In 1993-1996, serological tests for HIV were performed comprising seamen, fishermen, people travelling abroad, drug addicts,

patients of National Health Service Hospitals, health workers and other groups of people from the Gdaosk Region. HIV-antibodies were determined by means of immunoezymatic method ELISA, using Abbot's test recombinant HIV1/HIV2 third generation. Positive results were verified with the aid of the specific confirmation test Western blot. All in all there were 34,911 tests made and in 40 patients (0.11%) HIV-antibodies were revealed. In the group of seafarers made of 26,988 people HIV-antibodies were detected in 14 men (0.05%): 11 seamen and 3 deep-sea fishermen. The group of people travelling abroad consisted of 4269 subjects, and out them 6 men (0.18%) and one woman (0.12%) were seropositive. Out of 137 people from the group of risk-drug addicts taking narcotics intravenously-8 men (8%) and one women (2.7%) were infected. In the group of 2442 National Health Service patients, HIV-antibodies were noted in 5 men (0.31%) and one women (0.12%). Out of 172 health service workers examined nobody was infected. The group defined as "other subjects", was composed of 703 men, out which 2 were seropositive (0.28%) and 200 women-2 of them had HIV-antibodies (1.0%). The majority of seropositive subjects were men, 35 of them; there were 5 seropositive women.pp.30

Review of Related Literature

This chapter of the research presents some reviews made from previous researches and other literature that is related to the main problem of the study which is to find out the reason why most call center agents are prone to acquiring HIV/AIDS. Included in this part of the research is a brief history of the HIV/AIDS and methods of transfer of the virus. Also presented are some facts about the call center industry and what a call center agents life is. This chapter ends with the summary of the literature review. Even before HIV/AIDS became a threat to humankind, it had been an infectious disease that have affected animals, specifically the apes (Jones, 2009). Based on a study conducted by Bette Korber of Santa Fe Institute, HIV or Human Immunodeficiency Virus was proven to have started in small African communities where people were alleged to have some kind of relationship to chimps (chimpanzees). It was believed that the virus started from a chimpanzee retrovirus that has infected people. It then mutated inside the human body and later turned out to become HIV (par. 3). The said virus is believed to be the causative agent of AIDS or Acquired Immunodeficiency Syndrome. Cases of HIV infections have been present in the last years and has become a worldwide epidemic (Aronstein and Thompson, 1998). Today, millions are suffering from HIV/AIDS all over the world and majority of this number is situated in the small communities in Africa. In African communities, they have this so called sex markets where anyone can practice any kind of sexual activities with sex workers or simply known as prostitutes (Greenwood, Kircher, & Tertilt, 2009). The so called sex markets tolerate the spread of the HIV/AIDS because the sex workers there dont protect themselves by using condoms during intercourse. Having sexual

