A Predictive Model on the Spread

of the HIV Virus in Cebu City

By Jose D. Velez, Jr.
Abstract:

Among Philippine cities, Manila made It for several years to the UN list of cities with high incidence of
HIV infections. Lately, however, Cebu City outranked Manila. With the UN goal to end the AIDS
epidemic by 2030, Cebu Citys case is alarming. The problem needs immediate attention. Without any
form of intervention, the infection rate is bound to rise further. To simulate what would be the AIDS
scenario sans any intervention, a predictive model on the spread of the HIV virus is made using data
from the University of the Philippines Population Institute. In 2010, the University of the Philippines
came up with a comparative study on the lifestyle and health of call center agents in Metro Manila and
Metro Cebu. Among the data gathered were those of risky lifestyle of BPO agents in Cebu that could
make them vulnerable to infection. This paper designs a predictive model on the spread of the HIV
virus by the year 2020 to illustrate the probable extent of infection if the trend continues.

Keywords: Cebu City, BPO, Philippines, UNAIDS

I. INTRODUCTION
The Joint United Nations Programme on HIV and AIDS (UNAIDS), the UN body tasked
to maximize results for the global AIDS response hopes to end the AIDs epidemic by
the year 2030. Dubbed Fast Track 2030, UNAIDS focuses its campaigns in different
cities throughout the world. The reason for this is the observation that two of the
most dramatic events the past two decades have converged in cities: the
astonishing growth of cities themselves ... and the global AIDS epidemic (UNAIDS,
2014). Manila in the Philippines made it to the list of cities being monitored by the
global body since for several years now; it is the Philippine city with the most
number of HIV infections. However, in June 2015, the Department of Health (DOH)

Region 7 reported that Cebu City, the Philippines second most prosperous city has
outranked Manila.
While cities such as Bangkok, New York, Paris and Vancouver have successfully
reduced HIV transmissions (UNAIDS, 2014) Cebus HIV infection has been
accelerating. According to the DOH Report, Cebu City ranks first among Philippine
cities with high incidence of HIV cases. It has a prevalence rate of 7.7%, ahead of
Manila and Quezon City which recorded 6.7% and 6.6%, respectively. Central
Visayas, to which Cebu belongs, ranks second next to the National capital Region
(NCR) with the most number of persons living with HIV. In Central Visayas, Cebu
leads the provinces with 67 people confirmed to be with AIDS and 1872 others
infected by HIV. This paper explores the implication of said report focusing mainly
on workers of Business Process Outsourcing (BPO) industries in Cebu whose
lifestyles are considered to be high risk factors in the spread of the HIV virus.
Of great help to this paper is a comparative study made by the University of the
Philippines Population Institute in 2010 titled, Lifestyle, Health Status and Behavior
of Young Workers in Call Centers and Other Industries: Metro Manila and Metro
Cebu. The said study documented the lifestyle, health, sexual practices, and
awareness of the AIDS disease, among others of BPO workers in Metro Manila and
Metro Cebu. Data on Cebu call center agents gathered by researches of the said
study were singled out and tapped to make the simulation. They shed light on the
current high-risk lifestyle and behavior of call center agents which make them
vulnerable to HIV infection.
The history of the AIDS epidemic reveals some important facts regarding the spread
of the disease which can be useful in addressing the Cebu HIV and AIDS situation.
Risky lifestyle such as having multiple sexual partners is among the identifiable
factors that can lead to the spread of the virus according to a study by Anderson
and Dahlberg (1992).

In a survey involving Americans titled, High-risk Sexual

Behavior in the General Population (Results from a National Survey, 1988-1990), it

has been found out that a large number of adults in the United states are at a risk
of acquiring an STD because of their reported sexual behavior. In an estimated 180
million persons in the US who are 18 years of age and older, we estimate that 4.8

million have had 5 or more sexual partner in the past year and 6.6 million have
had sex with a stranger Higher number of sexual partners, both recently and
totally, is associated with increased risk for a number of bacterial infections It
also poses a greater cumulative risk for acquiring viral infections, such as general
herpes, human papillomavirus, hepatitis B and HIV (Anderson and Dahlberg,
1992).
With the recent report of DOH 7 placing Cebu in the first place among cities with
high HIV infections, it is pressing to assess once again the risks factors involving the
general population, focusing this time on the probable spread of the HIV virus
among BPO workers. BPO workers are of concern to this study as most of them
share a common high risk lifestyle and are prone to get infected by the virus. To
explore the probable spread of the disease, and to bring attention to the AIDS
situation in Cebu, this study comes up with a predictive agent-based model using
the data from the UP study. This paper presents what the AIDS and HIV scenario will
be among call center agents In Cebu by the year 2020.
2. ASSUMPTIONS
88 men and 72 women from various BPO companies agreed to be made the
respondents in the UP study (UP Population Institute, 2009). However, the response
rate varies and is low for some questions.
The simulation in this study relies on the following assumptions which are
themselves based on the data gathered by the UP study.
3.1. Sexual Behavior
160 call center agents in Cebu who are less than 35 years old were surveyed in
2009 and asked on their sexual practices the past 12 months prior to the survey. 88
men and 72 women were made the respondents.
following assumptions can be made:

