The Ministry of Health, the World Health Organization and UNAIDS have released an update on their ongoing investigation into an HIV outbreak in Battambang’s Roka commune, saying that a preliminary enquiry does indeed point to tainted injections as the main source of transmission.

According to a joint statement dated January 9, UNAIDS, the WHO and the National Center for HIV/AIDS Dermatology and STDs (NCHADS) said that based on interviews conducted in the area, the percentage of people who reported having received intravenous injections as a part of medical treatment was “significantly higher” among those who had tested positive for HIV.

The statement also largely ruled out other modes of transmission, such as unprotected sex and intravenous drug use, as well as mother-to-child transmission. Most of the children who tested positive for HIV, the groups said, had HIV-negative mothers.

In the statement, Minister of Health Mam Bunheng said that steps were being taken to ensure that unsafe medical practices do not continue to result in HIV transmission.

“The Ministry of Health is ensuring health facilities follow universal precautions and use clean and sterile equipment, as well as working on raising awareness of safe injection practices and overall HIV prevention among the general public,” he said. “We have reinforced implementation of the MOH policy to stop unlicensed informal medical practices.”

While the medical investigation of the outbreak is still ongoing, criminal liability for the cluster of HIV cases has been laid at the feet of local unlicensed medical practitioner Yem Chroeum.

In late December, Chroeum was charged with murder, “intentionally” infecting his patients with HIV and operating an unlicensed clinic, though it remains unclear whether any of his patients actually died as a result of his treatment.

If found guilty, Chroeum could face life imprisonment.

Police singled out Chroeum early on as an inordinate amount of positive HIV infections began cropping up in the commune following the positive testing of an elderly man in November. Many of those who tested positive reported receiving injections from Chroeum, who reportedly confessed to reusing needles.

NCHADS director Mean Chhivun also said in an interview yesterday that most forms of transmission had been ruled out, “so that we said the major source causing people to be infected with HIV was injection and intravenous injection”.

“We are also waiting on results from the USA and South Korea too,” he added.

According to Friday’s release, the number of people found to be infected in the area has risen to 212, with 82 per cent of cases hailing from Roka.

Just under 20 per cent of those infected are 14 years old or younger, and 22 per cent are over 60.

In the same statement, Dr Dong-Il Anh, the WHO’s representative in Cambodia, praised the Ministry of Health for stopping the spread of infections when it did, but said that there is still much work to be done to reform the informal health sector.

“There is a pressing need to strengthen the regulatory framework for the private and informal health sector in order to ensure that health care is responsive, safe and of high quality,” he said.

Friday’s statement says all HIV-positive persons in Cambodia are offered free treatment, and that 78 people started anti-retroviral therapy in Battambang between December 22 and 31.

Some have expressed scepticism that a single doctor could have infected more than 200 people with HIV, even if he was reusing needles.

According to the US Centers for Disease Control and Prevention, about one in 300 needle-stick or cut exposures to HIV-infected blood results in infection.

However, Dr Masami Fujita, HIV team leader at the WHO, said in an interview yesterday that different types of injection procedures carry different levels of risk, and investigators were still trying to learn what types of services those infected in Roka had received. Given what investigators know so far, he said, injections are currently a “major suspect”.

“But exactly how it happened among this community, exactly what kind of procedure caused these infections, we still don’t know the details,” he added.

Whatever the cause, the government must shoulder some of the blame for its lax handling of the informal medical sector, said Am Sam Ath, senior investigator at the rights group Licadho.

“The ministry itself and the government are responsible,” he said yesterday, adding that “we do not know how many unlicensed doctors are treating people in this way”.

In a statement dated December 18, the Ministry of Health advised all municipal and provincial health institutions to crack down on “illegal health services”, and drafted a similar letter to provincial authorities.

“All directors of the health departments have to take serious measures against illegal health services defying the law and previous directives and send them to court,” reads the December 18 statement, signed by Dr Te Kuyseang, a secretary of state at the Ministry of Health.

ADDITIONAL REPORTING BY STUART WHITE