Ateneo de Manila Graduate School of Business

Masters in Business Administration – Standard

MANSCI Management Science G16

Case Research on the Increasing Number
of HIV Cases in the Philippines

March 12, 2011

Submitted To:
Sir Rene Aguila

Submitted By:
Alsim, Patrick
Igot, Sarah
Rivera, Paulo
Sadeghi, Sanaz
 Table of Contents

I. INTRODUCTION

II. HISTORY OF HIV IN THE PHILIPPINES

A. Statistics from January 2008 to December 2010

B. Articles examined related to the issue
C. Summary of the challenges in containing the issue

III. FORECASTING
A. Forecasting of HIV cases for January to December 2011
based on 2010 data
B. Conclusion about the numbers

IV. PROPOSED SOLUTIONS

A. Challenges for the society in general
B. Challengers for the government (DOH)
C. Challenges for AGSB faculty and students

V. REFERENCES
Introduction

This is a case research that will employ the management science concept of forecasting in determining
the possible number of reported cases for 2011. The Mulat Diwa element of this paper is in proposing
solutions to curb the increasing number of HIV/AIDS victims in the Philippines; it aims to help society
understand the available solutions such as the Reproductive Health Bill being passed as well as natural
methods being prescribed by the Catholic church.

The following is a working definition of HIV and AIDS from the World Health Organization (HIV/AIDS
2011):

The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system,
destroying or impairing their function. As the infection progresses, the immune system becomes weaker,
and the person becomes more susceptible to infections.

The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). It can take 10-
15 years for an HIV-infected person to develop AIDS; antiretroviral drugs can slow down the process even
further.

HIV is transmitted through unprotected sexual intercourse (anal or vaginal), transfusion of contaminated
blood, sharing of contaminated needles, and between a mother and her infant during pregnancy,
childbirth and breastfeeding.

HIV and AIDS in the Philippines

On December 2010, the Department of Health reported a total of 174 cases of HIV in the Philippines.
This alarming number is the highest since DOH started tracking the number of victims back in 1984. It
also brings the number of infections since 1984 past the 6,000-person mark (Aning 2011).

In a study conducted by 2008 Secretary of Health and Chair Hon. Secretary Francisco T. Duque III, MD,
MSc., one of the reasons for the surge in reported cases of HIV low condom use in heterosexual men
aged 15 to 24; the study revealed only 13.5% of this population used condoms. And it is with high-risk
groups that the incidence of AIDS is high; these groups include men who have sex with men (MSM),
prostitutes and their clients, overseas Filipino workers and injecting drug users (IDUs).
According to current Health Secretary Esperanza Cabral, at the rate of the increase of HIV cases since
2009, 30,000 Filipinos will be infected with HIV/AIDS by 2012 with most of the infected being as young
as 25 to 29 years old.

HISTORY OF HIV IN THE PHILIPPINES

The following chart from the Philippine HIV and AIDS Registry of DOH's National Epidemiology Center
describing the increase of Filipinos infected with HIV/AIDS from year 2008 to 2010:
The latest available AIDS registry report from the National Epidemiology center is that for December
2010; and in the graph below, it can be seen that majority of the infected are aged 25 to 34:

Interesting to review as well are the modes of transmitting the virus. From 2008 to 2010, we see no
reported cases for needle pricks and blood transfusion; we see the there is a rise of the infected via
homosexual and heterosexual contact.
Articles Examined Related to the Issue

Below is an article by Edcel Lagman, a proponent of the Reproductive Health bill and a representative of
the Catholic church. Edcel Lagman’s article was chosen because it discusses how the government will
proceed with preventing and managing sexually transmitted diseases including AIDS/HIV through the
Reproductive Health Bill.

To provide the arguments being raised against the Reproductive Health Bill, an article written by
Santosh Digal from CBCP on the perspective of Lingayen-Dagupan Archbishop Oscar Cruz was also
included. This in turn discusses the moral implications of passing the bill.

Reproductive health bill: Facts, fallacies

By Rep. Edcel Lagman

Philippine Daily Inquirer

THE BILL IS NATIONAL IN SCOPE, COMPREHENSIVE, rights-based and provides adequate funding
to the population program. It is a departure from the present setup in which the provision for
reproductive health services is devolved to local government units, and consequently, subjected
to the varying strategies of local government executives and suffers from a dearth of funding.

The reproductive health (RH) bill promotes information on and access to both natural and
modern family planning methods, which are medically safe and legally permissible. It assures an
enabling environment where women and couples have the freedom of informed choice on the
mode of family planning they want to adopt based on their needs, personal convictions and
religious beliefs.

