The outbreak no one saw coming
Fiji, a Pacific nation with fewer than a million people, has witnessed a dramatic and fast-moving rise in HIV infections over the past decade. Once home to under 500 people living with HIV in 2014, the country reported around 5,900 by 2024. That same year brought a surge of 1,583 new cases, a thirteenfold rise above long-term averages. Health officials describe this as a national crisis, with warnings of potential further growth into 2025.
The expansion has touched both adults and children, with a notable number of cases among those aged 15 and younger, underscoring that the epidemic is increasingly intertwined with social and structural vulnerabilities, including drug use, poverty, and stigma that previously hindered HIV testing and treatment.
What’s driving Fiji’s surge
At the core of Fiji’s HIV increase are two intertwined trends: unsafe injecting practices and changing sexual behaviors. A practice termed blue-toothing has emerged where an intravenous drug user withdraws blood after a hit and shares it with others, hoping to extend or intensify the effect. For some, this means multiple people are exposed to blood-borne infections like HIV with a single needle and one shared vial of blood. In parallel, methamphetamine use, sometimes referred to as chemsex when linked to sexual activity, is fueling additional transmission risks. Fiji’s geographic position as a trafficking hub for crystal meth has intensified local usage and created new vulnerabilities for young people who experiment or are coerced into drug use.
The age factor
Experts warn that the age of users has been trending downward. NGOs report seeing more young people seeking drugs, and testimony from frontline advocates notes that several youths arrive at outreach programs already infected or with exposure histories that require immediate intervention. The combination of IV drug use, limited access to sterile equipment, and few syringe access points has created a fertile environment for rapid transmission within communities that already face barriers to care.
Systemic gaps and the response
The Fiji Health Ministry declared an HIV outbreak in January after recording a spike in new cases. A lack of robust needle-syringe programs, restricted access to clean injecting equipment, and periodic stockouts of HIV tests and medicines have hampered surveillance and treatment efforts. The Global Alert and Response Network has called for a well-coordinated national response to reverse the trajectory, but staffing shortages and lab capacity issues continue to impede progress.
Public health advocates emphasize that more people are getting tested and treated as awareness grows, which is both a sign of progress and a reminder that the epidemic could be far larger than the official figures suggest. NGOs argue that the essential solutions include expanding harm-reduction services, increasing discreet and stigma-free testing, and ensuring reliable supply chains for antiretrovirals and rapid diagnostics.
What’s at stake for the future
Researchers and policymakers worry that without a scaling of prevention and treatment, Fiji could experience an “avalanche” of new infections in the coming years. The Pacific region’s health security is linked to Fiji’s ability to mobilize resources, train health workers, and maintain the cold chains and testing capacity needed for effective HIV management. As experts note, the earliest steps toward turning the tide are clear: expand needle-syringe access, promote routine testing in schools and communities, and normalize care-seeking without shame.
Voices from the frontline
Health advocates like Sesenieli Naitala and Kalesi Volatabu describe a landscape where compassion and urgent action must meet. They highlight the need for culturally sensitive education, rapid linkage to care, and ongoing support for people who use drugs, sex workers, and their families. Their work is a reminder that HIV is not just a health issue—it is a social issue that requires community-led, stigma-free responses.
