THE shape of Fiji’s HIV epidemic is now being described in alarming terms — a graph rising sharply, almost like a cobra lifting its head before a strike.
For years, Fiji recorded very low HIV numbers across its scattered islands.
Over the past five years, infections have increased fourteen-fold.
Health authorities now believe about 12,000 people may be living with HIV in Fiji, a nation of fewer than one million people spread across more than 300 islands, around 100 of them inhabited.
“What is driving this epidemic now is risky injecting drug use among people who currently inject methamphetamines,” said Dr Jason Mitchell, chair of Fiji’s National HIV Outbreak Cluster Response Task Force.
Mitchell said some users also share blood after using methamphetamine, believing it can help extend the effect of the drug.
Fiji has long sat on trafficking routes used to move illicit drugs between East Asia, the Americas, Australia and New Zealand.
COVID-19 border disruptions changed the local picture, with drugs that once moved through Fiji instead helping create a domestic crystal meth market.
“In January 2025, we declared a national HIV outbreak, which was initially confined to the population of people who inject drugs. The epidemic is now spilling over into every other population group in the country,” Mitchell told a media briefing at the International AIDS Conference, AIDS this year.
UNAIDS figures cited by Mitchell put adult HIV prevalence at 1.2 per cent among people aged 15 to 49 — about one in every 60 adults — and still climbing.
Among pregnant women, prevalence has passed 2 per cent. In 2025, Fiji recorded one baby born with HIV each week, and one child dying every month from HIV-related illness.
“In a country of less than a million people, this is very significant,” Mitchell said. “Perhaps for me it is the greatest crime and shame of all, because this is all preventable.”
The country also recorded an 18 per cent mother-to-child transmission rate last year, which Mitchell described as the highest vertical transmission rate in the world.
Young adults are carrying much of the burden. Two-thirds of those diagnosed last year were aged 20 to 34, while 94 per cent of recent cases were among Fiji’s indigenous iTaukei population, Mitchell said. Men made up most earlier cases, but infections among women are rising.
He also pointed to a 45 per cent increase in infections among children aged 10 to 19.
Mitchell said the spread among people who inject drugs is being worsened by two issues: a culture of sharing in indigenous Fijian communities, and limited access to clean needles and syringes.
“We typically share everything,” he said, pointing to kava ceremonies, where people commonly drink from a shared bowl and cup.
He said that same pattern can be seen in alcohol use and, increasingly, in meth use, where groups may pool money to buy the drug and then share injecting equipment, or even blood.
The crisis is placing new pressure on already stretched health services, from HIV testing and treatment to prevention and harm-reduction support.
Health officials say the priority is to slow transmission by improving clean needle access, strengthening services for mothers and babies, and reaching young people at risk.
Source: Health Policy Watch
