A FIJI Ministry of Health counsellor living with HIV for nearly 20 years has called for greater access to harm-reduction services, HIV prevention and treatment, and support for people who inject drugs.
Rebecca Kubunavanua, a counsellor with the ministry’s Sexual Reproductive Health and HIV Hub, said HIV responses must focus on people’s lives and challenges rather than statistics, policies or labels.
“When we talk about harm reduction, HIV adherence, and people who inject drugs, we are not simply talking about statistics, policies, or health interventions,” Kubunavanua said.
“We are talking about real people, live lives, families, choices, challenges, and opportunities for support.”
Kubunavanua, who lives with HIV, said next month would mark 20 years since her diagnosis. She described herself as “a proud mom and a very, very proud grandmother” and said her experience had given her a personal understanding of the issues under discussion.
“I know what it feels like to receive an HIV diagnosis and to have to process what that means for my life, what it means for the remainder of my journey, my relationships, my future, and my identity,” she said.
But she said an HIV diagnosis did not mark the end of a person’s life.
“Because of effective HIV treatment, support and knowledge, people living with HIV can actually live a long, healthy, and meaningful life,” Kubunavanua said.
She said treatment was effective only when people could access it, understand it and remain engaged with it. Adherence, she added, was about more than remembering to take medicine each day.
“For me, adherence is more than simply remembering to take a tablet every day,” she said. “Adherence is about choosing life. It is about understanding that my health matters.”
Kubunavanua said people living with HIV could struggle with stigma, discrimination, mental-health challenges, unstable living circumstances, substance use, financial difficulties, transport barriers and fear of being judged.
She urged health workers and support services to change the way they respond when someone has difficulty taking medication.
“When someone is struggling with adherence, we should not immediately ask, ‘Why aren’t you taking your medication?’” she said.
“We should also ask, ‘What is making it difficult for you to take your medication, and how can we support you?’”
Harm Reduction Saves Lives
Kubunavanua said harm reduction was particularly important for people who inject drugs because HIV can be transmitted through the sharing of needles, syringes and other injecting equipment that may contain infected blood.
She called for access to sterile injecting equipment, safe-injecting information, HIV testing and treatment, condoms, pre-exposure prophylaxis, PrEP, post-exposure prophylaxis, or PEP, hepatitis services, substance-use support, mental-health services and peer support.
“These interventions are not about encouraging drug use,” she said.
“They are about preventing harm, preventing HIV transmission, protecting health, and keeping people connected to care.”
Kubunavanua said PrEP could be an important prevention option for people who were not living with HIV but might face an increased risk of acquiring it.
For people living with HIV, she said, immediate access to treatment and support could protect their health and, when viral suppression was achieved and maintained, prevent sexual transmission of HIV.
She also said harm reduction involved shared responsibility, including avoiding the sharing of needles and injecting equipment, using sterile equipment whenever possible, making informed choices about HIV prevention and remaining engaged in HIV treatment.
But she warned that responsibility must not become shame.
“We should be able to say, ‘Do the right thing not because you are being judged, but because your life and the lives of others matter,’” she said.
Kubunavanua urged people who inject drugs, people living with HIV and anyone vulnerable to HIV to understand that an HIV diagnosis did not remove their value, dreams, relationships, family life, work or contribution to the community.
“HIV is not the end of your life,” she said. “A positive HIV diagnosis does not take away your value. It does not take away your dreams. It does not take away your right to love, to have a family, to work, to contribute to your community, or to live a healthy and fulfilling life.”
She said people could not manage the challenges alone and pointed to health workers, counsellors, peer educators, community organisations and other services that could provide support without judgement.
“Sometimes the most powerful intervention is simply having someone say, ‘I hear you, I understand, you are not alone. Let us work through this together,’” Kubunavanua said.
As Fiji and Pacific countries strengthen their harm-reduction responses, she called for a shift away from judgement and towards compassion, prevention, treatment and support.
“Let us make HIV services accessible and friendly,” she said. “Let us make harm reduction services available to the people who need them. Let us expand access to PrEP and other prevention interventions. Let us support adherence rather than shame people when they struggle.”
“Most importantly, let us see the person before we see the behaviour, the diagnosis, or the label,” Kubunavanua said.
“Because behind every statistic is a human being. I am not defined by HIV, and neither should anyone else.”
What is harm reduction in simple terms?
Harm reduction is a practical approach that focuses on keeping people safe and minimising negative consequences when they engage in risky behaviour, rather than judging them or demanding they stop immediately.
It meets people with compassion and tools to protect their health.