The bill does not have any bias for or against either natural or modern family planning. Both
modes are contraceptive methods. Their common purpose is to prevent unwanted pregnancies.

The bill will promote sustainable human development. The UN stated in 2002 that “family
planning and reproductive health are essential to reducing poverty.” The Unicef also asserts that
“family planning could bring more benefits to more people at less cost than any other single
technology now available to the human race.”

Coverage of RH. (1) Information and access to natural and modern family planning (2) Maternal,
infant and child health and nutrition (3) Promotion of breast feeding (4) Prevention of abortion
and management of post-abortion complications (5) Adolescent and youth health (6) Prevention
and management of reproductive tract infections, HIV/AIDS and STDs (7) Elimination of violence
against women (8) Counseling on sexuality and sexual and reproductive health (9) Treatment of
breast and reproductive tract cancers (10) Male involvement and participation in RH; (11)
Prevention and treatment of infertility and (12) RH education for the youth.

Strengthening of Popcom. The existing Population Commission shall be reoriented to promote

both natural and modern family planning methods. It shall serve as the central planning,
coordinating, implementing and monitoring body for the comprehensive and integrated policy
on reproductive health and population development.

Capability building of community-based volunteer workers. The workers shall undergo

additional and updated training on the delivery of reproductive healthcare services and shall
receive not less than 10-percent increase in honoraria upon successful completion of training.

Midwives for skilled birth attendance. Every city and municipality shall endeavor to employ an
adequate number of midwives and other skilled attendants.

Emergency obstetrics care. Each province and city shall endeavor to ensure the establishment
and operation of hospitals with adequate and qualified personnel that provide emergency
obstetrics care.

Hospital-based family planning. Family planning methods requiring hospital services like ligation,
vasectomy and IUD insertion shall be available in all national and local government hospitals.

Contraceptives as essential medicines. Reproductive health products shall be considered

essential medicines and supplies and shall form part of the National Drug Formulary considering
that family planning reduces the incidence of maternal and infant mortality.

Reproductive health education. RH education in an age-appropriate manner shall be taught by

adequately trained teachers from Grade 5 to 4th year high school. As proposed in the bill, core
subjects include responsible parenthood, natural and modern family planning, proscription and
hazards of abortion, reproductive health and sexual rights, abstinence before marriage, and
responsible sexuality.

Certificate of compliance. No marriage license shall be issued by the Local Civil Registrar unless
the applicants present a Certificate of Compliance issued for free by the local Family Planning
Office. The document should certify that they had duly received adequate instructions and
information on family planning, responsible parenthood, breast feeding and infant nutrition.

Ideal family size. The State shall encourage two children as the ideal family size. This is neither
mandatory nor compulsory and no punitive action may be imposed on couples having more
than two children.

Employers’ responsibilities. Employers shall respect the reproductive health rights of all their
workers. Women shall not be discriminated against in the matter of hiring, regularization of
employment status or selection for retrenchment. Employers shall provide free reproductive
health services and commodities to workers, whether unionized or unorganized.
Multimedia campaign. Popcom shall initiate and sustain an intensified nationwide multimedia
campaign to raise the level of public awareness on the urgent need to protect and promote
reproductive health and rights.

THERE IS A CONTINUING campaign to discredit the reproductive health bill through

misinformation. Straightforward answers to the negative propaganda will help educate and
enlighten people on the measure.

The bill is not antilife. It is proquality life. It will ensure that children will be blessings for their
parents since their births are planned and wanted. It will empower couples with the information
and opportunity to plan and space their children. This will not only strengthen the family as a
unit but also optimize care for children who will have more opportunities to be educated,
healthy and productive.

The bill does not interfere with family life. In fact, it enhances family life. The family is more than
a natural nucleus; it is a social institution whose protection and development are impressed
with public interest. It is not untouchable by legislation. For this reason, the State has enacted
the Civil Code on family relations, the Family Code, and the Child and Youth Welfare Code.

The bill does not legalize abortion. It expressly provides that “abortion remains a crime” and
“prevention of abortion” is essential to fully implement the Reproductive Health Care Program.
While “management of post-abortion complications” is provided, this is not to condone
abortion but to promote the humane treatment of women in life-threatening situations.

It will not lead to the legalization of abortion. It is not true that all countries where
contraceptive use is promoted eventually legalize abortion. Many Catholic countries criminalize
abortion even as they vigorously promote contraceptive use like Mexico, Panama, Guatemala,
Brazil, Chile, Colombia, Dominican Republic, El Salvador, Honduras, Nicaragua, Venezuela,
Paraguay and Ireland. The Muslim and Buddhist countries of Indonesia and Laos also promote
contraceptive use yet proscribe abortion. According to studies, correct and regular use of
contraceptives reduces abortion rates by as much as 85 percent and negates the need to
legalize abortion.

