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Cambodia’s Hun Sen in the Dark about HIV/AIDS

Prime Minister Hun Sen of Cambodia is probably not the only national leader totally confused about HIV/AIDS. The news that over 100 people may have been infected with HIV as a result of an “unlicensed” doctor reusing skin piercing equipment, such as syringes, needles, intravenous drips and possibly others, underlined the leader’s complete ignorance about HIV transmission.

The prime ministers first response was to doubt if the HIV tests were accurate. But he seems to believe that HIV is exclusively transmitted through sex (and perhaps from mother to child or through injecting drug use). He doesn’t seem aware of transmission through blood exposure as a result of unsafe health, cosmetic or traditional practices. He also seems to believe that the quack arrested for performing these unsafe procedures must himself have been infected with HIV, which is not the case.

If one of the quack’s patients was HIV positive, reusing equipment that pierces the skin, or even is inserted into the mouth or other orifices, runs the risk of transmitting HIV and various other pathogens.

It wasn’t that long ago that Cambodia was predicted to be the first country to eliminate HIV transmission altogether, perhaps in the next few years. The epidemic is very small there and most transmission is likely to be through male to male sex and intravenous drug use.

But the outbreak in Roka Commune, Battambang Province shows that there are other risks. This kind of outbreak is likely to have happened many times in many countries over the past few decades. What makes this outbreak different is that it was noticed and (hopefully) investigated. Many quacks, perhaps even legitimate healthcare practitioners, may be reusing equipment, completely unaware that this could be exposing their patients to HIV, hepatitis and other bloodborne diseases.

A survey in Kenya and several other African countries found that people who have had injections in the past 12 months are far more likely to be HIV positive than those who have not. Babies in Mozambique and Swaziland have been found to be infected with HIV even though their mothers are negative (or the mothers have been infected by their babies). Women who only have sex with other women, which is extremely low risk, have been infected.

But in African countries this kind of outbreak remains uninvestigated. The women in Mozambique have never been told how their babies may have been infected, and have been allowed to believe that it was their (the mother’s) fault. The women who have sex only with other women have been told that such sexual behavior must be, after all, risky. And the many people who have probably been infected through unsafe healthcare have never been given any explanation.

So it’s not surprising that PM Hun Sen doesn’t believe the results: he, like most people in most countries, rarely hear anything about non-sexual transmission of HIV, through unsafe healthcare, cosmetic and traditional practices. This is in a country where healthcare conditions are poor and a lot of people resort to self medication, quacks or other people with few or no healthcare skills.

Hun Sen asks if an 80 year old person or a child are likely to be infected with HIV; and the answer is yes, anyone can be infected through any skin piercing practice where the equipment is reused and conditions are unsterile. They are also likely to be infected with hepatitis and any other bloodborne pathogen that is going around. Hospitals, dental surgeries, tattoo parlors, hairdressers and many other settings may be similarly risky.

So it’s time for UNAIDS and the WHO to come clean, because if national leaders are so confused about HIV modes of transmission, how clear can members of the public be? If we are constantly bombarded with misleading statements about sexual risks, but rarely told about serious non-sexual risks, everyone could be as confused as the Cambodian Prime Minister.

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