Graduation Year


Document Type




Degree Granting Department

Public Health

Major Professor

Julie Baldwin, Ph.D.

Committee Member

Amina Alio, Ph.D.

Committee Member

Eric Buhi, Ph.D.

Committee Member

Dawood Sultan, Ph.D.


Syndemic Theory, Sexually Transmitted Infections, Health Disparities, Occupational Health, Pornographic Film


Existing literature provides support for a possible syndemic among adult film actresses. Multiple studies emphasize that a combination of economic, social, and cultural issues work together in tandem to synergistically amplify HIV/STI risk in this vulnerable population. It is critical to acknowledge how the detrimental effects of the high prevalence of substance abuse, psychological distress, intimate partner violence, and childhood sexual abuse work together in a system to heighten HIV/STI risk among adult-film actresses. Additionally, issues including the retrogressive dynamic and unequal power and hegemony in the industry function as facilitators which lower the overall health profile of adult-film actresses. It is therefore important to explore the additive relationship between multiple psychosocial health problems of HIV/STI risk among adult-film actresses. The goals of this study are to explore the tenets of the adult-film actress syndemic and use the ecosocial model to organize the associations between psychosocial health problems and HIV/STI risk.

This thesis utilizes a two-phase, transformative explanatory sequential mixed methods design which combines multivariable logistic regression and ethnography to understand HIV/STI risk and how depression, childhood sexual abuse, intimate partner violence, and substance use are embodied in the daily lives of adult-film actresses. The quantitative component of this study utilized data collected from a survey of 134 adult- film actresses from the United States. Statistically significant relationships were seen between the independent variables (psychosocial problems) and the dependent variables (i.e., number of personal sex partners, perception of HIV risk, and participation in other sex work). Other relevant quantitative findings included the statistically significant relationships between the syndemic variable and multiple dependent variables.

The second component of this study consisted of an ethnography that addressed the theoretical deficiencies in the quantitative phase. Eight adult-film actresses living in the United States were recruited through a testing agency located in Florida, a non-profit located in California, and social networking sites (You tube, Twitter, Facebook, and MySpace) and were then interviewed by phone. The ethnography provided substantive information on the processes which potentially undergird and fuel the syndemic among adult-film actresses including the link between traumatic childhood experiences, substance use and depression. Additional qualitative findings also included elucidating how components of occupational culture increase HIV/STI risk among adult-film actresses. Prominent qualitative themes included traumatic childhood experiences, tenuous romantic relationships and multiple rapes.

The integration of both phases of this study provide information on how the interplay between micro, meso and macro level factors work together in a system to additively augment HIV/STI risk among adult-film actresses. Findings from this study have the potential to influence risk reduction policies that could improve the lives of adult-film actresses.