Cambodia had seen success in its efforts to lower its numbers of new HIV infections and to address the impacts of HIV among men who have sex with men, people who inject drugs and people who earn income through sex. But it was not until about a year ago, when the numbers of people known to have HIV in the rural community of Roka jumped from four to 30, that the consequences of another high risk became clear. While more than 5 percent of medical injections administered in the Western Pacific region were estimated in 2013 to have been performed with reused equipment, investigators note, it was the sharp rise of new infections in Roka that drew Cambodian health authorities’ attention to the dangers of unnecessary and unsafe injections for medical purposes, often administered by unlicensed practitioners.
This week’s Morbidity and Mortality Weekly Report from the U.S. Centers for Disease Control and Prevention details the findings of an investigation of a cluster of HIV infections that began in November 2014 with the diagnosis of a 74-year-old man in Roka, followed by the diagnoses of two more of his family members, all of whom had received medical injections from an unlicensed practitioner. In the next three months, more than 2,000 residents of the community were tested for HIV and a team that had come to Roka to investigate the cluster had confirmed 242 cases there. Investigators found indications that those diagnosed with HIV were about five times as likely to have have received a medical injection, and four times as likely to have received an intravenous infusion than those who were not diagnosed with HIV.
The investigators’ report makes note of the cluster of HIV infections in rural Indiana propelled by shared needles and syringes among people injecting drugs that drew notice shortly after the Roka investigation. Both, they point out illustrate “the explosive outbreak potential when HIV is introduced into settings where contaminated needles are shared.”
Cambodian officials, according to the report, are responding with guidance to local health departments, heightened enforcement of medical licensing regulations and increased access to HIV testing and treatment. Still ahead will be work to promote awareness of infection control and alternatives to injections among health workers.