Individuals who are HIV-positive are not permitted to participate in the adult entertainment industry. That standard is enforced through the Performer Availability Screening Services, otherwise known as PASS. Anyone who tests positive for HIV is permanently banned from the system.

The same applies to other regulated subsets of sex work. To date, Nevada is the only state where full-service sex work is legal. All individuals who apply for work must undergo medical testing for STIs, including HIV. According to Jeremy Lemur, a P.R. representative for one of Nevada’s 21 legal brothels, anyone who tests positive for the virus is not welcome to work at any legal establishment within the state.

But not all sex workers think HIV-positive people should be banned from the field. Jacen Zhu is an adult performer and LGBTQIA activist. According to him, there are schools of queer performers who believe in opening up the industry gates to those living with an undetectable HIV status.

The word “undetectable” is important to emphasize here. The advance of antiretroviral therapy has dramatically shifted the prognosis of those who test positive for HIV. The medication works by preventing copies of the exciting virus from replicating and blocking new ones from entering human cells. So long as they remain vigilant with this medication regime, HIV positive individuals are able to maintain a normal lifespan. In fact, the medication is able to suppress viral loads so effectively that standard blood tests will not be able to detect any trace of the virus. This is what it means to become “undetectable.” And that’s an important status to carry, especially in the context of intimate relationships. A 2017 report conducted by the Centers for Disease Control and Prevention found that 49% of people living with HIV in the United States had reduced their viral loads to an undetectable level.

“If you have an undetectable viral load for an extended period of time, say 6 months, it is extremely unlikely that you would transmit the virus to an uninfected partner,” explains Dr. William Short, an infectious disease specialist based in Philadelphia. Short is also an Associate Professor of Clinical Medicine at the Perelman School of Medicine of the University of Pennsylvania and serves on the board of directors for the American Academy of HIV Medicine. “Thousands and thousands of acts of condom-less sex have been studied,” he adds. “The science is very clear.”

“Many gay and queer performers are rallying in support of undetectable performers being able to work,” says Zhu. “[We are] fighting stigma from within our own safe-spaces. These performers are proactive in their sexual health. If we’re in an industry promoting sex, we also hold the responsibility of being sexual health advocates.”

While there is a notorious lack of data about sex work, it’s safe to say that some will face financial hardship if they are no longer able to work in this field. Sure, there are the headlines that suggest some individuals have been able to amass incredible earnings from their time in the field, but the more likely reality is that the many more turn to sex work as a means of survival. This is especially true of marginalized communities who experience difficulty securing housing, employment and the proper documentation required to enjoy a safe and stable existence.

To be sure, people in the industry have genuine fears. Some of the backlash is coming from other performers. In January of this year, thousands of people poured into the Hard Rock Hotel and Casino in Las Vegas in anticipation of the Adult Entertainment Expo. The annual event is designed to spotlight new products and services related to the adult entertainment industry. This year, the organizers agreed to throw in a discussion surrounding HIV, a subject that is often shunned from conversations concerning mainstream porn. The idea was to decrease the stigma of what has now become a controllable diagnosis, open up a dialogue about safety and consent, and explore how HIV and the adult entertainment industry may interact in the future. But hopes of what that conversation may blossom into disintegrated the moment performers hit the web with concerns over what a more lax approach to the virus could mean for the industry.

Some grassroots organizers emphasize that the decriminalization of sex work is critical to protecting the health of workers and clients.

Nina Luo is a community organization at Vocal-NY, a grassroots organization that provides harm-reduction services to low-income individuals affected by HIV/AIDS. She’s also the press coordinator for Decrim NY, a coalition designed to decriminalize the sex trade in New York City and State. According to her, decriminalization gives sex workers a better shot at actually tracking their interaction with the virus. Without the fear of police, they are in a better position to do things like negotiate condom use, disclose their status and access medical resources. This, in turn, gives clients the ability to utilize informed consent when deciding whether or not they want to move forward with things. According to a Lancet study, decriminalization can reduce new HIV infections amongst sex workers, partners and clients up to 45%.

This is important to keep in mind, even for those currently working within legal environments. Sky (who prefers to be identified by her professional name) has been working at Sheri’s Ranch in Nevada for a little over a year. Earlier this year, a federal lawsuit was introduced aiming to outlaw the brothels. “If the brothels go away, none of the women I’m speaking with are talking about how to leave the sex industry,” she says. They’re all talking about how they’re going to survive in a sex industry that’s no longer legal.” At the brothels, the women are required to use barrier methods during any sexual interaction with a client. Escorts don’t typically enjoy that same security working independently, and illegally.

According to an investigation conducted by UNAIDS in 2014, stigma, discrimination and “punitive legal environments,” are key determinants in HIV vulnerability. UNAIDS found that of as many as 48% of U.S. sex workers say they have had their condoms confiscated by police.

It’s a tightrope to walk between forging a system designed to protect the health and wellness of those in the industry and protecting the individual freedoms of sex workers. Decriminalizing the industry means law-enforcement officials would be unable to intervene in activities and transactions related to sex work. This would give both clients and providers more say in whom they choose to work with and in what capacity. Legalizing it, on the other hand, would require a series of regulations be put into place, ones that would likely alienate certain individuals from the field, particularly those who test positive for HIV, even if undetectable.

Loosening up stigmas surrounding the virus, meanwhile, would serve sex workers even—when off the clock.

“Sex workers are afraid of disclosing their work to healthcare providers for fear of lower quality service, discrimination, criminalization or harassment. This linkage between a patient and healthcare provider is critical to identifying violence, exploitation, trafficking, yet it’s disrupted by criminalization,” says Luo.

“We’re not trying to create a new industry,” she adds. “But we do want to remove policing and criminalization from sex workers’ lives.”

This article was originally published at In These Times on July 10, 2019. Reprinted with permission.