As a Kandal village braces for an investigation into a cluster of HIV cases, the US Centers for Disease Control on Friday published a new report on the now-infamous HIV outbreak in Battambang’s Roka commune, pointing to high demand for medical injections and a lack of training as risk factors the government should address.

Between December 2014 and February 2015, the National Centre for HIV, AIDS, Dermatology and STDs recorded 242 HIV infections among nearly 8,900 Roka commune residents – with even more cases detected later. The re-use of tainted needles by an unlicensed doctor was ultimately blamed.

“A majority of the confirmed cases in this outbreak were from a population not associated with commercial sex work, men who have sex with men [MSM], or injection drug use, the primary risk factors driving Cambodia’s HIV epidemic,” according to the CDC.

Despite progress in reducing HIV among these usual at-risk populations, the report says, the Roka “outbreak highlights the risk for HIV transmission in the general population through unsafe medical injections”.

While the government’s response to the Roka commune outbreak included initiatives to encourage safe injection practices and a purported crackdown on unlicensed medical practitioners, the report says “measures to reduce the demand for unnecessary medical injections and the provision of unsafe injections are needed”.

While a causal relationship between unsafe medical injections and HIV infection could not be established by the authors of the report, a clear association exists – which is noteworthy as “demand for medical injections among Cambodian adults is high, averaging 2.6 injections per person” yearly compared with 1.5 in neighbouring Vietnam.

Mey Sovannara, policy and advocacy manager for the Cambodian People Living with HIV Network, agreed that “it’s the government’s responsibility” to promote safe practices, although he said authorities should not “kick out” unlicensed practitioners, but instead provide them training.

Unlicensed doctor Yem Chroeum was sentenced to 25 years’ imprisonment in December in connection with the Roka outbreak. Sovannara, however, said he blamed “no one”, as Chroeum was the only practitioner available at the time.