Minimizing Illness and the Transmission of Infections on Set: In Conversation with Evelin Dacker, MD
COVID-19 has brought conversations of health and safety in the workplace to the forefront. For those of us working in entertainment, we’ve become accustomed to sharing our vaccination cards and frequent testing, and good general practices like hand-washing and surface sanitization have become prioritized. I found myself thinking, what could a full examination of the risks associated with filming scenes including kissing or simulated sex look like? I wanted to consult with a medical doctor who aligned with my values to get my questions answered, so last week, I met with Dr. Evelin Dacker. Dr. Dacker is a Board-Certified Integrative and Holistic Family Physician who specializes in sexual health and consent. She prioritizes familiarizing other health care providers with sex-positivity, the destigmatization of STIs, and having a more open attitude toward alternative sexual practices and relationship styles. In addition, she holds workshops on consent and sexual communication geared toward young adults to help reduce sexual assault on college campuses. I was thrilled to get her advice on how intimacy coordinators can be cautious about the health of actors while committing to doing so in a science-backed way that breaks down shame and stigma.
There are quite a few viruses and bacteria that can be transmitted from kissing, but we often focus on those labeled as STIs. Dr. Dacker commented:
We give each other viruses all the time. And it’s not a bad thing to get viruses; It’s not a bad thing to get bacteria. It’s actually good for our immune system to be exposed to things. I think that we just stigmatize sexuality so much that anything that we get through sex is thought of to be so much worse because we’re not supposed to be doing it. So the way, I think, to unbundle the stigma is to actually do disclosures and just make it normal… Just make it as part of an overall, ‘How do we minimize risks of transmission of all infections?’ If we walk around eggshells when it comes to STIs, we’re just continuing that stigma.
Generally, Dr. Dacker recommended that we continue to encourage good hygiene, that we normalize getting tested for STIs the way that we get COVID tested, and that actors disclose their status in the interest of consent and empowering them to make informed choices. She also encouraged intimacy professionals to be cautious of the language we use, advising, “Don’t say the word protect or prevent, because those words tend to give false expectations as well as shame people who live with a chronic virus or issue.” She encouraged the use of the phrase “minimizing transmission” as an alternative and later commented, “Honestly, everything we do in life has risks. Getting into a car has risks, but we don’t stop getting into a car.” It's important to keep in mind that as intimacy coordinators, we cannot eliminate risks for actors and crew, but we can try to minimize them.
Regarding testing, Dr. Dacker recommended that actors get tested for chlamydia and gonorrhea as they can both live in the throat, as well as HIV and syphilis. She told me, “Normalizing testing is really important in destigmatizing...It should be part of what we do for the health of our own body and to help the health of other people’s bodies.” She does not, however, recommend seeking testing for herpes. She said, “There’s no real test for it. The only test for herpes is if they actually have an outbreak and you swab that lesion and it shows up as that virus. The blood test for herpes doesn’t test for the actual virus, it tests if you have antibodies to the virus, and there’s a lot of false positives because there’s a lot of crossover with other herpes viruses.”
Dr. Dacker clarified:
There’s two types of herpes. There’s type one and type two, and one is mostly on the mouth. Type one oftentimes is actually not transmitted through sex. It’s lumped into sexually transmitted diseases because it can be, but most of the time it can just be transmitted through people pecking and kissing externally. So a great number of people actually get it when they’re in their childhood, or when they’re an adolescent...For some people, they then have recurrent cold sores. For someone who has recurrent cold sores and has active herpes type 1, it can be transmitted to another person if they’re kissing when it’s either in the prodrome state, which is where they feel it, before it actually comes into a sore, or when it is a sore...If somebody has the virus, let’s say they had it when they were a child, but they never actually have a cold sore as an adult, or they haven’t had a cold sore in years, then the risk of them transmitting it to someone else is practically zero. So what you need to do is really assess those people that do get recurring cold sores, because they then should take precautions if they’re doing any kind of touch with another person using their mouth or places where they break out.
Dr. Dacker recommended that actors with recurrent cold sores disclose this and take a daily antiviral during filming to prevent transmission and that during a breakout, contact should be avoided. She said, “An antiviral will prevent transmission of herpes type 2 up to about 80%, but herpes types 1 responds even better. So it’s almost like, if they take an antiviral and they only have oral cold sores, then it can pretty much prevent transmission. Antivirals are really benign medications with very few side effects. The hardest thing about an antiviral is the pills are big. But other than that, it’s one of the safest medications to take.” I asked about the risk of herpes transmission through contact with the skin around the genitals not covered by a modesty garment- i.e, the upper thigh. Dr. Dacker answered, “It depends if they had genital herpes type 1 or 2. If they have type 1, it’s probably not a high risk at all. If they have type 2, it still can be, because genital herpes can shed anywhere within the boxer short region of the body.” So for an actor with recurrent genital herpes performing in a scene with simulated sex, the recommendation to disclose and take an antiviral during filming stands and additional precautious can be taken, such as additional barriers.
Finally, I wanted to dive into oral hygiene. It’s common for actors to be provided with a toothbrush and toothpaste or floss on the day of a scene with intimacy, and some intimacy coordinators recommend the use of an antiseptic mouthwash within 20 minutes of working the scene as an additional precaution against the transmission of infections. I asked Dr. Dacker if injuries to the mouth that can occur during vigorous brushing or flossing can make actors more vulnerable to infection and how much confidence we can have in our mouthwashes. She answered, “Brushing teeth and flossing, because it can create micro-abrasions in the gums, can increase risk of an infection setting in if they’re doing something with another person. So it’s probably a better idea if they’re going to floss or brush their teeth, that they do so at least two hours to 90 minutes beforehand. And then it’d probably be a good idea to gargle with a product such as Listerine...I think [mouthwashes] can decrease the risk of a lot of viruses and bacteria...It’s not a bad idea. I think it can minimize transmission. Could it mitigate it? I can’t say.”
To my knowledge, there are currently no union guidelines that address the transmission of infections in scenes with intimacy, but I think it’s an important consideration as the scope of our work continues to adapt. My goal as an intimacy coordinator is to encourage a culture of informed consent and safety, and this is just one more avenue where we can do our best to make a change and break down stigma. I want to encourage us to continue to challenge our biases around STIs and always seek scientifically-backed information from professionals where we can. On that note, it was an absolute pleasure speaking with Dr. Evelin Dacker and I’d like to thank her again here for her work. If you’d like to hear more from her, her website is https://www.evelindacker.com/ and her instagram is @sexmeddoc.
What do you think? If you’re an intimacy coordinator/intimacy director, will you bring any of this information into your practice?
If you're an actor, do you feel that destigmatizing the conversation around minimizing infection in scenes with intimacy would make you feel more confident going into filming?
Let me know below!