intercourse with a person infected with the virus creates a passageway for the virus to transfer to the other person. HIV/AIDS is believed to be spread through sexual contact. As mentioned in the preceding paragraph, the virus transfers from the carrier to the partner when a couple doesnt use condoms during an intercourse. Greenwood, Kircher, and Tertilt, (2009) reveal that A persons vulnerability in acquiring HIV/AIDS is somewhat based in his/her sexual history whether the person engages in safe sex or in an unprotected sex. (par. 3, p. 2). HIV/AIDS is one of the many Sexually Transmitted Diseases (STDs) that threaten the lives of many people around the world. STDs are diseases that are commonly spread by means of having sexual contact. But not all STDs can only be transmitted through sexual means. HIV/AIDS is an exception since there are other possible ways in which a person can be infected with HIV/AIDS without engaging in sex. HIV/AIDS can be passed by using contaminated needles of injected drugs, towels or beddings of a person infected with it, or by transmission through blood supplies or simply blood transfusion, from an infected mother to her unborn child in the womb, and a possible transmission form an HIV patient to his/her health worker (Nevid, 1998, pp. 29-36). Stine (1995) also said that aside from the methods of transfer mentioned above, HIV can also be transmitted through the semen, vaginal secretions, and any other fluids containing visible blood of the person infected with the virus. However, other fluids such as cerebrospinal, amniotic, and the like are not yet proven to cause such transmission of the virus. Dr. Bullecer, a known AIDS activist, pro-life, and the head of the AFP (AIDS Free Philippines) stressed that any person can be a victim of AIDS regardless whether the person has the capability to engage in sex because AIDS can be transmitted even with the absence of sex (Cena, 1999 par. 4, p.5). If an infected blood is transfused, the risk of acquiring HIV is extremely high with a percentage rate ranging from 90 to 100% (Lifson, 1992). According to Bregman (2004), the HIV/AIDS has taken the lives of more than 25 million people around the world for the last two decades and today, it is estimated that there are about 40 million people around the world that is positive with HIV (par. 2). The number of cases of Sexually Transmitted Diseases (STDs) caused by the spread of HIV/AIDS has coincidentally increased together with the rise of Business Process Outsourcing (BPO) companies in the country. According to Rene Soriano (1985), offshore outsourcing or offshoring was made possible by the Internet Communications Technology (ICT). Businesses, projects, tasks, and jobs are being transferred to virtual work across the world into countries where the costs are lower. Countries such as the India, China, Thailand, and of course, the Philippines are the top countries where BPO companies establish their businesses. BPO consists of four main categories: 1.) supply chain management; 2.) operations; 3.) business administration; and 4.) sales, marketing, and customer care. People who work in BPOs are termed as call center agents. A call center agents job is to answer telephone calls from other countries where their company is really based. Some of these countries belong to the Western part of the world such as the United States of America and Canada.

The calls which call center agents receive ranges from people asking questions about their computers and how to fix their Internet connection, people having problems with their credit or debit cards, people inquiring or even paying their telephone bills, and even booking their flights. Call center agents also handle business operations like marketing, selling and servicing through multiple channels of customer interaction such as electronic mail (e-mail), the World Wide Web (WWW), electronic messaging, voice messaging, fax messaging, and traditional mail (Alava, 2009). Call centers have different dynamics compared with other service-oriented industries. Call centers operate 24 hours a day, 7 days a week, catering to client companies by dealing with customer inquiries and complaints and they also follow the time zone of the country from where they receive the calls which makes the call center agents biological clock a little opposite to the normal body clock of non-call center agents. In addition to all the information above, call centers also function as sales arm of their various clients through telemarketing efforts as well as taking orders for deliveries (Grozman, 2005). Tasks assigned to call center front liners are very delicate that they must be courteous and pleasant to their callers no matter how their callers treat or call them. Thus, many call centers operate through teams, each dealing with a particular client company, to take advantage of the benefits that the team can provide to the organizations (par. 3, p. 97). As for the Philippines being the worlds third largest English speaking country, many college students and some even high school graduates become attracted to work in BPOs where salaries and other benefits are high. Filipinos have a higher advantage in terms of language skill compared to other countries in Asia. American English or simply English is slowly becoming a dominant lingua franca in sales and other transactions made in the country. And our way of speaking English is the easiest to understand in the whole of Asia according to Aileen S. Alava, Assistant Professor in the College of Business Administration in UP-Diliman (as cited in Sibal, 2006). With that, the Philippine Call Center Industry has grown 100% annually as compared to other countries like India, Thailand, Malaysia, and China and continues to grow up to this moment. The call center companies have set up not only in Metro Manila but also in other regional areas of the country such as Metro Cebu, Pampanga, Davao, and even in Baguio. The Philippine Economic Zone Authority (PEZA) recorded an investment of P854 million and the hiring of 3,802 call center workers in February 2006 (Bureau of Investments 2006 estimate). Convergys, the worlds largest contact center with 8,000 workers in the country at present, invested the biggest at P257 million. Ambergris Solutions Philippines Inc. came in next with P233.5 million investments and hired 650 Filipinos annually. Others included Sitel Customer Care Philippines Inc. at P196 million and 600 workers hired, People Support with P91 million, and Pacific Hub with P76 million (Nantes, 2004 par. 13). The Philippine government is giving more focus on BPO industries since it can attract more foreign investments. This is a part of the 2006 Investment Priorities Plan under former President Gloria Macapagal-Arroyos governance. This is also to ensure the sustainability of the Philippines competitive position in the global arena. According to the result of the health and wellness study to BPO workers conducted by the Call Center Association of the Philippines (CCAP), our government have disregarded the employees sexual and reproductive health. And so in order to act on the issue, our country passed the Philippine AIDS Prevention and Control Act in 1998 which called for the founding of the PNAC

