Overview: A fast-moving HIV crisis in Fiji
Fiji is confronting one of the world’s fastest-growing HIV epidemics, driven by a mix of unsafe injecting practices, sex, and drugs. The country recorded a dramatic surge in cases over the past five years, with the number of people living with HIV rising from under 500 in 2014 to about 5,900 by 2024. In the same year, 1,583 new infections were reported, including a troubling rise in cases among adolescents.
Key drivers: bluetoothing, chemsex and needle-sharing
Experts point to several intertwined factors. Bluetoothing, or hotspotting, involves sharing blood from one syringe with others, amplifying the risk of HIV transmission. Chemsex, the use of drugs prior to or during sex (often methamphetamine), and high-risk injecting practices compound this danger. In Fiji’s context, crystal meth is frequently used via injection, a trend linking drug use directly to new HIV infections.
Why bluetoothing is spreading
Bluetoothing has grown in visibility as awareness of HIV improves and more people seek testing. Yet the practice remains a desperate coping mechanism in environments with limited access to clean syringes. In Suva, health workers and NGOs report shortages of needle-syringe programs, plus stigma and religious conservatism that hinder prevention efforts. When clean equipment is scarce, people may share and reuse supplies, elevating transmission risk.
The role of injecting drug use and the epidemic’s age shift
Injectable drug use has become the most common known route of transmission in Fiji, accounting for about 48% of documented cases in recent data. Sexual transmission closely follows at 47%, with some pediatric cases arising from mother-to-child transmission. Alarmingly, the age of many users is trending younger, with frontline workers noting a growing number of teenagers and young adults participating in injecting drug use.
Policy responses and on-the-ground realities
After declaring an HIV outbreak in January, Fiji’s health ministry has sought to strengthen surveillance and expand access to treatment. International bodies, including the Global Alert and Response Network, emphasize the need for a robust, well-coordinated national response. Challenges persist: staffing shortages, laboratory constraints, and stockouts of rapid tests and medicines complicate screening, diagnosis and treatment. In parallel, NGOs are shouldering much of the prevention and support work for sex workers and drug users, including distributing condoms and clean injecting gear where possible.
What this means for Fiji’s future
Analysts warn that the official numbers may only reveal the tip of the iceberg. An “avalanche” of infections could be underway, with many cases remaining undetected for years due to limited testing and delayed presentation for care. Public health experts stress the urgency of scaling up harm-reduction services, improving education around HIV, and reducing stigma so more people seek testing and treatment early.
Voices from the frontlines
Advocates like Sesenieli Naitala of the Survivor Advocacy Network highlight the persistence of risky behaviors while underscoring a path forward through education and outreach. NGO workers describe daily realities in Suva’s streets where injecting equipment and information are in short supply, and where communities are working to break cycles of transmission. As one healthcare strategist notes, reversing the trajectory will require sustained funding, community engagement, and transparent data sharing to guide the response.
Looking ahead
Fiji’s situation demands not only medical interventions but also cultural and political will to normalize testing, dispel stigma, and ensure access to clean supplies and treatment. While international partners can assist, lasting change hinges on local leadership, expanded harm-reduction programs, and comprehensive education that reaches the country’s most at-risk populations.
