Overview: A rising crisis in a small island nation
Fiji, a Pacific nation with fewer than a million people, is facing one of the world’s fastest-growing HIV epidemics. From fewer than 500 people living with HIV in 2014, the country recorded about 5,900 by 2024 and 1,583 new cases in that year alone. Public health officials warn that the trajectory may continue to climb through 2025. The crisis is driven by a combination of unsafe practices, shifting drug use patterns, and gaps in prevention and treatment services.
The mechanics of transmission: bluetoothing, chemsex and needles
Several intertwined factors have accelerated HIV transmission in Fiji. Bluetoothing—also called hotspotting—describes a practice where intravenous drug users draw blood after a hit and share it with others, creating a bloodstream network of potential infection. Alongside this, chemsex, the use of drugs such as methamphetamine during sexual activity, compounds risk, as do the widespread sharing of needles when clean equipment is scarce.
Frontline workers recount scenes of groups pooling injections, often in informal settings where clean syringes are hard to obtain. In parallel, meth has proliferated through coastal towns and urban areas, with many young people turning to injection as a method of use. The combination of bloodborne transmission and high-risk sexual behavior is fueling new infections, including among adolescents and young adults.
Why needle access matters
Access to sterile syringes and needle-syringe programs remains limited in Fiji. Police pressure at pharmacies and cultural barriers hinder easy obtainment of injection equipment, intensifying risky practices. NGOs have stepped in to fill gaps by distributing syringes and educating at-risk communities, but they contend that coverage is still insufficient to meet demand. The lack of systematic harm-reduction infrastructure leaves many people exposed to HIV and other bloodborne infections.
Other drivers: chemsex, stigma, and testing challenges
Chemsex is another critical driver of the epidemic. The injection of crystal meth, more common in Fiji than in many other countries, is linked to longer, riskier sexual encounters and reduced negotiation power for safe sex. The result is a surge in both sexually transmitted HIV and injection-related transmissions. While awareness and testing have improved in some communities, stigma and fear continue to deter people from seeking care, testing, and treatment. The net effect is a larger, more hidden pool of individuals unaware of their infection.
Public health response: recognizing the outbreak and building capacity
In January, Fiji declared an HIV outbreak, signaling the seriousness of the situation. The government and international partners have sought to strengthen surveillance, expand testing, and improve access to antiretroviral therapy. However, reports point to persistent challenges: staffing shortages, limited laboratory capacity, and intermittent stockouts of essential medicines and rapid tests. Experts warn that without a robust, well-resourced response, the country could see an “avalanche” of cases in the coming years.
Expert perspectives: a regional crisis with global implications
Researchers and practitioners warn that Fiji’s HIV surge is not an isolated event. The Pacific region faces similar vulnerabilities—geographic isolation, drug trafficking routes, and limited public health infrastructure. Analysts like José Sousa-Santos describe the situation as a “perfect storm,” stressing that the current infections may far outpace available resources and complicate containment efforts for years to come. The best path forward involves a coordinated national strategy that integrates prevention, treatment, harm reduction, and stigma reduction.
What this means for communities and policy
For Fijians, the crisis translates into urgent needs: expanded needle-syringe programs, greater access to testing and treatment, and comprehensive education that reaches youth before risky behaviors become entrenched. NGOs report that as education improves, more people are willing to get tested and seek care, suggesting that data may be underrepresenting the true scale of infection. Policymakers must balance cultural considerations with proven public health practices to turn the tide against HIV in Fiji.
