Fiji Declares National HIV Emergency as Infections Hit 1 in 60 Adults

Fiji has declared a national HIV crisis, with health authorities revealing that an estimated one in 60 adults in the Pacific island nation is now living with the virus, following a surge in new diagnoses driven by sexual transmission and a spiralling illicit drug epidemic.

Health Minister Atonio Lalabalavu formally declared the national HIV emergency on Wednesday, telling reporters in Suva that the decision recognised "the seriousness of the epidemic and the urgent, coordinated response our country now needs". New HIV diagnoses surged to 2,016 cases in 2025 — 16 times the level recorded in 2019 — according to government figures. The government has vowed a "whole of government" response to address the crisis.

The scale of the outbreak represents a dramatic reversal for a country that five years ago had an HIV prevalence of one in 167 adults. Today, that figure stands at one in 60, with two in every 100 pregnant women carrying the virus. The epidemic has reached Fiji's newborns with devastating consequences: of the 59 babies born with HIV in 2025, 18 died before their first birthday. A two-month-old infant recently became the youngest identified patient living with both HIV and tuberculosis, according to Save the Children Fiji.

The drivers of Fiji's HIV crisis are multifaceted, but injecting drug use has emerged as a rapidly accelerating route of transmission. The archipelago has become a crucial transit point for narcotics trafficked from the Americas to lucrative markets in Australia, New Zealand, and parts of Asia, with massive stockpiles of methamphetamine seeping into local communities. Among HIV cases with a known mode of transmission, more than 42 per cent were linked to injecting drug use, while more than half were attributed to sexual transmission, exacerbated by low condom use and persistent stigma.

A particularly alarming practice known as "bluetoothing" or "hotspotting" has fuelled the outbreak, where intravenous drug users inject the blood of already intoxicated individuals to share a cheaper high. The practice, which requires only one syringe , a scarce commodity in Fiji , has been identified as a significant contributor to the spread of the virus.

The human cost of the crisis is compounded by a stark treatment gap. Of the 9,100 Fijians living with HIV in 2025, only 39 per cent knew their status and just 22 per cent were accessing antiretroviral treatment, according to UNAIDS — a figure that stands in stark contrast to the global average of 78 per cent. Fiji reported 117 HIV-related deaths in 2025, up from 25 in 2021.

The Fijian government has announced a series of measures to combat the epidemic, including expanded access to free HIV testing, prevention services, and treatment. The response includes rapid testing, prevention medicine for people at higher risk, harm-reduction measures for people who inject drugs, and free treatment for those diagnosed with HIV. Legislation for a needle and syringe programme will be introduced in parliament, with Lalabalavu confirming the country already has sufficient supplies.

The government is receiving external support from Australia, New Zealand, India, the Global Fund, and the United Nations. UNAIDS has welcomed Fiji's emergency declaration, with Executive Director Winnie Byanyima stating it "signals the urgency needed to ramp up response to a higher level" and serving as "a stark reminder to the world that Aids is not over".

Jason Mitchell, who leads Fiji's national HIV response taskforce, cautioned that bringing the epidemic under control will take "upwards of five years," describing HIV as fundamentally different from COVID-19 in its trajectory. The crisis has placed immense strain on Fiji's health system, with Mitchell noting that "for a health system that's already struggling, to have people who should really be well because there's treatment available taking up beds in hospitals... our clinical services has really been under a lot of pressure".

The outbreak in Fiji bucks a global trend of falling HIV infection rates, with UNAIDS estimating a 42 per cent decline in new infections worldwide between 2010 and 2025. For a nation of less than a million people, the declaration of a national emergency represents a sobering acknowledgment that without urgent and sustained action, one of the world's most effective public health success stories could be undone in a single generation.