(Philippine National AIDS Council), the countrys highest HIV/AIDS policymaking body, which developed the Philippines AIDS Medium Term Plan: 20052010. This act serves as a national road map toward universal access to prevention, treatment, care, and support, outlining country-specific targets, opportunities, and obstacles along the way, as well as culturally appropriate strategies to answer these issues regarding HIV/AIDS (Dela Cruz Tan, undated). Despite the existence of the said act, only 10% of Filipinos positive with the HIV are receiving these medical support from PNAC based on the data of UNAIDS in 2006 which means that until now, many people are suffering from HIV without even having something to relieve the pain. Also, the fact that many Filipinos are still unable to receive this medical support from the government means that the government still hasnt done much in order to answer the problems regarding HIV/AIDS. However, the continuing threat of HIV/AIDS to the Filipino community has not affected much the BPO industries in the country. Gayares and Romero (2010) stated in their article that the call center industry has started to boom causing many young professionals get attracted to work there. Fortunately, many major companies started to worry on the health conditions of their workers especially those working in BPOs where the work is usually graveyard shift. Most call center agents have unhealthy eating habits and get insufficient time of sleep; heavy drinkers and are current smokers. According to the YAFS (Young Adult Fertility and Sexuality) survey of Domingo and Marquez (1999), about two for every five adolescents have ever tried smoking; 21% were current smokers (90% of which were males) and 16.1% already quit the habit in 1994. Boys were more likely to smoke (40.3%) than girls (4.2%). Drinking was a more acceptable behavior than smoking with more than half of the youth having tried it. In the 1994 study, about 37% of those who tried smoking have not cut the habit while 32.8% were drinking occasionally and 17% already stopped. Data presented above only shows that many are inclined into smoking and drinking even at a young age here in the Philippines, and that it is not something to be surprised if call center agents, considering the stress they get from their work, are into smoking and drinking, too. Newmeyer (1989) also noted that the use of alcohol and illegal substances increases a persons vulnerability of acquiring HIV/AIDS in three ways: 1.) sharing hypodermic needles or other drug paraphernalia such as syringes with someone infected with HIV/AIDS; 2.) being intoxicated and losing inhibition against risky sex practices such as neglecting the use of condom during a drunken sexual encounter; and 3.) taking substances such as alcohol, cocaine, and other prohibited substances that can suppress a persons immune system and can cause the collapse of the helper T-cells in the body (pp. 108-117).