Based on the UP study, the

Male call center agents tend to engage more in risky sexual behavior compared
to their female counterparts. The UP study revealed that men have a higher
mean number of sexual partners at 3.7 while women only have a 1.2 mean
number of sexual partners. Together they have a mean of 2.6 sexual partners i.e.
3 sexual partners.

Males too engage more in same-sex sexual experience at 15% as compared to

women who merely have a 3.3 % engagement. More males also engage in
commercial sex at 17.5% as compared to 0 by females.

Since the survey covered 12 months of sexual activity by the respondents, the
number of weeks in a 12-month period was divided by the number of sexual
partners. The resulting figure constitute the average commitment period of the
respondents or the number of weeks the sexual activity would last.

3.2. Protection
In the same study made by UP, a survey on use of condoms among call center
agents during their last casual sex was also conducted.

63 call center agents,

involving 53 males and 10 females responded to the questions.

Based on the UP study, the following assumption can be made:

Male call center agents since they engage more in sexual activity have a slightly
higher condom use with 41.5% of the male respondents admitting they have
engaged in protected sex. 40% of the female respondents said they too, engage
in the practice. Together they constitute 41.3% of the total number of
respondents who engage in safe sex.

3.3 Aids Test

In the same study, a survey of 29 call center agents, involving 20 males and 9
females on whether they have taken an AIDS test was conducted.

Based on the UP study, the following assumptions can be made:

60% of the male respondents said they had undergone an AIDS test. Together
they constitute 41.3% of the total number of respondents who engage in safe
sex.

3. MODEL SPECIFICATION
This study uses an agent-based simulation software called Net Logo 5.2.1 (2005)
principally authored by Uri Wilensky. Using high risk lifestyle i.e. multiple partners
and unprotected sex as the parameters mitigated only by condom use and AIDS
test, the software simulates the spread of HIV virus. Based on the aforementioned
parameters the software provides sliders for the following:
INITIAL-PEOPLE: How many people simulation begins with.
AVERAGE-COUPLING-TENDENCY: General likelihood member of population has sex
AVERAGE-COMMITMENT: How many weeks a person remains committed to a sexual
partner
AVERAGE-CONDOM-USE: General chance member of population uses a condom.
AVERAGE-TEST-FREQUENCY: Average frequency member of population will check
their HIV status in a 1-year time period.
The red-colored agents in the simulation are those infected with HIV; the greencolored, those who are not infected and the blue agents are those who may or may
not have the virus.
4. MODEL VALIDATION
AND SENSITIVITY ANALYSIS
Based on the assumptions and data mentioned in the previous chapter, a simulation
model was generated using agent-based simulation programming language
NETLOGO (2005).

Since the study was made in

2009,

an

11-year

study

involving

(representing
number

of

simulation

143
the

people
average

respondents

who

replied in the UP study) was

conducted in order to make the
2020

predictive

simulation

model.
4.1. Male and female sexual
behavior
The first simulation model in this study uses an average coupling tendency of 2.6
based on the actual data gathered by the UP Population Institute on the
respondents number of sexual partners the past 12 months prior to the survey. The
20 weeks average commitment is derived by dividing the number of weeks in a
year by the average coupling tendency. Given these parameters, the result is
combined rate of 5.59% among male and female call center agents. This is much
lower compared to the 7 percent infection rate reported by DOH as of June 2015.
The discrepancy could be due to the fact that the DOH survey does not include only
call center agents.
However, considering it is a predictive model for the next five years (from 2015)
using 2009 data, it is still a very conservative estimate. Factor influencing the
simulation is the less risky sexual behavior of female call center agents that is
affecting the overall result.
4.2. More risky behavior by men
Changing the variables by focusing on the data on male sexual practices alters the
result dramatically.

