Some of the recent articles about the massive outbreak of HIV caused by reuse of syringes, needles and other skin piercing instruments in health facilities in Roka Commune, Battambang Province, Cambodia, make it sound as if being unregistered is the main problem; unregistered practitioners, unregistered clinics, etc.
But as this article about unsafe injections in US health facilities makes clear, it is the behavior of well qualified people in legitimate facilities that can threaten the health and lives of patients, especially in poor areas. Being registered may result in practices and practitioners being scrutinized from time to time, if there are mechanisms and personnel for such scrutiny.
But in Cambodia there are numerous unlicenced practitioners and facilities because there is a chronic and long term shortage of trained and qualified personnel. There are also shortages of equipment and supplies. The cost of healthcare is simply too high for most people, so they resort to unlicenced practitioners and practices.
But that does not mean things are completely safe in legitimate facilities, where some or most of the employees may be relatively well trained and qualified. Nor does it mean that there are adequate measures taken to inspect premises or practitioners, nor consequences for unsafe behaviors.
The current ‘investigation’, which seems to be progressing at a snail’s pace, is being carried out in conjunction with UNAIDS and the World Health Organization. But these organizations specialize in disinformation about health facility transmitted HIV. The current approach in Cambodia is to point the finger at one unlicenced practitioner, and his practice, rather than health services in their entirety.
Now it seems the investigation into how almost 300 people became infected with HIV is being further watered down by concentrating on the issue of licences, which suggests that it is not scrutinizing the potentially unsafe behaviors of those working in healthcare. It even appears that some of the clinics being closed down are run by Chinese nationals or ethnic Chinese Cambodian nationals, using unsafe healthcare to deflect attention from anti-Chinese prejudice (something UNAIDS is unlikely to question).
The Cambodian government, UNAIDS, the WHO and others are missing the most important point about the 300 people so far identified as being infected with HIV through unsafe healthcare: it is not unlicenced practitioners or facilities that spread diseases, it is unsafe behaviors, such as reuse of syringes, needles and other equipment; people have a right to SAFE healthcare, not just any old healthcare.