Table 2.
Grid of identified themes and subthemes of pathways to health risk among adult film performers, with examples (N = 30)
| Female performers | Male performers | |
|---|---|---|
| HIV and other STD risk | ||
| Communicable diseases | Chlamydia | Chlamydia |
| Gonorrhea | Gonorrhea | |
| Herpes | Herpes | |
| HPV | HPV | |
| HIV/AIDS | HIV/AIDS | |
| Hepatitis C | Hepatitis C | |
| Condom use | Lack of condom use for low and high-risk sexual acts | Lack of condom use for low and high-risk sexual acts |
| Substance use | ||
| Drugs | Marijuana | Marijuana |
| Methamphetamines | ||
| Cocaine | ||
| Valium | ||
| Opiates | ||
| Alcohol | Underage drinking among <21-year-old performers | Drinking on the set |
| Body enhancement | ||
| Surgical | Breast augmentation | Hair implants |
| Vaginal surgery/reconstruction | Penis extensions | |
| Other cosmetic surgery | ||
| Medical | Self-administering enemas | Taking Viagra |
| Tanning | Tanning | |
| Excessive dieting and exercise | Excessive dieting and exercise | |
| Risk of physical trauma | ||
| General | Chemical burns from sex toys | Wounds due to penile injections |
| Anal tears | ||
| Cuts and bruises | ||
| Being slapped, having hair pulled on set by other performers | ||
| Asphyxiation | ||
| Simulating rape or violence in the scene | ||
| Sex acts | Vaginal sex | Vaginal sex |
| Anal sex | Simultaneous double-vaginal penetration | |
| Double-vaginal penetration | Simultaneous double-anal penetration | |
| Double-anal penetration | ||
| Simultaneous double penetration (vaginal and anal) | ||
| “Gang bang”: 1 woman has >2 sexual partners one after the other | ||
| Mental health risk | ||
| Clinically diagnosed | Depression | Depression |
| Suicide | Suicide | |
| Schizophrenia | ||
| Bipolar disorder | ||
| Anxiety disorders | ||
| Post-traumatic stress disorder | ||
| General symptoms | Anxiety | Anxiety |
| Stress | Stress | |
| Low self-esteem | Low self-esteem | |
| Poor body image | Poor body image | |
| Sex addiction | ||
| Financial risks | ||
| Finances | Adopting patterns of increased consumption of materials and goods | Males earn less relative to females for same sexual acts |
| Having children, partners, or other family members to support | ||
| Contracts/negotiations | Being offered increasing amounts of money for higher risk sex acts | Being offered increasing amounts of money for higher risk sex acts |
| No royalties from movies | No royalties from movies | |
| Agents controlling contract terms and/or payment | Agents controlling contract terms and/or payment | |
| Female performers eventually make less money for the same acts, making it necessary to do more scenes to maintain the same lifestyle | ||
| Social interactions | ||
| Relationships in the industry | Immersion in adult industry social networks, leaving behind other supportive family and friends outside the industry | Immersion in adult industry social networks, leaving behind other supportive family and friends outside the industry |
| Agents control female performers: provide clothes, trips, car services to sets in exchange for more work | ||
| Forcing or coercing female performers into sex acts | ||
| Sex with agents, directors, or producers to get work (“couch casting”) | ||