Introduction: A nation at a crossroads
Fiji, a small Pacific island nation with a population under one million, faces a rapidly escalating HIV epidemic that has confounded health workers and policymakers. From fewer than 500 people living with HIV in 2014 to about 5,900 in 2024, the country has witnessed an abrupt, sharp rise in new infections, driven by intertwined factors including intravenous drug use, bluetoothing, chemsex, and gaps in prevention services.
What bluetoothing means for Fiji’s HIV landscape
Central to the crisis is a risky practice known as bluetoothing — or hotspotting — where drug users draw back blood after an injection and pass it to others, who repeat the cycle. In theory, it multiplies the reach of a single hit, but in practice it creates a direct conduit for bloodborne infections like HIV to spread quickly through communities. Frontline workers describe scenes where multiple people share a single syringe, amplifying health risks across social networks that already face stigma and limited access to care.
Chemsex and the rise of younger users
Another complicating factor is chemsex, often involving methamphetamine, which Fiji has seen increasingly among young people. Intriguingly, crystal meth is predominantly consumed via injection in Fiji, adding a dangerous dimension to the epidemic. The combination of drug use and sexual activity can intensify transmission risks, particularly when prevention tools such as condoms and clean injecting equipment are scarce or stigmatized. Health officials note a disturbing trend: more cases are linked to intravenous drug use, and the age of many users is trending downward.
The age factor and the data gap
National statistics show a rise in pediatric and adolescent cases, heightening concern about mother-to-child transmission and the need for comprehensive prevention and treatment. Yet experts warn that official figures likely undercount true prevalence due to under-testing, stigma, and limited surveillance. As awareness grows and more people seek testing, case numbers climb — but the real scale may be far larger than reported.
Systemic challenges: policy, access, and funding
Fiji’s public health system faces significant constraints in countering the epidemic. Needle-syringe programs (NSPs), a proven harm-reduction strategy, remain limited in reach due to policy, religious conservative norms, and resource gaps. Pharmacies often require prescriptions for syringes, while NGOs shoulder a heavy burden distributing clean needles and condoms in an environment where stigma can deter people from seeking care. The Ministry of Health has acknowledged bluetoothing and chemsex as drivers, but translating recognition into scalable action remains a work in progress.
What experts say and what’s next for Fiji
Public health researchers warn that the current trend could metastasize without intensified national action. Staffing shortages, lab capacity constraints, and stockouts of rapid tests and antiretroviral medicines complicate efforts to diagnose and treat people living with HIV. Analysts emphasize the need for a coordinated, well-resourced national response, extending testing, treatment access, and harm-reduction services, while also addressing the social determinants that fuel risk behaviours.
Hope and practical steps
Despite the bleak trajectory, progress is possible. NGOs are expanding outreach to people who use drugs and sex workers, helping to normalize testing and treatment. Community-led education aims to reduce stigma and misinformation about HIV, encouraging earlier testing and adherence to treatment. Strengthening NSPs, improving supply chains for medications, and fostering regional collaboration can help Fiji bend the curve and mitigate future waves of infection.
Conclusion: A national commitment is essential
Fiji’s HIV outbreak is not just a health story—it is a mirror of governance, education, and social support. The coming years will test Fiji’s resolve to protect vulnerable communities, deploy evidence-based prevention, and ensure that treatment is accessible to all who need it. As public awareness grows, so too does the opportunity to avert a much larger epidemic and safeguard the health of future generations.
