At gay bathhouses in the Bay Area, monitors pop in on the “playroom” irregularly — “every 20 minutes, every 40 minutes, every hour,” one manager says, trying to make sure patrons are having sex safely.

“You put the condom on or get the hell out,” a monitor at one such club said, upon discovering a couple violating the rules.

William Woods and his colleagues talked to these bathhouse monitors, as well as managers and patrons, about their safer sex monitoring programs, detailed in a recent article in the academic journal Sexuality Research and Social Policy. Some bathhouses enacted aggressive monitoring because “they sincerely care about their patrons’ health,” Woods said. These bathhouses in the Bay Area often were “at the table when the guidelines that are in place were developed, so they have a personal stake in them.” In other cities, bathhouses were under threat of closure from state health departments, and their monitoring programs, some implemented so the clubs could remain open, were only lackadaisically enforced.

The attempted policing of HIV transmission has been in the news a lot lately. Soon after four porn stars revealed they had been infected with HIV in early September, calls for laws requiring condom usage on set began to spring up again. The AIDS Healthcare Foundation, a public advocacy group at the forefront of the debate, argued for a previous law that voters passed in Los Angeles, saying that the adult film industry should protect its workers despite economic pressures to the contrary. They say condom usage is an occupational health measure for porn stars and should be as routine as requiring construction workers to wear helmets. Until filmmakers’ feet are held to the regulatory fire, many advocates believe actors will face an untenable choice between the risk of HIV infection or losing work in a latex-phobic industry. In response, adult filmmakers threatened to move their operations to Nevada. A “sexodus,” some called it. Industry representatives complained that compliance with condom laws would mean less viewer interest in their films.

The law eventually died a procedural death in the California Senate but the story is far from dead: Recently, newly infected adult actors themselves pleaded for improved industry condom usage, the flash of cameras glinting off of the tears on their cheeks.

Not all adult actors support mandatory condom legislation, however. I talked with Grace Evangeline, a retired adult film actress with credits like Sexy Cougars andLike Father Like Son #3.

“Performers need to be able to make the decision on using a condom, and the companies should respect it,” she said. Performer autonomy was not Evangeline’s only argument against mandatory condom usage. “Porn isn’t normal sex. It lasts longer, the male talent are above average in size, and it requires positions most people don’t perform in a normal situation. Male talent must become erect, then during the shoot, they become limp, and [are] required to become erect again, on and on. I’m not a male, but I would think this would be more difficult with a condom.” Evangeline supports voluntary condom use and frequent HIV and STD testing.

Adult actress Alana Evans also advocates publicly against legal condom mandates. I spoke with her on the phone, and she said that in the current climate of the porn industry, “If I’m condom-only, I know I’m not going to get hired.” She did not think requiring condoms by law would fix that problem. Just as some adult filmmakers circumvent HIV testing laws, she said, slack enforcement would undermine condom laws as well. “Most [filmmakers] don’t get permits anyway. It’s not like requiring condoms will make it happen.” Evans said she fears that condom laws could lead to a de-emphasis on testing, which is one of the reasons “the sex I am having is a heck of a lot safer than having sex in the general population,” where HIV testing is less common.

Evans recalled “a wake up call” she got one month into her 15-year adult film career. Shortly after meeting with adult film actor Marc Wallice to consider performing together, Evans learned Wallice was infected with HIV but had been showing filmmakers falsified negative test results for months. Several female actors ended up infected by Wallice, but Evans was lucky not to have been exposed. At the time, she said she was impressed by how actors and filmmakers came together “like a family” to stop HIV transmission. “It was all condoms all the time,” she said, and industry leaders encouraged frequent testing and HIV education campaigns. Evans hopes such grassroots efforts will emerge again.

Some prominent adult filmmakers agree. Popular porn producer Tristan Taormino argued the porn industry itself should require condoms and said she was skeptical that industry profits would suffer as much as naysayers predict. Porn director Nica Noelle wrote in Salon that she has had a change of heart: after years of looking the other way she will now require condoms on set.

HIV transmission among adult film actors is, of course, a miniscule proportion of the total HIV transmission around the world. Two million people will be infected with HIV this year whether or not we can stop HIV transmission among the uninhibited thespians of the San Fernando Valley. But the way we contain HIV transmission among porn stars reflects how we contain the whole HIV epidemic. And the visibility of porn stars sets them up as exemplars of our HIV prevention efforts in general.

I fear that condom laws will hoodwink us into thinking that we have addressed HIV transmission with the stroke of a legislative pen when, in fact, the work of HIV prevention remains undone. The real road to epidemic containment requires more challenging interventions like personal empowerment, sex education, and global scale-up of effective HIV treatment.

I learned this in part from Roger. At 45 years old and 200 pounds, Roger was not a typical lothario. When we first met in my HIV clinic, he was having sex with more than 100 men a year. Most days he logged onto Manhunt.com or another hook-up site to arrange same-day rendezvous with men whose names he rarely learned.

“Condoms?” Roger laughed. “I’m fine with condoms. I use a condom if the guys ask for one.” They rarely did. Roger also never disclosed that he was HIV positive to the men he met in the clubs and bathhouses outside of Boston. “Bringing up HIV isn’t very romantic,” he said. “Plus, these are grown men. They’d be stupid not to know about condoms. It’s their funeral.”

I asked if he thought some men might be unaware of the risk of HIV, or assume he was uninfected. “What if they are being naïve?” I asked, “Is that fair, to get HIV for being naïve?” He shrugged his shoulders and said he needed to think about it. Later Roger confessed he had been infected in exactly that way: as a young man, half in and half out of the closet, he frequented the bathhouses for months before learning about safer sex from a doctor who also diagnosed him with HIV.

Each time Roger visited my HIV clinic, we discussed what he called his “extracurricular activities,” and we brainstormed about how he might feel more comfortable mentioning condoms and his HIV status beforehand. I sympathized with his reticence on the topics and said I hoped we could find a more comfortable way for him to bring them up. Roger seemed genuinely interested. “I’d hate to hurt someone,” he said eventually. In time, Roger started HIV therapy and responded well.

Slowly, he changed his behavior too. He continued to have sex with anonymous men, but he shifted to sex acts less likely to transmit HIV. He selected “Ask me” next to his HIV status on Manhunt.com. Recently one of his dates took him up on the offer and asked him. “I took a deep breath, and I told the truth,” Roger said. And then they had sex. With a condom.

This is the key. People will have sex, but they can learn to be safer. To get there, they need strong internal motivation, not a doctor’s wagging finger or the threat of being busted by the condom police. Generating internal motivation to prevent HIV transmission is difficult. Much like getting bathhouses to support safer sex among their patrons or adult filmmakers to encourage their actors to wear condoms, HIV transmission prevention requires education, collaboration, buy-in, and time. These are imperfect and time-consuming tools, but they are the best we have.

Timothy Lahey is an infectious disease physician and medical ethicist who blogs at [M U R M U R S].  This article originally appeared in The Atlantic.