It was discovered that three actresses who had worked with James shortly after his return to the United States had also become infected: Canadian newcomer Lara Roxx, Mareisa Arroyo, and Czech-born Jessica Dee. It was concluded that James had possibly been infected while engaging in unprotected anal sex with Brazilian actress Bianca Biaggi during a scene for the video Split That Booty 2 in Rio de Janeiro. The search and subsequent testing were conducted by the Adult Industry Medical Health Care Foundation, where James had received his diagnosis. In an attempt to prevent a possible outbreak, an urgent search was initiated for potentially infected performers.