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Misplaced Condemnation in Cambodian Nosocomial HIV Outbreak

The ongoing inquiry into an outbreak of HIV in several Cambodian villages has so far found more than 160 cases. Most cases were found in one village, but 20 were found in a nearby village and a few more in a third.

However, the inquiry needs to be expanded to include all villages where such an outbreak may have occurred. It also needs to be expanded beyond unlicensed premises and practitioners. It should include all health facilities, pharmacies, practices and anywhere skin piercing procedures take place.

The reason the inquiry needs to be so broad is that anyone in the country may be as ignorant as their esteemed leader, Hun Sen, about the risk of being infected with HIV through unsafe healthcare. Many people may only have heard about sexual risk; those who have heard about non-sexual risks have probably heard that it is very unlikely, which is the received view propagated by UNAIDS, WHO, CDC and the like.

Also, the CDC estimates for the risk of being infected through reused injecting equipment seem unbelievably low. They claim that the risk from needle-sharing during injection drug use is 63 in 10,000. The one unlicensed practitioner arrested so far has admitted to reusing syringes and needles, so the risk may be similar to that faced by injection drug users. But compare those CDC figures to estimates on the Don’t Get Stuck With HIV site.

If the risk is as low as CDC’s 63 in 10,000 then this single unlicensed practitioner must have an impossibly large number of clients, who receive a lot of treatment that involves skin piercing of some kind. It is far more likely that other practitioners, licensed and unlicensed, also take risks. Yet, infections will only be brought to light if the investigation is broad and thorough enough.

The investigation also needs to report honestly. Hun Sen may wish to protect his country’s image of one that has avoided a very serious HIV epidemic; UNAIDS may wish to continue denying non-sexual transmission through unsafe healthcare; CDC may not want to review their estimated risk, for whatever reasons, etc.

But the most important thing is to discover how people have been infected, then cut off these routes to infection. This kind of outbreak could happen again and again, because neither practitioners nor members of the public are being warned of the risks of infection through reused medical instruments and other unsafe practices.

The investigation so far has demonstrated one of the dangers of the sort of culture of blame that has been developed by UNAIDS and the HIV industry. If those found to be engaged in unsafe practices are persecuted, threatened, imprisoned or otherwise punished, the investigation is unlikely to bring too many outbreaks and unsafe practices to light.

Those already infected need to be identified, and given treatment and support. Those at risk, likely to be a very large number of people, need to be proteted from harm.

The arrest of a single practitioner to date looks like a case of scapegoating, somewhat resembling Libya’s reaction when an outbreak was discovered there, or the Ugandan nurse sentenced to several years in prison for ‘negligence’ because she is said to have risked infecting an infant with HIV (she was released after serving nearly one year but the conviction was upheld).

Condemnation of those engaging in unsafe practices, when the HIV industry itself has failed to warn practitioners and patients about the risks, is entirely misplaced. It only adds to a systematic failure to protect people from being infected, as well as exposing health practitioners and others to abuse and accusations of ‘deliberate’ transmission of HIV.

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