand the current structure of the AFI and identify risks to female performers while entering, performing and exiting the industry to develop a future intervention in this population.

Methods: Semi-structured in-depth individual interviews were performed with performers and key informants identified through Protecting Adult Welfare, a nonprofit, and through snowballing technique. A codebook was developed and Atlas-TI was used to manage the data including building and applying codebooks.

Results: 22 interviews were completed with 14 female and seven male performers, one director and one agent. Female performers' reported reasons for entering included financial need, suggestion from a significant other, or as a transition from other sex-related work. However, upon coding the data personal characteristics associated with entry included a history of sexual abuse, low self-esteem or body image, exhibitionism, and alternative sexualities. Performers engage in risky behavior that include body manipulation, such as weight loss, enemas, and breast augmentation, high-risk sexual acts that are usually unprotected, and alcohol and drug abuse. They are exposed to verbal and physical abuse. During and upon leaving the industry, they suffer from many mental health issues.

Conclusions: Physical and mental health are predisposing factors and consequences for female performers working in the AFI that require attention by health planners and policymakers.