Overview: A rising HIV crisis in Fiji
Fiji, a small island nation in the South Pacific, is confronting one of the world’s fastest-growing HIV epidemics. From fewer than 500 people living with HIV in 2014, the country reached about 5,900 by 2024, an elevenfold increase. The surge is not only about numbers—it reflects a complex mix of risk behaviors, limited access to sterile injecting equipment, and gaps in public health outreach that leave many cases unreported.
Key drivers: bluetoothing, chemsex and needle sharing
Experts point to several intertwined factors fueling the outbreak. Bluetoothing, or hotspotting, involves blood-sharing among intravenous drug users to extend the effects of a single hit. In Suva and other urban centers, frontline workers have witnessed groups sharing needles and blood, a practice that dramatically raises HIV transmission risk. Alongside this, chemsex—using drugs such as methamphetamine before or during sex—has become more widespread, amplifying risky sexual behavior and further spreading the virus.
Crystal meth plays a central role in Fiji’s drug landscape, with the substance increasingly available via illicit networks. The country’s geographic position between major drug-producing regions has made it a transit and consumption point, feeding a local market and elevating health risks. The Ministry of Health notes that intravenous drug use accounted for roughly 20% of new cases in the first nine months of 2024, with sexual transmission making up most of the remainder.
Age trends and visibility
One distressing trend is the downward shift in age among some users. NGO workers report more young people getting involved in injecting drug use, which correlates with rising infection rates among those under 20. This age shift underscores the need for early intervention, targeted education, and youth-focused testing and treatment services. While more people are coming forward for testing as stigma decreases and awareness grows, health experts warn that official figures may still underestimate the true scale of the epidemic.
Public health response and challenges
In January, Fiji declared an HIV outbreak, and officials have pledged to bolster surveillance and response. However, several structural challenges hinder progress: staffing shortages in health services, limited laboratory capacity, and frequent stockouts of rapid tests and medicines. The Global Alert and Response Network has highlighted the necessity of a coordinated national strategy to reverse the epidemic’s trajectory.
Needle-syringe programs (NSPs) are a contested but increasingly discussed tool to reduce transmission by providing clean injecting equipment. In conservative and deeply religious communities, implementing NSPs has faced resistance, and coverage remains sparse. NGOs such as Drug Free Fiji and survivor advocacy groups are stepping in to distribute syringes and condoms, educate at-risk groups, and connect individuals with treatment. Yet the onus often falls on civil society to fill gaps left by limited government reach.
What lies ahead?
Public health experts warn that the current indicators may only foreshadow an even larger “avalanche” of infections. Officials expect that testing and treatment expansion will improve visibility into the epidemic, but structural weaknesses and ongoing drug trade networks complicate efforts. A well-coordinated, adequately funded response is essential to prevent further spread while ensuring access to HIV prevention, testing, and antiretroviral therapy for all who need it.
Why awareness and education matter
Across Fiji, education campaigns are expanding to reach schools, communities, and at-risk populations. Reducing stigma, promoting safe injecting practices, and encouraging regular HIV testing are central to turning the tide. As more people seek treatment early, the prognosis improves, and transmission networks can be disrupted more effectively.
Ultimately, Fiji’s HIV crisis is a cautionary tale about how fast trends in drug use, sexuality, and health service accessibility can intersect to reshape public health in a small nation. With sustained investment and coordinated action, there is hope for a future where transmission rates decline and people living with HIV can access the care they need.
