RIO DE JANEIRO – A graph showing the progression of HIV infections in Fiji resembles a cobra poised to strike. For years, the 330+ islands that make up Fiji had almost zero HIV cases, but the country’s 14-fold increase in infections over the past five years is represented by a near-vertical line rearing up over the country.

Around 12,000 people are believed to have HIV in a country of less than a million people spread over 100 or so habitable islands.

“What is driving this epidemic now is risky injecting drug use of people who currently inject methamphetamines,” said Dr Jason Mitchell, chair of Fiji’s National HIV Outbreak Cluster Response Task Force.

People share needles to inject the crystal meth, another exploding epidemic, and sometimes also deliberately share their blood after taking the drug to make it go further.

The Pacific islands – positioned between East Asia, the Americas, Australia and New Zealand – have long been a gateway for drug traffickers. But during COVID-19, the drugs were unable to move, and a domestic market for crystal meth was cultivated.

“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 2026).

“UNAIDS estimates that we currently have 1.2% prevalence in people between the ages of 15 to 49, and that of course continues to increase. That’s roughly one in every 60 adults,” said Mitchell.

‘The prevalence in our antenatal population now exceeds 2% and, in 2025, one child was born with HIV every week, and we lost one child to HIV-related matters every month,” Mitchell added. 

“In a country of less than a million people, this is very significant, and perhaps for me it is the greatest crime and shame of all because this is all preventable.”

Last year, around 18% of mothers with HIV passed the virus on to their babies – the highest vertical transmission rate in the world.

Two in three of last year’s people diagnosed with HIV were aged between 20 and 34, and  94% are in the indigenous iTaukei population. Men initially outnumbered women by over 2:1, but the rates in women are increasing.

There has been a 45% increase in children aged 10 to 19 becoming infected with HIV, said Mitchell.

Communal culture drives HIV spread

Mitchell attributes the rapid spread among people who inject drugs to two things: the culture of communality in indigenous Fijans and a shortage of clean needles and syringes.

“We typically share everything,” explained Mitchell, giving the example of kava, a root that is used in traditional ceremonies that has an antidepressant effect. 

“The practice of consuming kava is you have one mixing bowl and one receptacle or glass that we all share. The practice of kava has spilt over into our consumption of alcohol. Anyone who has grown up in Fiji will be introduced to this practice of one glass and one alcohol. You would never have your own glass.”

Similarly, with crystal meth, people pool resources to buy the drug, which they then share along with the needles and blood.

Mark Shaheel Lal, founder of Living Positive Fiji and one of the few people to come out publicly with his HIV status, says that “a needle and syringe programme is something that really needs to be implemented, and it is not”. 

“We constantly run out of [antiretroviral] medication, which has just been introduced, and no one really knows about antiretrovirals themselves.”

Huge obstacles

Mitchell concedes that Fiji is struggling: “Our 90-90-90 [global HIV] targets are 40-22-3.2,” he says. This means that, instead of 90% of people knowing their HIV status, only 40% do. Instead of 90% of those living with HIV being on treatment, only 22% are and of those, only 3.2% have undetectable viral loads instead of the 90% target.

Many HIV cases are being diagnosed through routine HIV testing when people donate blood.

The government has introduced pre-exposure prophylaxis (PrEP) and “we’re trying to strengthen our condom programming in a region that does not use condoms”, said Mitchell. 

However, he agrees with Lal that “what is missing from this response is the availability of a needle and syringe programme”.

“That is a central part of a harm reduction programme,” said Mitchell. “There’s a lot of will, especially from our politicians and government, but we need to introduce the systems first.”

However, Mitchell concedes that police crackdowns on pharmacies selling needles and syringes have exacerbated the situation. He also recognises that it will be hard to convince people that “the practices they have adopted from consuming kava and alcohol should not be used in the situation where you’re injecting drugs”. 

The country is also struggling with resources. Australia and New Zealnd are assisting Fiji, both with resources and technical support, and India has made a significant donation of ARVs, but Mitchell says the islands need more.

Despite getting a small grant from the Global Fund, Fiji is heavily dependent on this – although it is due to transition off Global Fund money within three years.

“We need a full upscaled response,” said Mitchell, warning that the epidemic also poses a threat to other Pacific islands.

Image Credits: World Health Organization, Kerry Cullinan, Fiji Ministry of Health, Wikipedia.