The Performer Availability Screening Service includes HIV in the 14 day clearance testing panel.
HIV testing has been used to prevent infections in the adult industry since the late 1990s.
PASS testing protocols have prevented any transmission of HIV on PASS-compliant sets since 2004.

 What is HIV?

• Human Immunodeficiency Virus (HIV) is a virus that disrupts the body’s immune system by destroying white blood cells. White blood cells help the body fight infection. Without treatment, this virus can make a person very sick and prone to other diseases and infections. HIV can also lead to Acquired Immunodeficiency Syndrome (AIDS), which is when the body’s white blood cell count drops below 200 cells/ml of blood. 

How is HIV transmitted?

• HIV is transmitted through bodily fluids such as blood, semen, pre-seminal fluid (pre-cum), rectal fluid, vaginal fluid, and breast milk. In order to be transmitted, infected fluids with sufficiently high viral load must come in contact with a mucous membrane or injected into a person’s bloodstream. This can happen through unprotected sex without use of condoms or Pre-exposure Prophalactics (aka PrEP), from sharing drug injection equipment, or during childbirth without appropriate medication. However, it is important to note that medications and prevention methods are available (visit PrEP and PEP) that prevent HIV+ individuals from transmitting the virus to another individual. 

What are the different stages of HIV?

• Stage 1 is called Acute HIV Infection. This stage occurs 2-4 weeks after infection. Individuals have flu-like symptoms that can include sore throat, fatigue, mouth sores, rash, swollen lymph nodes, night sweats, muscle aches, fever and chills. It is important to note that a PASS certified STI panel must include an antigen or nucleic acid test, because it is the only HIV test that can diagnose a Stage 1 Acute HIV infection. 

• Stage 2 is a Chronic HIV Infection. This is the stage where individuals can show no symptoms and likely have a low viral load. With medication, individuals likely will not progress on to Stage 3. 

• Stage 3 is Acquired Immunodeficiency Syndrome (AIDS). This stage occurs when an HIV+ individual’s white blood cell count drops below 200 cells/ml of blood. This can have very severe impacts on a person’s immune system, and while fatal, is also reversible with appropriate medication and treatment interventions.

What is used to treat HIV?

• Medications used to treat HIV are called Anti-Retroviral Therapy (ART), that help decrease the viral load in the body. These treatments can suppress the virus to the extent that an HIV+ person will no longer be able to transmit the virus to an HIV- person, and the virus will no longer have an effect on life expectancy.

How is an HIV infection prevented?

• HIV infection can be prevented using Pre-Exposure Prophylaxis, which can be taken daily like birth control, and Post-Exposure Prophylaxis, which can be used in the first few days after exposure--similar to the morning after pill. Barrier methods such as condoms are also effective in preventing infection. 

• For people who are HIV+, using Anti-Retroviral Therapy can decrease the viral load to untransmittable levels in which unprotected sex with HIV- individuals cannot lead to transmission. This is know as Undetectable = Untransmittable (U=U) because when a person’s viral load is low enough to be untransmittable, that person will also test negative for on an antigen or nucleic acid HIV test 

• Regular testing for HIV is one of the most effective options to reduce the risk of transmission of the virus on adult film sets. One can only contract HIV from someone who actually has the virus. PASS includes one of the most highly effective HIV tests available, which can identify the virus before it can even be transmitted.

What kind of HIV tests are there?

There are different types of tests for HIV. Some tests detect presence of the virus directly while others look for the immune system’s response to an HIV infection. The effectiveness of different tests depends on the stages of infection with viral RNA being detectable first, antigens second and antibodies third. 

• RNA Testing
  HIV RNA tests are the gold standard of testing, and the most important HIV test used by adult performers in PASS. Also known as NAAT (Nucleic Acid Amplification) testing, it specifically tests for the building blocks of the virus, the so-called HIV RNA. These tests have the shortest window period of all accessible tests, meaning they can detect the virus the quickest. The HIV NAAT test that is used as part of the PASS system can detect an HIV infection almost as soon as it becomes transmittable--ie: approximately 7 - 10 days after initial transmission.