Using data involving males only results in higher percentage of infection. Changing
the average coupling tendency to 3.7 (the mean number of multiple partners by
male call center agents according to the UP study) and running the simulation in
Net Logo; by 2020, male call center agents will have a 9.09% rate of infection. This
is higher than the combined infection rate of 5.59% involving male and female call
center agents.
The result apparently is mitigated by the average test frequency of .60 times per
year and a 1.5 average condom use per statistics from the UP Population Institute
study.
The result is consistent with the DOH report stating that male to male sex is second
highest cause of the spread of the HIV virus in Cebu City.
4.3. More exposure means more chances of infection
From 143 initial people, the figure is raised to 220 to include 50% of the remaining
see what would be the result with more people involved. Simulating the spread of
the virus by 2020 with the new data, results in an even higher rate of infection at
18.33%.
Increasing the initial people in
the model also increases the
percent of infection. It means
the greater the exposure of a
probable HIV positive call center
agent,

the

greater

are

the

chances of him infecting other

people.
4.4.

More

sexual

partners

means an exponential rise of infection

Increasing the number of sexual partners by merely rounding off the 3.7 mean
number of sexual partners to 4 results in an exponential increase in the percentage
of infection. With the change in the data and running a simulation in Net Logo, by
2020 an alarming 36% rate of infection is estimated.
The simulation shows more and
more people infected. As shown by
the simulation, by the end of 572
weeks, the infection still has not
stabilized.
5. CONCLUSION

Based on the data from UP and the

simulation made with Net Logo,
male call center agents in Cebu with their high risk sexual behavior have more
chances of getting infected by the HIV virus. This finding is consistent with the
findings of DOH Region 7 identifying male to male sexual practice as the second
leading cause of the spread of the HIV virus, next only to injecting drug use. The
finding has major implications on the AIDS scenario in Cebu and the rest of the
country. Without any intervention between now and 2020, the number of those
infected will reach epidemic level considering that Cebus infection rate has been
rising.
The spread of the HIV/AIDS is becoming to be the underside of Cebu Citys rapid
development. With an economy propelled mainly by OFW remittances and the BPO
Industry, the spread of the virus, like in other cities around the world, seem to tag
along with the citys development. Phenomenon like this, which thwarts the
UNAIDS effort to end the AIDS epidemic by 2030, is what the UN body is trying to
avoid. New cases of cities with high incidence of HIV infection set back global effort
to arrest the epidemic by 2030. Political leaders in Cebu City have to put the citys
AIDS scenario in a global context to fight the spread of HIV/AIDS within and outside
the citys boundaries.

To curb the spread of HIV/AIDS by injecting drug use, DOH intervened by giving
away clean, uninfected syringes to drug users. Its a radical solution which was
criticized heavily by various sectors including the Church. The critics saw it as
tantamount to encouraging and promoting drug abuse. Aside from infecting drug
use, theres also a need to curb HIV transmission through risky sexual behavior, the
second leading cause in the spread of the virus. With the BPOs critical role in the
countrys economic development, the government has to do a good balancing act in
addressing the problem (hopefully with the help of BPO firms) so as to save lives,
and before dire consequences manifest and affect greatly the industry and the
economy.
6. REFERENCES
Anderson and Dahlberg, High-risk Sexual Behavior in the General Population
(Results from a National Survey, 1988-1990), 1992
Joint United Nations Programme on HIV and AIDS (UNAIDS), Report on AIDS , 2006
Joint United Nations Programme on HIV and AIDS (UNAIDS), The Cities Report, 2014
University of the Philippines (UP) Population Institute, Lifestyle, Health Status and
Behavior of Young Workers in Call Centers and Other Industries: Metro Manila and
Metro Cebu, 2010
Wilensky, U. (1997). NetLogo AIDS model.
http://ccl.northwestern.edu/netlogo/models/AIDS. Center for Connected Learning
and Computer-Based Modeling, Northwestern University, Evanston, IL.
Wilensky, U. (1999). NetLogo. http://ccl.northwestern.edu/netlogo/. Center for
Connected Learning and Computer-Based Modeling, Northwestern University,
Evanston, IL

1.1 AIDS and Cities

While the disease seems to spread discreetly among individuals, the rise of HIV and
AIDS infection affect cities considerably considering the following statistics from the
UNAIDS The Cities Report (2014): in Brazil, 15 cities account for 60% of people
infected with HIV; in the United States of America, 21 cities account for 40% of
people living with HIV; in Vietnam, two cities alone account for 31% of people with
HIV; and in Pakistan, only one city, Karachi is home to 30% of people with HIV.
Worldwide, according to the UNAIDS Report on AIDS (2006), an estimated 38.6
Million people were living with HIV at the end of 2005. The incidence rate is said to
have peaked in the 1990s but stabilized subsequently (UNAIDS, 2006). However,
alarming incidents of infections have been observed despite efforts by the UN body
to have the disease under control. One such case is Cebu City.