Penile sexual acts were defined as any penile—oral, penile—vaginal, or penile—anal contact. However, no scientific studies have been done to show whether or not these factors actually do increase the risk of getting HIV or STI from oral sex. To obtain 50 eligible homosexual films, we reviewed films sampled from the available films.
We developed a codebook of definitions of sexual acts. Because there was no search tool to identify compilations on the Adult DVD Empire gay film site, exclusion of compilations required review of the DVD information provided on the Web site. Often there are no initial symptoms; however, after first being infected some people experience flu-like symptoms. We documented the prevalence of sexual acts and condoms in adult films and compared the frequency of condom use in scenes from heterosexual and homosexual adult films. The largest Internet rental sites for heterosexual and homosexual adult films were identified through key informant interviews and an Internet search; 10 heterosexual and 4 homosexual rental sites were reviewed. We also noted the presence of visible blood during a scene as well as the location of seminal ejaculation, because blood and ejaculate are potentially infectious bodily fluids. We compared the prevalence of condom use during a variety of sexual acts portrayed in adult films produced for heterosexual and homosexual audiences to assess compliance with state Occupational Health and Safety Administration regulations. Because little is known about what types of sexual acts occur in adult films and how consistently performers use condoms during sexual acts that can transmit HIV and other STDs, we conducted what we believe to be the first study on the topic. As shown in Table 1 , the prevalence of 5 of 6 measured types of sexual acts differed between heterosexual and homosexual films. Nonsexual and single-performer scenes were excluded. Adult films that were identified through Adult DVD Empire and had been released in the 12 months preceding August were eligible for the study with the following exceptions: The site's database included heterosexual and homosexual DVDs released in the 12 months prior to August Country and year of production were obtained from the DVD cover or opening credits. However, many infected persons may be unaware of their infection because STIs often have no symptoms and are unrecognized. It included DVDs from heterosexually and homosexually oriented production companies. Unprotected sex in adult films is an occupational health risk for performers. HIV damages the body by destroying specific blood cells that help the body fight disease. The surest way to not get a sexually transmitted infection from oral sex is to abstain from vaginal, anal, and oral sex or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected. For heterosexual films, we used the Adult DVD Empire's advanced search tool to exclude all films defined by the site as compilations, which reduced our initial sample of heterosexual films from to No penile—oral acts were protected with condoms in any of the selected films. These sexual acts can expose performers to sexually transmitted diseases STDs such as HIV, hepatitis, human papillomavirus, herpes simplex virus, chlamydia, and gonorrhea. Use plastic polyurethane condoms, if a partner is allergic to latex. We reviewed each selected scene for the nature of the sexual acts performed and whether condoms were used where appropriate. In addition, because these tests produce negative results for approximately 2 weeks after HIV exposure, a negative result does not preclude HIV transmission. The principal investigator and the 2 coders then used an iterative process that involved reviewing 10 sample scenes to clarify the definitions; these 10 scenes were not included in the reported analyses. A film was classified as homosexual if it was listed as being for rent or for sale on the Adult DVD Empire gay film site which included bisexual films ; films not listed on this site were classified as heterosexual.
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