A rash of HIV cases has rocked a small village in Kandal province, and with a Ministry of Health team slated to arrive this morning to take blood samples, its inhabitants are anxious to get tested.
The suspicious cluster of cases has raised the spectre of an explosive outbreak of HIV uncovered in Battambang province’s Roka commune, where more than 280 cases have been discovered among fewer than 9,000 residents starting in late 2014.
An investigation into the outbreak laid the blame at the feet of a local unlicensed medical practitioner who was found to have been re-using needles.
As in Battambang, rumours are already flying from house to house in Peam that local doctor Phearum’s* syringes are the source of the infections, an allegation Phearum vigorously denied yesterday.
Sitting on the floor of her home in Peam, Vicheaka*, 73, smiled even as she spoke about her diagnosis, though her heavy eyelids betrayed her exhaustion.
Vicheaka said she believes she contracted the virus from her eldest son, whom she tended to six years ago as blood seeped from his nose, mouth and skin.
“I did not think about transmission; who could take care of him? His wife was pregnant,” she said. “Then last year I started to get sick. The doctor came here and said I’m HIV-positive.”
The virus took her son’s life at 26, leaving behind his wife and two children.
A friend, 65-year-old Neary*, who dropped by to visit Vicheaka yesterday, said she received her diagnosis on February 13.
“I didn’t have any symptoms,” she said. “But there was a rumour lots of people had HIV, so I got tested.”
Most of Peam’s recent diagnoses have been elderly, and many of them had never considered themselves at risk.
“I don’t know why I have this, I don’t have sex,” Neary said. “When I told people [I had HIV] they were shocked because I live alone and go to the pagoda.”
Both Vicheaka and Neary said yesterday that they had received injections from Phearum, although neither went so far as to accuse him of wrongdoing.
“Everyone who got injected by him got really concerned,” Neary added.
Lika*, 52, one of many women milling outside Vicheaka’s house, said she did not have HIV and had never been treated by Dr Phearum.
“Look at them, they are all concerned about their children,” she said, pointing at the other women gathered there, all of whom maintained they “never had a blood test in our lives”.
While everyone is eager to discuss the string of diagnoses, the persistent stigma attached to the disease means that many with the virus are hesitant to come forward in the small village of just 270 families. Many are concerned that a diagnosis will hinder their children’s marriage prospects.
“People don’t want others thinking their unmarried children might have HIV,” Lika explained.
As another villager put it, “It’s a Cambodian tradition, if the parent has HIV no one wants to marry their children.”
With the official investigation into the cluster of cases set to begin today, health authorities have so far confirmed only 14 cases in Peam, but most residents are sure the actual count is far higher.
“Thirty to 40 people have HIV but are afraid to tell,” said Sopheak*, 45, a fisherman who exhausted what little money his family had getting treatment for Hepatitis C from Dr Phearum.
Not long after he completed his treatment, he and his wife were diagnosed with HIV, which, in Sopheak’s case, has progressed to AIDS.“We lost our land, our money and now our health to AIDS,” he said. Sopheak and his wife blamed Dr Phearum for their infection.
“We want justice; we can’t keep this doctor. It’s over for me, but there are other younger people,” he said. “Only one in 10 that gets injected escapes [infection].” As the family prepared to go fishing yesterday, Sopheak said he now finds it difficult to summon motivation to work.
Anxiety over not knowing “what day will be our last” has left him depressed. The day he received his diagnosis, he said, he tried to throw himself in front of a passing car.
Sopheak also attacked local authorities for not doing more for his family, and called on the government to act before it is too late. “If the government doesn’t help, how many people will be infected?” he asked.
In the shade of Peam’s pagoda, deputy village chief Tech Saliatt sat chatting with four friends. None of them have been tested for HIV, but all but one said they were eager to do so. All of them were struck by the unusual demographic caught by the recent diagnoses.
“Before, we knew about four cases, all younger than 30,” said Sam Rith Kay, 63. “But now it’s 50 to 60.” “The shocking thing is, these are not people who stay out at night and drink and have sex,” said deputy village chief Saliatt. “They are old people; they sleep.”
None of the five have been treated by Phearum, and took pains not to blame him for the spate of cases. “We have no evidence to accuse him; without evidence he can sue us for defamation,” said Saliatt.
Sokunthear*, 63, who was diagnosed as HIV-positive about two years ago, was not so quick as the rest of the village to blame her condition on Phearum.
“I had injections from him but cannot jump to conclusions,” she said. Up until being diagnosed, Sokunthear had been getting tested twice a year ever since her now-deceased husband was found to have HIV six years ago.
Sokunthear, sitting on a broad wooden bed, was visibly fatigued but remained defiantly upbeat in the company of her family.
“I don’t feel desperate,” she said. “I feel strong; I do not have any fear. I told the doctor I have no fear. I’m already 63, so what should I fear for?”
Her daughter is trying to see the bigger picture. “At first [when I heard my mother had HIV] I was crying . . . but then I realised the village is not only her. There’s more people infected. The thing is, young people can easily be infected,” she said.
So far, very few of Peam’s young people have been tested, locals said yesterday. Many are dissuaded by the reduced odds of finding a spouse if diagnosed, and for the last seven days many have been away from the village attending a funeral.
Village chief Oun Khann said the last HIV cases he had heard of in Peam were seven or eight years ago. Regardless, he took a test earlier this month.
“I saw many people were having it and I was afraid. Every member of my family was tested,” he said.
“This morning the commune chief came to tell me to tell the people not to hide [their diagnosis],” Khann added. “It’s difficult if you keep it secret, and you will lose your life.”
When asked about the allegations against Phearum, however, Khann said he had “never heard of the doctor”.
Phearum’s clinic is just across the provincial boundary on the outskirts of Phnom Penh. He and his family were cheerful as he fended off accusations similar to those that saw the practitioner implicated in the Roka outbreak jailed for 25 years in late 2015.
“It’s not true because, firstly, I’ve been a doctor for 23 years. Secondly, I’m the director of the referral hospital. Also, I’m the head of the infection program for the district and a trainer in infectious diseases,” he said.
“One syringe for each person, then it gets thrown away,” he said when asked to clarify. “I use injections, but it’s a small number. The majority of patients are prescribed pills.”
He said just 10 to 15 per cent of patients are treated with needles. “Talking makes you feel 50 per cent better,” he said. “It’s not just the injection, it’s belief in the word of the doctor.”
Phearum declined to speculate as to the causes of Peam’s recent spike in HIV cases, saying he wanted to wait for the outcome of the Health Ministry and National AIDS Authority’s investigation.
A representative of the Ministry of Health could not be reached for comment on the Peam village case, but Kuoy Bunthoeurn, director of Kandal province’s health department, confirmed yesterday that Phearum was a licensed doctor running a legal clinic. He also confirmed that the Health Ministry is carrying out an investigation.
“If we find the 14 people with HIV, we will analyse whether or not they were recently infected,” he said.In the meantime, locals in Peam are stuck in limbo. As Kay put it, sitting with his friends in the pagoda, “Everyone is just waiting.”
*Given the nature of the allegations against him, the Post has chosen to withhold the name of the doctor and his patients pending the commencement of an investigation.