Aid & development, explained.
Ensuring the availability of sterile needles and syringes for drug users was the highest priority recommendation to combat Fiji’s HIV crisis (Getty Images)
Fiji now has the world’s fastest-growing HIV epidemic. Public education campaigns could stop it spreading across the region.
Subscribe to The Informer for monthly expert analysis, and to Events for advance notice of visiting world leaders and distinguished guests.
You may unsubscribe from Lowy Institute newsletters at any time. For information on our privacy practices and how to unsubscribe, see our Privacy Policy.
Pacific Islands must act now on Fiji’s HIV lessonsPacific Islands must act now on Fiji’s HIV lessons
Fiji recorded 1,583 new HIV cases in 2024, an incidence of about 158 per 100,000 people. For comparison, Australia, a nation with around 27 times the population of Fiji, had just 757 new cases in 2024 (2.9 per 100,000 people).
Even more concerning is the trajectory. Fiji’s new HIV cases have exploded, increasing by 1,219% between 2019–24, showing no signs of slowing down, and contrasting global trends of a steady decline since the mid-1990s.
This staggering data awards Fiji the unenviable title of having the fastest-growing HIV epidemic in the world, and yet the figures likely underestimate the extent of Fiji’s HIV crisis due to poor testing rates. Only a third of people living with HIV in Fiji know their status and only about a quarter receive treatment.
Mirroring Fiji’s HIV crisis is increasing illicit drug use, particularly methamphetamine taken intravenously. Needle sharing has accelerated HIV spread in Fiji with conservative estimates reporting half of all new HIV cases stem from using contaminated syringes. The shocking act of “bluetoothing” – a practice documented in Fiji where drug users inject someone else’s blood to share their high – is perhaps the most efficient HIV transmission method imaginable.
Fiji’s HIV crisis may rapidly escalate from domestic concern to regional threat. Fiji is a hub for education and labour migration in the Pacific. What starts as a Fijian crisis won’t respect borders and poses direct health security concerns to already strained health systems in other Pacific Island nations, as well as Australia and New Zealand whose seasonal worker programs (PALM and RSE) could introduce new transmission networks.
Continued expansion of regional networks targeting transnational crime, such as enhanced intelligence sharing, is needed to match increases in trafficking volume and ingenuity.
Pacific Island nations must take steps to insulate themselves, and the region, from additional HIV outbreaks, learning from Fiji’s experience. Many nations, including French Polynesia, Tonga, Samoa, Vanuatu and Solomon Islands are already seeing the warning signs of an increasing drug presence. It is via traffickers using the Pacific Islands’ quiet and largely unpatrolled borders as waystations that hard drugs have leaked into Fiji.
For Australia and New Zealand whose domestic drug markets drive the trafficking that fuels Fiji’s crisis, both moral obligations and direct health security concerns underpin the need for action.
Recently, major seizures in the Pacific seemingly occur every few days, reflecting the volume of trafficking taking place in the region. The burst of seizures is also indicative of regional security cooperation, with Pacific Island defence forces working alongside partner countries, such as Australia, to disrupt supply lines. Continued expansion of regional networks targeting transnational crime, such as enhanced intelligence sharing, is needed to match increases in trafficking volume and ingenuity.
Fiji’s HIV crisis was compounded by an initially sluggish public health response. Warning signs of a burgeoning crisis were present early, with the alarm definitively raised by UNAIDS in 2022. Regrettably, Fiji did not launch a national response plan to combat the HIV outbreak until 2025, and by then the window for early intervention had closed.
A recently published rapid assessment of Fiji’s HIV crisis revealed that some individuals who contracted HIV via unsafe injecting practices were still unaware of how HIV is spread, and the risks associated with contaminated blood. Others viewed the disease as untreatable or inevitable. Fundamental gaps in public knowledge of HIV in Fiji are likely to resonate around the Pacific.
An assessment of Fiji’s HIV crisis revealed that some individuals who contracted HIV via unsafe injecting practices were still unaware of how HIV is spread (National Cancer Institute/Unsplash)
A simple step Pacific Island nations could take to build resilience to HIV outbreaks is an education campaign targeting public knowledge of HIV risk factors. Importantly, messaging must not be negative, or fear basedas has previously been the case in Fiji, but include details of risk factors, promote safe sex, encourage testing and discourage needle sharing and other unsafe practices.
A more complex but crucial step toward building resilience to drug-related HIV outbreaks in the Pacific is destigmatisation. Both drug users and people living with HIV in Fiji report feeling judged and shunned by their communities, emotions that drive riskier behaviours and make them less likely to seek treatment or access support services. The value of removing stigma-based barriers to accessing testing and treatment, and enabling safe drug use, has been observed globally.
Ensuring the availability of sterile needles and syringes for drug users was the highest priority recommendation to combat Fiji’s HIV crisis per the previously mentioned rapid assessment. The “Fiji National HIV Surge Strategy”, developed by the Fijian government and launched in 2025, also notes the value of needle exchange programs and supervised injection sites. The Fijian government’s progressive approach to tackling the HIV crisis is commendable, and will contribute to the erosion of stigma, enabling access to testing, treatment and support services. However, the delay in such action undoubtedly contributed to the extent of the crisis; a mistake other Pacific Island nations must not repeat.
Though some argue enabling safe use is akin to promoting drug use, this approach decreases stigma and disease transmission. There is little evidence that enabling safe drug use has ever resulted in increased drug use, and drug-related harms are invariably reduced.
The Pacific Islands face a choice; act now on proven harm reduction measures, or risk watching Fiji’s HIV crisis replicate across the region.
About the author
Connor Graham
Connor Graham is a Research Fellow in the Pacific Islands Program at the Lowy Institute.
The most-pressing world events explained by Lowy Institute experts and global contributors, in your inbox, every Thursday.
You may unsubscribe from The Interpreter at any time. For information on our privacy practices and how to unsubscribe, see our Privacy Policy.