Also, according to Springer (1991), aside from being free from possible HIV/AIDS transmission, abstinence from drugs is a good way of keeping the cells in the body strong in order to be free from possible risks in the immune system. Michael Asterholm, (as cited in Ellis, 1989) Minneapolis States Epidemiologist and one of the Chief designers of the states AIDS program highlights the importance of education in reducing the risks of acquiring HIV/AIDS. He found out that it does not greatly produce a change on the high risk sexual behaviors. He cited a study by a Psychologist in San Francisco that the participants level of education about safe sex was extremely high at the start of the study and yet many well informed men had little or no change at all in their sex life (par. 4, pp. 8-9). This result shows that some of the participants or the respondents included in the study only showed interest during the beginning but in the end, the respondents didnt put their learning into practice. But in some cases, education about HIV/AIDS had been seen as a success especially with the homosexual community. After an education campaign organized by gay activists, gays increased their use of condoms, cut down pick-ups, and practiced less physically damaging sex (Ellis, 1989, p. 9). The success of AIDS prevention education may help prevent the spread of other communicable diseases by providing a model for personal and societal awareness, protective behavior, and life options. In the researches done on how high-risk heterosexuals respond to testing on AIDS and education, evidence suggests that while many do change, a surprising number do not. California State University at Hayward interviewed 40 whites, middle class women who were in danger of HIV infection or re-infection because their male sex partners, including bisexuals, drug users or hemophiliacs were already carrying the virus itself and the results showed the same (Ellis, 1989). With that, countries that are part of the United Nations (UN) have agreed to make an all-out action to lessen the spread of HIV/AIDS throughout the world. In some parts of Africa, mass media and social marketing, using popular culture, and especially popular youth culture are able to convey important information about how can people be protected from HIV/AIDS (Forman, 2003). Mass media campaigns use television, radio, Internet websites, online discussion groups, print media, and school and other youth based education for maximum effect in order to spread the word and other information on how to avoid being infected with HIV/AIDS. There have been studies conducted that aims to take a look into the health aspects of BPO workers in the country. In a study conducted by the Department of Health (DOH) and the University of the Philippines Population Institute (UPPI), call center agents in Metro Cebu tend to involve themselves in risky sexual behavior due to environmental and peer pressure (Baguio, 2010). According to Dr. Crisol Tabajero, Health Information and Research Coordinator of Department of Health Region 7 (as cited in Baguio, 2010, par. 3), the results of the study regarding call center agents arent that surprising but the number of cases are alarming. Also, more call center agents not just in Metro Cebu are into casual sex and sex with the same sex (men-to-men). But in an article by Dela Cruz Tan (undated), it was stated that most BPO workers tend to have sex only with a fellow BPO worker in order to ensure that the virus gets isolated in the industry only. A BPO worker confessed in a forum conducted by Planet Romeo Foundation that, because of the stressful

environment in the call center industry, they engage in sex as a form of relaxation. These are the reasons why call center agents are most vulnerable to HIV/AIDS (Dela Cruz Tan, undated, par. 11). And so in order to come up with better ideas for this research that focuses on the relationship between the call center agents and their vulnerability of acquiring HIV/AIDS, we ensured that we fully understood the nature of HIV/AIDS and the concept of being a call center agent. As Reyna (2001) quoted in her research about HIV/AIDS, In determining the behavior of the respondents, a researcher must ask the respondent on their sexual practices and also their STD prevention practices. (pp. 4-9). With the fast growth of call center industries in the country, it is a good thing that these businesses help our economy grow and encourages infrastructure development in major cities and also in rural areas. Not only does these industries boost the economy but also gives jobs to thousands of Filipinos in the country. Although HIV/AIDS is continuously spreading throughout the world, there are still many ways in which we can protect ourselves from acquiring HIV/AIDS.

Mann, J., D. Tarantola, and T. Netter. 1992. AIDS in the World. Cambridge, MA: Harvard University Press.pp. 415-434 Schenker, Inon. 2001. "New Challenges for School AIDS Education within an Evolving HIV Pandemic."Prospects 31, no 3: 415-434. Schenker, Inon, G. Sabar-Friedman, and S. S. Sy. 1996. AIDS EducationInterventions in MultiCultural Societies. New York: Plenum Press.pp.415-434 World Bank. 2002. Education and HIV/AIDS: A Window of Hope. Washington, DC: World Bank.pp. 415-434

