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Cambodia, Unsafe Healthcare, Injections: Time for a Changing of the Guard?

There’s a very succinct set of photographs by Marc Koska of the SafePoint Trust about the HIV outbreak in Cambodia’s Roka Commune. Over 270 people are said to have tested positive so far, several of whom have already died. Unsafe healthcare is thought to have been behind this outbreak, reuse of syringes and other skin piercing equipment by medical practitioners who do not have the knowledge, skills or equipment to avoid such occurrences.

Koska invented an auto-disable syringe many years ago, a syringe that breaks if you try to reuse it, but he has been lobbying health and HIV institutions to promote the use of this simple and cheap technology ever since.

It is highly unusual for the BBC to express the slightest hint of disagreement with the mainstream view of UNAIDS and other institutions, that HIV is almost always transmitted through unsafe sex, and hardly ever through unsafe healthcare. Perhaps because this outbreak was in Cambodia, where HIV prevalence is low, this story flew under the radar.

Sadly, as the article points out, use of auto-disable syringes is too late for those already infected, but it is not too late for other Cambodians, nor for HIV negative people living in countries where HIV and other blood-borne viruses are common and, more importantly, where safe healthcare is uncommon.

UNAIDS and others in the HIV industry have been ranting on about ‘unsafe sex’ and completely avoiding the issue of unsafe healthcare, even denying its possible role in the most serious HIV epidemics in the world, which are all in Africa. Perhaps this will bring various kinds of unsafe healthcare into focus, however belatedly.

Cambodia is not the only Asian country where unlicensed practitioners operate; and even licensed practitioners may reuse needles, syringes and other skin-piercing equipment. The practitioner who has so far been the only scapegoat is unlikely to be the only person to practice healthcare unsafely. The investigation should be global, not confined to a population of a few thousand.

As for African countries, it should be clearer than ever that unsafe healthcare must no longer be denied by UNAIDS and other health agencies as an important mode of transmission of HIV and other viruses in African countries. People shouldn’t have to be Buddhist monks, very young or very old to be believed when they say they have not engaged in ‘unsafe’ sex, or any sex at all.

The UNAIDS view that HIV is almost always transmitted through ‘unsafe’ sex and hardly ever through unsafe healthcare is vehemently expressed in a BBC article from 2003, and these views don’t appear to have changed since (although the UNAIDS official in question, along with some of her senior colleagues have since availed themselves of the revolving door).

The maliciously racist view of Africans that the senior UNAIDS official is, apparently, allowed to make public, doesn’t seem to have changed either.

It’s also worth bearing in mind that UNAIDS are well aware of the risks of healthcare transmitted HIV and other infections in developing countries. They publish a brochure warning UN employees not to use health facilities in such countries; this contrasts very strongly with what the BBC published the year before. Perhaps now they UNAIDS will promote this in Cambodia, and hopefully in Africa too?

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