Contraceptives do not have life-threatening side effects. Medical and scientific evidence shows
that all the possible medical risks connected with contraceptives are infinitely lower than the
risks of an actual pregnancy and everyday activities. The risk of dying within a year of riding a car
is 1 in 5,900. The risk of dying within a year of using pills is 1 in 200,000. The risk of dying from a
vasectomy is 1 in 1 million and the risk of dying from using an IUD is 1 in 10 million. The
probability of dying from condom use is absolutely zero. But the risk of dying from a pregnancy
is 1 in 10,000.

The bill will not promote contraceptive mentality. The bill does not prohibit pregnancy. Critics
are mistaken in claiming that because contraceptives would be readily available, people would
prefer to have no children at all. Couples will not stop wanting children simply because
contraceptives are available. Contraceptives are used to prevent unwanted pregnancies but not
to stop pregnancies altogether. Timed pregnancies are assured.
The bill does not impose a two-child policy. It does not promote a compulsory policy strictly
limiting a family to two children and no punitive action shall be imposed on parents with more
than two children. This number is not an imposition or is it arbitrary because results of the 2003
National Demographic and Health Survey show that the ideal of two children approximates the
desired fertility of women.

Sexuality education will neither spawn “a generation of sex maniacs” nor breed a culture of
promiscuity. Age-appropriate RH education promotes correct sexual values. It will not only instill
consciousness of freedom of choice but also responsible exercise of one’s rights. The UN and
countries which have youth sexuality education document its beneficial results: understanding
of proper sexual values is promoted; early initiation into sexual relations is delayed; abstinence
before marriage is encouraged; multiple-sex partners is avoided; and spread of sexually
transmitted diseases is prevented.

It does not claim that family planning is the panacea for poverty. It simply recognizes the
verifiable link between a huge population and poverty. Unbridled population growth stunts
socioeconomic development and aggravates poverty. The connection between population and
development is well-documented and empirically established.

UN Human Development Reports show that countries with higher population growth invariably
score lower in human development. The Asian Development Bank in 2004 also listed a large
population as one of the major causes of poverty in the country.

The National Statistics Office affirms that large families are prone to poverty with 57.3 percent
of families with seven children mired in poverty while only 23.8 percent of families with two
children are poor. Recent studies also show that large family size is a significant factor in keeping
families poor across generations.

Family planning will not lead to a demographic winter. UP economics professors in their paper
“Population and Poverty: The Real Score” declared that the threat of a so-called demographic
winter in the Philippines is “greatly exaggerated, and using it as an argument against a sensible
population policy is a plain and simple scare tactic.”

The National Statistical Coordinating Board projected that a replacement fertility of 2.1 children
per couple could be reached only by 2040. Moreover, despite a reduced population growth rate,
the effects of population momentum would continue for another 60 years by which time our
total population would be 240 million.

Humanae Vitae is not an infallible doctrine. In 1963, Pope John XXIII created the Papal
Commission on Birth Control to study questions on population and family planning. The
Commission included ranking prelates and theologians.

Voting 69 to 10, it strongly recommended that the Church change its teaching on contraception
as it concluded that “the regulation of conception appears necessary for many couples who wish
to achieve a responsible, open and reasonable parenthood in today’s circumstances.”
However, it was the minority report that Pope Paul VI eventually supported and which became
the basis of Humanae Vitae.

Even 40 years ago when the encyclical was issued, theologians did not generally think that it was
infallible. Monsignor Fernando Lambruschini, spokesperson of the Vatican at the time of its
release, said “attentive reading of the encyclical Humanae Vitae does not suggest the
theological note of infallibility… It is not infallible.”

Five days after the issuance of the encyclical, a statement against it was signed by 87 Catholic
theologians. It asserted that “Catholics may dissent from … noninfallible Church doctrine” and
that “Catholic spouses could responsibly decide in some circumstances to use artificial
contraception.”

Reproductive Health Bill to ruin people’s health, warns Archbishop Cruz

By Santosh Digal, CBCP Communication

MANILA, September 11, 2008—The controversial Reproductive Health Bill 5043 will ruin the
health of the people, said Lingayen-Dagupan Archbishop Oscar Cruz.

“The bill will lead to the implementation of an immoral policy—a proposed synthetic artificial
contraceptives eventually designed to ruin health as it slants the idea of responsible parenthood
to issues of depopulation, which proponents claim will result to progress among
underdeveloped countries like ours,” he said.

