The rise in HIV transmission in the Philippines has been linked to the local call center industry. The Philippines overtook India as the largest provider of business product outsourcing (BPOs) in 2009; and over half a million young Filipinos are working in what has been locally termed a “sunshine industry”. Voice services or “call centers” make up 70% of the local BPO industry. Because BPOs are seen as a high growth area of the economy, linking the nascent HIV epidemic with it has been a politically thorny issue. Three local studies have looked at this purported association. An International Labour Organisation-funded cross-sectional study on risk behaviors in call centers found a high prevalence of risky behaviors among call center workers‟ including early sexual activity, low condom use, and promiscuity. A University of the Philippines Population Institute study compared sexual behaviors of call center workers to non-call center workers and showed 150% and 450% higher rate of engagement in risky sexual behavior in male and female call center workers compared to their non-call center counterparts respectively. Gangcuangco et al. tested a convenience sample of 406 men who have sex with men (MSM) in Manila and identified employment in a call center as a significant risk factor for testing positive for HIV. Forty eight persons (12%) tested positive for HIV. While one-third of those tested indicated that they worked in the call center industry, one-half of those who tested positive reported being call center agents. The economic impact of a generalized HIV epidemic on the Philippine economy will be significant. Using figures specific to the BPO sector, the entry level salary for a BPO employee is more than double the average compensation rate for the Philippines (US$4,631/year versus US$1,980). At a current median age of diagnosis of 28 years old [8], most persons will develop AIDS and die within ten years if not treated with antiretroviral (ARVs). Each missed AIDS diagnosis therefore removes at least 27 years of productivity for these workers, assuming a retirement age of 65 years old. Without taking into account costs of excess hospitalization, increased wages with promotion, or losses from declining health, this translates into a lost productivity cost of more than US$125,000 per person infected. Treating an HIV-positive individual costs the Philippine government US$600/year. Latest figures from Africa show that early treatment restores life expectancy and should likewise restore productivity. Using current life expectancy estimates from the National Statistics Office [12] of 69 years for males and 74 years for females, the lifetime cost of treatment is US$24,600 and US$27,600 for men and women respectively. This translates to recovered productivity of approximately US$100,000 per person successfully identified and appropriately treated with ARVs in the BPO industry. Although more comprehensive studies are needed to corroborate these findings, the rapid acceleration of confirmed HIV cases in the Philippines means that HIV prevention and education campaigns need to be ramped up to address increasing risk in young people. Whether or not risk and infection rates are truly increased in the BPO sector, the large proportion of young, sexually active individuals employed in this industry means that the progression to a generalized HIV epidemic will have a severe socio-economic impact on the country.

While the Philippines has one of the lowest HIV prevalence rates in the world, an unprecedented increase in recent years seems to indicate that a large epidemic is only be a matter of time. Multiple factors including poor condom use, increasing rates of casual sex, and misinformation, are ingredients for the widespread emergence of HIV. Financial consequences will be significant since the Philippine economy is increasingly driven by industries employing young people who are at risk. Recent research showing better clinical outcomes for early treatment with antiretrovirals (ARVs), coupled with data demonstrating a drastic reduction in transmission with early therapy, provide a compelling argument for a universal test and treat strategy. With just over 7,000 confirmed cases, this approach is financially feasible, and is an efficient model for proof-of-concept.
Human ; Male ; Female ; ANTIRETROVIRAL THERAPY, HIGHLY ACTIVE ; HIGHLY ACTIVE ANTIRETROVIRAL THERAPY ; OCCUPATIONAL HEALTH

The unprecedented increase in HIV cases in the Philippines has not spared healthcare workers. Due to the severe stigma associated with this disease, healthcare workers (HCWs) with HIV face signification discrimination especially if they elect to continue practicing medicine. This article examines the evidence for occupation transmission of HIV from healthcare workers to patients and provides a framework for ethical testing of HCWs and a means to continue practice while preserving patient safety.

Human ; Acquired Immunodeficiency Syndrome ; Health ; Hiv ; Philippines ; Occupational Health ; Hepatitis B ; Hepatitis C