A woman prepared medicine for her mother in Roka, western Cambodia, a farming village where more than 200 people have tested positive for HIV.
Frail and depressed after her diagnosis, Chem Mao decided to take her life by climbing a mango tree in her backyard, fastening one end of a rope around a sturdy branch and the other around her neck, and jumping. As she shuffled weakly beside her cinder-block house toward her family’s small orchard she saw her grandchildren playing nearby and relented, collapsing into tears.
“I didn’t have enough strength to get up the tree,” she said. “Maybe I’ll try again another time.”
Ms. Mao, 55, is among more than 200 villagers in this rice farming community in western Cambodia who tested positive for HIV last month. The Cambodian authorities say that an unlicensed doctor who reused syringes and other medical equipment spread the infection.
Even in a country inured to hardship and suffering, the infection of such a large number of people within a radius of a few miles was shocking.
The victims are everywhere — in the wooden stilt houses, in the paddies harvesting rice, in the gilded Buddhist temple at the entrance to the village, and in the playground of the yellow ocher primary school. The 82-year-old abbot of the temple was infected, as were 12 children who attend the primary school.
Grief seems to reach a crescendo in Roka as a visitor walks down the main dirt road: Five minutes from the temple is a cluster of houses where 16 members of an extended family were infected.
What the victims appear to have in common is that they were treated by Yem Chrin, a village medical practitioner who was charged last month with aggravated murder, intentionally spreading HIV and practicing without a medical license. He is in prison while awaiting trial in the nearby city of Battambang.
The provincial prosecutor, Nuon San, said in an interview that a number of people in the area had died from HIV in the past and that the authorities were investigating whether Mr. Chrin may have been responsible. Officials quoted in the Cambodian news media said Mr. Chrin had admitted reusing needles and syringes.
For two decades, Mr. Chrin made house calls to sick villagers here, one of seven unlicensed doctors in the community, officials said. He trained and practiced as a nurse in a refugee camp during the convulsive years after the fall of the Khmer Rouge in 1979, according to his daughter, Chrin Reaksa.
When he moved to Roka, “more and more people asked him for help, so he started his medical practice,” Ms. Reaksa said in an interview. “The government never expressed any concerns about a license.”
Many villagers, even those infected, staunchly defend Mr. Chrin, describing him as a kind man who treated even those who could not pay.
“Honestly I don’t think the doctor caused this,” said Chhay Yao, 76, the matriarch of the family in which 16 people were infected. “He was so clean. And he’s not a bad person. If we had money we gave it to him. If not he would always say, pay me later.”
He made house calls, and was happy to oblige villagers who preferred a drip or injection instead of pills.
The villagers’ affection for the doctor does not blunt their pain and bewilderment over the mass infection. Prum Em, Ms. Yao’s 84-year-old husband, stares with blank incomprehension when asked about the infections, which struck across three generations.
“I have done only good deeds my whole life,” he said. “It’s inconceivable that the family could have this much bad luck.”
One relative, Em Seiha, 23, passed out when she learned she was infected.
“I was worried that my husband would think that I had had an affair,” she said.
A HIV infection is no longer the death sentence it once was and the Cambodian government is providing free antiretroviral medication, the drugs that suppress the virus and stop its progression. But Ms. Seiha feels condemned.
“I’m afraid that I’m going to die at an early age, leaving my son behind,” she said.
Family members say they are treated with suspicion when they travel outside the village, including one mother who was instructed to wash her hands with antibacterial gel when the clerks in a shop learned she was from Roka.
“People from other villages are not welcoming us anymore,” said Em Soeum, a member of the family. “They discriminate against everyone from the village, including HIV negative people.”
The mass infection in Roka comes just as Cambodia has received accolades for its handling of HIV In early December, around the time the infections were discovered, the United Nations praised Cambodia for reducing the number of new HIV infections by 67 percent since 2005. Cambodia has a HIV prevalence rate of around 0.7 percent, a third lower than that of neighboring Thailand, according to United Nations statistics.
The United Nations says two-thirds of the 75,000 people living with HIV in Cambodia receive antiretroviral therapy, the highest percentage of access to treatment among the country’s neighbors.
In a country of extreme poverty and lax law enforcement, it is not yet clear how widespread the reusing of needles is and whether this was a tragedy waiting to happen.
There are no nationwide statistics of the number of unlicensed doctors, but the Ministry of Health is committed to reinforcing the law, said Ly Penh Sun, the deputy director of the National Center for HIV/AIDS.
Aid workers said the outbreak here was unusual. “I’ve never seen anything like this,” Kong Wuthy, a project manager at the ARV Users, a nonprofit organization that helps people with HIV in Cambodia.
Roka is about five kilometers, or about three miles, from the nearest paved road and a 15-minute drive from Battambang, a hub of commerce in western Cambodia.
Soeun Sophath, the deputy head of the government health clinic in the village, which is staffed with nurses, said the first sign that something was wrong here came in August, when a routine HIV screening of a pregnant woman came back positive. It was the first positive result in the village since the screening program began two years ago, and health workers could not find an explanation for the infection. When another pregnant woman tested positive in November as well as an elderly man and his daughter-in-law, villagers panicked and stormed the health center to be tested. Dozens tested positive.
“They were crying and crawling on the ground and hugging each other,” Ms. Sophath said. “I was crying, too. I was shocked.”
Prime Minister Hun Sen initially expressed disbelief that the tests were correct. “Right now, 99 percent, I don’t believe it’s AIDS,” he was quoted as saying in the Cambodian news media.
A few days later, as the police and medical investigation and treatment teams sent from Phnom Penh blanketed the community, a court in Battambang charged Mr. Chrin.
Not everyone in the village is forgiving of Mr. Chrin. Ms. Mao bursts into a tearful rage when asked about him.
“I want to chop him to pieces. I want to torture him,” she said. “I want to inject my blood into his family members so they know what it feels like.”
Described by her neighbors as one of the most talented farmers in the village, Ms. Mao has been too weak to work lately. Her cucumber plants, neatly arrayed in rows, are dead. The bitter melons that she planted a few steps from her house have withered on the vine. A row of cornstalks are yellowed and stunted.
Ms. Mao said the HIV medication, which she began taking this month, made her feel nauseated and weak.
“I’ve always been able to take care of myself,” she said. “No one has ever helped me and I don’t want anyone’s help. I just want to be able to work again.”
LASS 