A Rural Cambodian Village Has Been Hit by a Massive HIV Outbreak

Roka is a rural village in Cambodia's northwest Battambang region, nearly 200 miles from the capital of Phnom Penh. Like much of rural Cambodia, Roka often suffers from outbreaks of various diseases, but a recent and mysterious wave of HIV cases has drawn the attention of international authorities. In December, a total of 1,940 residents were tested, and 233 had HIV—that's 12 percent, or about 30 times the national average.

As you'd expect in a predominantly Buddhist area, most of Roka's residents deny engaging in activities that are usually associated with HIV. The only constant between those infected is that many had received injections from a local unlicensed doctor named Yem Chrin.

The World Health Organization, UNAIDS, and the National Center for HIV/AIDS, Dermatology, and STD investigated this correlation in January, concluding that "the percentage of people reported receiving an injection or intravenous injection as part of their health treatment was significantly higher among the people who tested positive for HIV."

The study also looked at other risk factors such as unprotected sex and injecting-drug use, and found "no significant difference between the two groups."

Chrin was distributing intravenous injections of what he described as "serum" but what was found to be mostly glucose. After the report linked these injections with Roka's outbreak, Chrin was preliminarily charged with murder and detained. I found his house locked up and empty. His family had also left town, which is something the local chief of police attributes to stigma. "I've been told that villagers were very angry," he told me. "But I tell the infected villagers to take their medicine and avoid violence against the doctor's family."

In another part of the village I met with 53-year-old Som Tan, who tested positive in December. As a construction worker, he earned five to eight dollars a day but is now incapable of providing for his family of five. "I am too weak," he said. "Even walking is difficult." He also explained that his friends no longer visit because they don't understand the disease. "They're scared and don't know what I have. They relate it to karma and think it's a bad sign, so they stay away."

Next door to Tan is another man whose family has been tragically affected. Thirty-one-year-old Som Sokha's mother died, but Sokha admitted that he's still not sure why. "She was infected a year ago," he told me. "She felt sick and went to see the unlicensed doctor for a serum injection, but the more she took the HIV medicine, the weaker she became. Soon she couldn't walk and wouldn't eat anymore."

Sokha explained that after battling the disease for a year she succumbed in early February. He and his wife, as well as two of their four children—an eight-year-old and their ten-month-old baby—have all tested positive for HIV.

Since Chrin's arrest, the Roka Health Center has vowed to root out any other unlicensed doctors. "I have reported four unlicensed doctors," center director Dr. Beng Sora told me. "The authorities had them sign a paper promising they would stop, and they did."

Despite this, Sora admitted he still wonders how their former doctor spread HIV intravenously. "The police say Mr. Chrin intentionally transmitted the virus to the villagers," he said. "In my heart, I believe the infection was caused by the injections he did. But I do not see why he'd do it intentionally or how the HIV virus would have survived more than 15 minutes without appropriate storage."

Indeed the leader of the World Health Organization's investigation team, Dr. Masami Fujita, told press recently that although the needles are "a major suspect," it's still unclear how so many people were affected.

While it's unknown how many more cases will be uncovered, NGOs on the ground are confident that most have been identified. Local organizations such as Buddhism for Development are now paying the travel costs for infected villagers to visit provincial hospitals while others educate villagers on transmission prevention.

Names of HIV sufferers have been changed.

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