The lawmakers are to start the plenary debates next week with Albay Representative Edcel
Lagman, the bill’s principal author and sponsor supported by others.

“The multi-national companies manufacturing contraceptive drugs and devices must be looking
forward to the passage of the bill. This is apparently because such approval will see for
themselves a brisk sale of their products, a joyful raking in of profits,” said Cruz, a professor of
Canon Law said.

It is rather hard to ascertain that big corporations really consider the welfare of the poor.
“Neither are they really motivated by their desire to promote national development, nor are
they fundamentally concerned with the health of people. Instead, it is ‘business as usual’ which
at times can be gross and cruel,” he said.

The bill is immoral, he stressed saying, “No human act, no legislative bill, no executive function,
no judicial work is over and above morality. Morality is neither irrelevant in politics, not
indifferent in a secular society. Irrespective of the race, color and creed of those concerned, the
moment individuals fool around with private morals, the moment the government disregard
public morals, then the families and country are in big trouble respectively. This is the standing
lesson of history.”

The bill promotes use of contraceptives that are contrary to Catholic Church’s teaching. Church
authorities across the nation are spearheading advocacy movement against the passage of the
bill. According to them, the bill that allows contraceptives will necessarily entails abortion.
 “Contraception and abortion are intimate partners to the extent of being twins at times—
notwithstanding all convictions, pretensions and arguments to the contrary,” Cruz warned.

“What is the use of mandating a contraception bill when abortion is already prevalent? Can the
pro-contraception bill actually eradicate abortion?” he asked.

He said that it is a matter of bemoaned fact abortions in the country come in hideous form.
“This is why fetuses are disturbingly found here and there, some of them shamefully thrown at
garbage dumps or simply left behind in different unlikely places.”

The bill entitled, “An Act providing for a National Policy on Reproductive Health, Responsible
Parenthood and Population Development, and for other Purposes,” is intrinsically harmful to
life, family and society, Cruz said earlier.

The bill that claims to control population is a myth, the prelate said. “But no matter how ‘safe’
or ‘protective’ artificial contraceptive drugs and devises are advertised, every thing is altogether
false nor reasonable,” Cruz stressed.

The Church also plans to gather a million signatures against the reproductive health bill and
present them to Congress.

Summary of challenges in containing the issue

The Reproductive Health Bill aims to aid in managing and preventing AIDS by legislation. The challenge
with enacting the bill is the opposition being encountered from the Catholic church which argues that it
majority of the resolutions are reactive and does not target immorality as the problem to be resolved.

The implication of the arguments of the Catholic church is the solution lies with increased moral
awareness of Filipinos when it comes to sexual acts. The challenge with implementing this solution is
implementing values education and finding a way to reinforce a moral conscience.
FORECASTING

The following table is a consolidation of the monthly reported cases of HIV in the Philippines from 2008
to 2010. These are the data that will be used in forecasting the number of reported cases from January
to December 2011. The data will also be used in creating additional models for forecasting.

HIV REPORTED CASES IN THE PHILIPPINES

The succeeding graphs reflect the upward trend in the number of reported cases of HIV from year 2008
to 2010.
 200

150
Y 2008
100 Y 2009
Y 2010
50

0
1 2 3 4 5 6 7 8 9 10 11 12

Averaging the number of AIDS cases, the same trend is observed:

 HIV Reported Cases in the Philippines
200

150

100

50

0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2008 2009 2010 average

Using a 3-month moving average as a method for forecasting the reported number of HIV cases results
in the following forecast:
This is a graphical representation of the forecast using a 3-month moving average:

AIDS Forecasted Monthly Cases for 2011

200
180
160
140
120
100
80
60
40
20
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2010 2011

Additional Models for Forecasting

Performing a Polynomial, 6th order, trend line analysis from the reported number of HIV cases from
January 2008 to December 2010 produces the following model for forecasting the reported number of
HIV cases from January to December 2011:

y = 1E-05x6 - 0.0016x5 + 0.0634x4 - 1.1867x3 + 10.548x2 - 38.76x + 82.547

200

180

160

140

120

100
R² = 0.8538 Series1
80

60

40

20

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
Performing Power trend line analysis from the reported number of HIV cases from January 2008 to
December 2010 on the other hand results to the following model for forecasting the reported number
of HIV cases from January to December 2011:

y = 22.024x0.4466

200
180
160
140
120
100
R² = 0.5651 Series1
80
60
40
20
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35

Using an exponential regression in turn produces the following model for forecasting the reported
number of HIV cases from January to December 2011:

y = 32.722e0.0428x

200
180
160
140
120
100
Series1
R² = 0.769
80
60
40
20
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35
Finally, if we use a linear trend line analysis to model the forecast for January 2011 to December 2011,
the following model is produced:

y = 3.4175x + 18.832

200

180

160

140

120

100
R² = 0.7327 Series1
80

60

40

20

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35

On root mean square alone, the most accurate model for forecasting is that produced using a
Polynomial 6th order with a value of 0.8538being the closest value to 1, the more accurate the
forecasting model is.