AIDS in the World The number of people receiving antiretroviral therapy (ART) is increasing, with over 665 million patients in middle-income and low-income countries receiving treatment at the end of 2010. In the same year, nearly a half of pregnant women living with the HIV received prophylaxis to prevent mother-to-child transmission of HIV. Being on treatment has an impact on prevention as well. In sub-Saharan Africa, clinical trials have shown that if an HIV-positive person receives ART the risk of transmitting the virus to a partner is cut by 96%. Increased access to HIV-care services resulted in a reduction of new infections from 31 million in 2001 to 27 million in 2010, and a 22% decline in AIDS-related deaths in the past 5 years. Despite the promising data contained in the report, funding for HIV/AIDS care is a concern. At their meeting on Nov 2122 in Accra, Ghana, the board of the Global Fund to Fight AIDS, Tuberculosis and Malaria decided to cut its present round of funding and to postpone funding for new projects

until at least 2014. The move was prompted by a lack of financial support from donors and has caused dismay around the world. The Global Fund has established a transitional funding mechanism to provide emergency relief to current recipients who will run out of money before 2014. However, this will not allow countries to scale up their interventions to improve HIV care. Reduced funding will mean less support for HIV/AIDS support programmes and put at risk the goal of universal access to treatment by 2015. At the end of 2010, the total amount of money made available by both International agencies and domestic funding bodies for HIV was US$15 billion. But international assistance for HIV care declined from $87 billion in 2009 to $76 billion in 2010. Economic uncertainty threatens the future of people who still do not have access to treatment, many of whom do not even know that they are infected with HIV. Social and political marginalisation of certain groups means that programmes to reach them might be most at risk in the face of funding cuts, but in many cases these groups are now the stronghold of the epidemic and key in the fight against it. Particularly vulnerable groups include adolescent girls, people who inject drugs, men who have sex with men, transgender people, sex workers, prisoners, and migrants. For example, in eastern Europe ART coverage is low at 23%, and the most affected peoplethose who inject drugsare most likely to be unable to access care. The amount of money invested in the AIDS response from donor countries has fallen by 10% in 2010. Therefore, all countries must figure out how best to provide intervention with decreasing available funds. UNAIDS has recently established an investment framework with the intention to better manage national and international responses to HIV. The aim is to show that money sensibly invested and well spent can have a huge effect by reducing new infections and keeping people alive. This framework can be used by countries to refine current national programmes. Countries such as Brazil and Cambodia have looked at their own budgets and revised their current programmes. Other countries are encouraged to use the investment framework to revise their national efforts. Even with the optimisation approach suggested by the framework, investments needed to achieve and maintain universal accesss to ART would continue to rise, peaking at $2224 billion in 2015, but this investment would avert 122 million new HIV infections, including 19 million infections among children, and 74 million AIDS-related deaths between 2011 and 2020. The 2011 HIV/AIDS report shows successes in the HIV response. But after years of international investment, just when we seem to have the right technologies, drugs, and approaches to keep the epidemic under control, success hangs in the balance. Universal access to treatment by 2015 is certainly an ambitious goal, but a realistic one if donor governments can maintain their commitment and if recipient nations adopt strategic and sustainable approaches in their HIV/AIDS programmes. Money well spent today means less money spent tomorrow.

