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'We’re Testing About 20 People a Day': Inside the Cambodian Village Devastated by an HIV Outbreak

At least 212 people in Roka have tested positive for HIV and a village doctor is awaiting trial for murder and spreading the virus after habitually reusing syringes on patients.
January 16, 2015, 4:25pm
Photo by Nathan A Thompson

Outside a provincial hospital in Battambang, Cambodia, a young woman cradled her baby. "I have no hope left," she told VICE News. ''I don't know how long my child will live." Fellow villagers, people she had known all her life, stood with her gazing into the distance. Everyone was silent.

They came from Roka, a pretty village of wooden houses beneath giant trees that has become an HIV colony. The people there are in the midst of an outbreak of the virus that develops into AIDS and, without treatment, kills within 10 years.

In the Roka Commune administrative area, 212 people have tested positive for the virus out of a population of 2,700. Over 700 more have yet to be tested. In a savagely localized outbreak, 82 percent of victims are specifically from Roka village.

The news comes as a blow to Cambodia's much-lauded HIV prevention program that has slashed rates from 2.1 percent of the population in 1999 to 0.4 percent in 2014. By these stats, the infection rate in Roka is now 20 times the national average.

''This single outbreak is enough to bump the national average up to 0.8 for 2015,'' Dr. Oum Sopheap, director of Khana, a health NGO that is helping the Cambodian government investigate the outbreak, told VICE News.

And the number is set to rise. "We're still testing about 20 people a day," added Tout Sovannary, a research officer for Khana. ''A few weeks ago, at the height of the outbreak, people were coming to be tested by the busload."

A man is tested for the virus. All photos by Nathan A Thompson.

All photos by Nathan A Thompson.

HIV doesn't show up in blood tests for three to six months after the initial infection. This "window period" could mean even more people have been struck by the illness. ''I suspect at least 170 people are in the window period," Chanrith Prom, who collected data as part of the official investigation into the outbreak, told VICE News. ''I've never seen an outbreak so localized," he added.

Chi Heach is one of those who might be in the window period. She sells tissue paper, snacks, and soap from a roadside shack. ''I went to get tested but the results were inconclusive,'' she told me while nursing a squirming infant. ''I have to go back to hospital next month.'' She looked into the distance and her brow creased with anxiety. ''People are scared in this village; they don't know what is going on — virgin girls, old people, and even monks are infected.''

Chi Heach. All photos by Nathan A Thompson.

Indeed, two monks and one nun have tested positive for the virus. At Roka's Buddhist temple, Mom Heng, the 82-year-old head monk, looked at a handful of antiretroviral drugs in disbelief. ''I don't understand it,'' he said. ''I haven't been with a woman for ages.''

It all started back in November when a 74-year-old man tested positive for HIV. Then some of his family also tested positive. As more people returned from the health center with their lifespans slashed, more got tested, and the number of cases began to rise. Throughout December the national news reported a steady rise of infections that stoked feverish speculation as to the cause of the mystery outbreak.

A local doctor, Yem Chrin, who was practicing without a license, was arrested and charged on December 22. People said that he wasn't changing his syringes. Soon after his arrest his son-in-law set fire to his medical supplies leaving biohazard teams to comb through the ashes looking for evidence.

''I burned his supplies,'' said Chhem Choeun, the doctor's son-in-law. ''But we do that every month; it's not unusual.'' In rural Cambodia there are no rubbish collections and people do often burn rubbish.

Yet it turns out that evidence wasn't needed because the doctor confessed to habitually reusing syringes two or three times apiece. He has been jailed and is awaiting trial charged with murder, spreading HIV, and operating without a license. If convicted he faces a life sentence.

While it's not yet possible to determine the cause of each of the 212 infections, an investigation undertaken by the Cambodian government and partners — including the World Health Organization, UNAIDS and USAID — revealed that there was a "statistically significant" link to reusing syringes.

All photos by Nathan A Thompson.

''The percentage of people that reported receiving an injection or intravenous infusion as part of their health treatment was significantly higher among the people who tested positive for HIV than the people who were HIV-negative," said Cambodia's Ministry of Health in a statement on January 9th.

An epidemiologist who didn't want to be named confirmed the findings. ''Reusing a syringe containing blood from an infected person is likely to carry a high risk of transmission," he told VICE News. ''And since people have very high virus levels early in infection I can well imagine that this outbreak is indeed explained by the reuse of syringes.''

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The outbreak highlights concerns that many Cambodians have regarding healthcare in their country. Chrin reportedly practiced medicine for over 20 years with only rudimentary training first acquired while volunteering in a refugee camp in 1990. This makes it possible that the outbreak was down to ignorance rather than a will to mass murder, and raises the question of how many more unlicensed doctors are playing Russian roulette with their patients' lives.

Dr. Masami Fujita, the leader of the official investigation, told VICE News that the government and NGO partners would be looking to improve the surveillance of medical practitioners as a matter of urgency. ''It's highly important that we improve monitoring systems to prevent anything like this happening again,'' he said.

Everyone who worked on the government probe declined to comment on whether or not Yem Chin should be blamed. ''Ours is not a criminal investigation,'' said Fujita. They are now beginning a study of surrounding villages to see if they have too have been affected.

All photos by Nathan A Thompson.

Back in Roka, authorities were handing out blister packs of antiretroviral drugs to residents who returned to their wooden homes to swallow them down with water scooped from cavernous clay jars. In the temple, local charity, Buddhism for Development had set up a counseling center.

''Right now my main concern is to stop people killing themselves,'' Sim Po, the commune chief told VICE News. She spoke to me outside the village health center which was packed with people getting tested and at an outside table officials from the WHO, UNAIDS, and local government fussed over factsheets. "I see victims of this tragedy every day," she continued. "Unhappy people who are worried about the time when they will be too weak to farm rice — who will care for them then?"

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