Conclusion About the Numbers

Using the models for forecasting the number of reported cases of HIV in the Philippines projects an
upward trend for 2011. The government, Philippine society and the Catholic church need to find a
solution to the issue; whether it be by sex education, legislative measures or strengthening the morals
of Filipinos by reinforcing positive values towards sex.
Proposed Solution

Eversince it's outbreak in the 1980s, efforts had been made in addressing the problem of HIV and AIDS.
In the Philippines, the Philippine National AIDS Council (PNAC) was created in 1992 by Executive order
No. 39 as an advisory body to the office of the President on all matters related to AIDS. It was
reconstituted by virtue of Republic ACt 8504 as the central advisory, planning and policy making body on
the prevention and control of HIV and AIDS in the country. Moreover, the only current means of
stopping the epidemic is the use of condoms. Studies have shown that if a latex condom is used
correctly every time you have sex, this is highly effective in providing protection against HIV. In fact, the
use of condom is very much emphasized during AIDS awareness events. The majority of HIV infections
are acquired through unprotected sexual relations between partners, one of whom has HIV. The primary
mode of HIV infection worldwide is through sexual contact between members of the opposite sex. The
best evidence to date indicates that typical condom use reduces the risk of heterosexual HIV
transmission by approximately 80% over the long-term, though the benefit is likely to be higher if
condoms are used correctly on every occasion. However, the topic of religion and AIDS has become
highly controversial in the past twenty years, primarily because many prominent religious leaders have
publicly declared their opposition to the use of condoms and contraception. In the Philippines, both the
Deparment of Education's Sex Education Plan and the Reproductive Health bill had been debatable.
Religious and academic institutions, experts, and major political figures both support and oppose to it
has led to criticizing the government and each other in the process.

Moreover, recent reports from Unicef country representative to the Philippines Vanessa J. Tobin
revealed that HIV/AIDs infection has “an adolescent face” in the Philippines that about 1.4 million
Filipinos aged 15-24 are now infected with the dreaded disease. Due to the recent report of the
Department of Health that the HIV infections in the Philippines are “increasing at an alarming rate”
especially among adolescents; dubbed as “educational emergency,” the Department of Education plans
to take more proactive steps to intensify the information and education campaign among students
against the dreaded virus. However, the DepEd does not affirm that this is leading the the Sex
Education Plan. More than that, the Reprductive Health bill is also seen as beneficial to fight HIV.
Recently, the congress is bent on pushing Reproductive Health Bill. Nonetheless, opponent of the RH bill
advocate, Davao City Rep. Karlo Alexei Nograles, believes that the measure "creates more dangers than
solutions." He argued that it is "the wrong way to spend public money" and "gives undue partiality and
advantage to contraceptive manufacturers." Further, the Catholic church remains in opposion as well.
In 2008, Ateneo de Manila professors were headliners when they supported the RH Bill but the Ateneo
de Manila, as a Jesuit and Catholic University, stands with the Catholic Bishops Conference of the
Philippines and the Philippine Province of the Society of Jesus,” as clarified by the University President
Nebres. He further explained that “there are certain positions and provisions in the bill which are
incompatible with principles and specific positions of moral teaching which the Catholic Church has held
and continues to hold.”

The efforts of this case research in applying the qualitative tools of forecasting and simulation aims to
predict and provide a number of victims that the Filipino society could possibly face vis-a-vis AIDs and
HIV in the next year or even in the next 10 years. The information is a vital supplemantary of how
important it is to address the problem of AIDs and HIV as soon as possible before it becomes more than
what it already is. Moreover, this study neither supports nor oppose the Sex Education Plan and the
Reproductive Health Bill. Nonetheless, the numbers given also shows that the Philippines incidence of
AIDs and HIV is not as much as other countries. Thus, it would like to encourage that more research be
made, for instance if the incidence of AIDs and HIV is contained only in a certain areas of the country or
to which social classes or age group the victims belong to. Once these are identified, then it would
proposes that it would be more economical and feasible to target these specific areas or social classes in
educating about HIV and AIDs.
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