'The role of drugs in the origin of AIDS' foreign: It is proposed that the new American and European AIDS epidemics are caused by recreational and anti-HIV drugs rather than by human immunodeficiency virus (HIV). Chronologically, the AIDS epidemic in the 1980s followed a massive escalation in the consumption of recreational drugs that started in the 1960s and 70s. Epidemiologically, both epidemics derive about 80 % of their victims from the same groups of 20-44 year-olds, of which 90 % are males. In America 32% of these are intravenous drug users and an unknown percentage are prescribed the cytotoxic DNA chain terminator AZT, as inhibitor of aids. Direct evidence indicates that these drugs are necessary for HIVpositives and sufficient for HIV-negatives to develop AIDS diseases. The drug-AIDS hypothesis predicts correctly that: (i) AIDS is new in the US, because the drug epidemic is new, while the HIV epidemic is old -- fixed at a constant 1 million Americans since 1985; (ii) despite an increase in venereal diseases, AIDS remains restricted to long-term drug users and small groups with clinical deficiencies; (iii) over 72 % of AIDS occurs in 20-44 year old males, because they make up over 80% of hard psychoactive drug use; (iv) distinct AIDS diseases correlate with the use of distinct drugs, eg Kaposi's sarcoma with nitrite inhalants, tuberculosis with intravenous drugs, and leukopenia, anemia, and nausea with AZT; (v) AIDS diseases are only acquired after long-term drug consumption, rather than after single contacts as the virus-hypothesis predicts. The drug hypothesis can be tested epidemiologically and experimentally in animals. It predicts that most AIDS can be prevented by stopping the consumption of drugs, and provides a rational basis for therapy. AIDS epidemiology: Inconsistencies with human immunodeficiency virus and with infectious disease AIDS is a newly defined syndrome of 25 old parasitic neoplastic, and noninfectious diseases, including in the United States 53% pneumonia, 19% wasting disease 13% candidiasis, 11% Kaposi sarcoma, 6% dementia, 3% lymphoma and 2% tuberculosis (1). These unrelated diseases are grouped together because they are all thought to be indicators of an acquired immunodeficiency (2). In America AIDS is almost completely restricted (91%) to males (1). About 90% of all AIDS patients are 20- to 40-year-olds, 30% are intravenous drugs users and their children, 60% are male homosexuals and some heterosexuals who frequently use oral psychoactive drugs (3-7), and 7% are hemophiliacs and other recipients of transfusions (1). As of 1982, the Centers for Disease Control (CDC) considered AIDS infectious because it appeared to be transmitted among intravenous drug users and homosexuals by sexual contact or by contaminated blood (8). Among infectious agents, cytomegalovirus and various bacteria were proposed as causes of AIDS (6, 8,10). In 1983 Montagnier and coworkers (11) suggested lymphadenopathy-associated virus [now termed human immunodeiiciency virus (HIV)] and Gallo et al (12) human T-cell leukemia virus (HTLV) as causes of AIDS. However, psychoactive drugs, like aphrodisiac nitrite inhalants ("poppers"), were also proposed as causes for Kaposi sarcoma and pneumonia in homosexuals (3-7, 9). In April 1984 the Secretary of Health and Human Services announced that HIV was the cause of AIDS, and an antibody test for HIV, termed the AIDS test, was registered as a patent by Gallo and collaborators (13-15). This happened before even one American study on HIV had been published (13). According to this view HIV is a lymphotropic retrovirus that is sexually transmitted (16-20). On

average 10-11 years after infection and appearance of neutralizing antibodies, HIV is postulated to cause immunodeficiency by killing billions of T cells (16-21). Only then, indicator diseases are said to develop from which patients die on average within 1 year (21-26). Thus HIV became the first virus for which a positive antibody test is interpreted as an indicator for primary diseases that have yet to come. Antibodies against conventional viruses typically signal protection against disease and those against some persistent viruses also signal a small risk of secondary disease upon virus reactivation (27, 28). Although no retrovirus has ever been shown to be pathogenic in humans (29), HIV is thought to be 50-100% fatal, more than any other human virus (16-21). The novelty of AIDS is postulated to reflect the novelty of HIV. The large variety of indicator diseases are postulated to reflect underlying immunodeficiency and the almost exclusive concentration of AIDS in 20- to 40year-olds (1) is postulated to reflect sexual or parenteral transmission of HIV (16-20). This virus-AlDS hypothesis was accepted by most medical scientists, in particular virologists, by 1986 (16-18, 30). Accordingly, the virus was named HIV by an international committee of retrovirologists (30) and became the only basis for the definition of AIDS: "Regardless of the presence of other causes of immunodeficiency in the presence of laboratory evidence for HIV any disease listed . . . indicates a diagnosis of AIDS" (2). AIDS is now diagnosed whenever antibody to HIV is detectable along with any of the 25 indicator diseases, even if no immunodeficiency or opportunistic infections are detected as in cases of Kaposi sarcoma. lymphoma, dementia and wasting syndrome (2,18, 23-26 31). Moreover, infection in the absence of any clinical symptoms is now termed, and often treated as, "HIV disease" (18). However all efforts directed by the virus-AlDS hypothesis for over 2 billion dollars annually, have failed to contain or cure AIDS (32 33).