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Abstract
In 1998, Mitchell was contacted by The Free Speech Coalition, an adult film industry group who asked her to investigate an outbreak of HIV among performers. "When I found people I have worked with had HIV, I decided I was in", says Mitchell. "I was the only person who could do it. You have to have a special combination of clinical awareness and sensitivity to the population." She opened an office in Sherman Oaks, California, USA, in a room donated by a modelling agency that handled sex workers. "When people came out of the agency, I would draw blood and say come back next month. I went through the genealogies and found who they had sex with and found patient zero. He was a producer who had been stunting in his movies. He had forged test results from a public-health clinic in case he was asked." After this success, Mitchell decided to make her clinic a permanent, non-profit organisation. "I realised what I had to offer was unique", she says. "These people needed counselling, birth control, drug and alcohol groups, they needed to learn how to keep relationships together, tell their kids they were doing porn, and how to get out of porn." AIM now has a staff of nine, including three MDs, and provides services to 1200 actors that include monthly tests for HIV, gonorrhoea, chlamydia, and syphilis with pap smears, herpes, hepatitis C, and tuberculosis testing every 6 months. According to Mitchell, the compliance rate is 98% because, unlike in the general population, her clients have no stigma about sexually transmitted infections. "It's an occupational hazard they all share", she claims. "This is very high-risk stuff: unprotected anal sex, sometimes two or three times in a day." Mitchell estimates that between each monthly test some performers might have worked up to 40 times with multiple partners in every shoot. Nevertheless, the clinic's surveillance seems to be working. Of the 80 000 tests done to date, only 14 performers have tested positive for HIV infection.