• Antibody Test
  This was the first type of test developed to find out whether someone has an HIV infection. Today, antibody tests are the most commonly used HIV tests because they are relatively accessible, inexpensive, and reliable, but it also takes longer to detect an active infection due to the time it takes for the immune system to begin producing antibodies in sufficient quantities to be detectable, which can take up to 90 days. Modern antibody tests have a window period of about 28 days. While an HIV antibody test is currently a part of the PASS Certified panel, it is relatively unimportant due to the lengthy transmission window period. Example: Someone could contract HIV and not become detectable via an Antibody test until nearly a month later--not ideal for adult film industry workers.

• Antigen Test
  Antigen tests require 18-45 days post infection to detect the presence of the virus but that is for blood drawn from the veins. For a sample taken from a finger prick, to be certain of results that period increases to 18-90 days, so blood drawn from a vein is the preferred method when using this type of test. The p24 antigen that this test measures for unfortunately peaks at about 3-4 weeks and is undetectable after 5-6 weeks (sometimes less.)

• Antibody/Antigen Test 

These tests are often referred to as 4th generation tests, and as the name indicates they are a combination of an HIV antibody test and HIV antigen test. Their window period is 18-42 days to detect antigens and longer for antibodies. If you test at a free clinic, or in a standard doctor’s office, this is most likely the test you will be given.

Why do different HIV tests have different window periods?

• The three different signs that HIV tests search for become detectable at different times. In the first 100 days after a person becomes infected with HIV, the virus multiplies incredibly fast. This time is referred to as the acute period.

• HIV RNA becomes detectable first, but it usually takes between 7-10 days for there to be sufficient HIV RNA to be transmittable, and therefore detectable. Those who are virally suppressed (either due to adherence to antiretroviral medication or in rare cases, their own body’s immune response) have a quantity of HIV RNA that usually remains below detectable and transmissible thresholds.

• Specific to HIV, the p24 antigen becomes detectable next, after about 16 days. The p24 antigen triggers the person’s immune response and this antigen becomes detectable, but then ceases to be detectable after about five to six weeks, so timing is everything with this test.

• Antibodies are the last indication of an HIV infection that becomes detectable. Antibodies are produced by the immune system of a person after HIV infects them, which is why it is called the immune system response. These antibodies become detectable after about 28 days.

Why is the window period of an HIV test important?

• For us in the adult industry it is important to have the most accurate information as quickly as possible so workers can quickly make informed decisions about their health and safety both on and off set. Therefore, the PASS industry standard protocols require a test known as a  “qualitative HIV NAAT test”. Of all the available tests on the market, this test provides the fastest and most accurate results after a potential HIV exposure

What happens if I test “positive” for HIV?

• The PASS system processes hundreds of tests each year, and occasionally returns a “reactive” result. 

• (When we say a test has a “reactive” result, it means that the blood sample has reacted in a way that could indicate the presence of the HIV virus. In rare cases, a “reactive” test is inaccurate — what we refer to as a false positive.) 

• If your HIV test is initially reactive, you will be contacted by the testing facility and asked to retest. 

• If your re-test comes back reactive, indicating you have contracted the virus, PASS doctors will work with you to swiftly connect you to care so you can begin management of your viral load to get you to a healthy and untransmittable status as quickly as possible 

• PASS doctors will also work with you to try and identify the source of your infection, and to identify any people, on-set or in your personal life, that may have been exposed. They will ask you if they have the permission to work with Free Speech Coalition to confidentially attempt to identify and retest those people, to prevent any further possible transmissions.

• Your identity will NEVER be revealed to anyone by FSC or PASS, and your medical information will be kept entirely confidential. 

• Additionally, when speaking with potential partners, producers or the public, we avoid using all identifying information that could be used to identify or “out” the person who contracted HIV. 

More resources:

• The CDC has information related to HIV, prevention methods, and access to treatment. 

• The World Health Organization can direct you to information surrounding rates and current research. 

• Full panel STI testing and treatment is available at the Los Angeles LGBT Center. Regardless of your ability to pay, the Los Angeles LGBT Center provides a sex-positive, sex worker safe clinic.