Fiji's HIV outbreak: A Pacific crisis requiring urgent collective action

Fiji is facing a major challenge in managing an outbreak of HIV, exacerbated by increasing methamphetamine use and concerning trends in needle sharing, which the government warns are putting additional strain on the country’s already overwhelmed health sector.

With a dengue outbreak also declared in Fiji, health authorities are working to contain the HIV outbreak, officially declared by the government in January 2024.

The outbreak is attributed to the surge in methamphetamine use, a practice known as “bluetoothing”, and alarming rates of needle-sharing.

Health Minister Dr Ratu Atonio Rabici Lalabalavu says the outbreak reflects the alarming reality that HIV is evolving faster than Fiji’s current services can accommodate.

"We need the support of every Fijian. Communities, civil society, faith-based organisations, private sector partners, and international allies must join us in raising awareness, reducing stigma, and ensuring everyone affected by HIV receives the care and support they need."

According to the World Health Organisation (WHO), an outbreak occurs when the number of cases exceeds what is usually expected, typically affecting a localised geographic area.

The WHO says that in 2023, the Western Pacific region saw 53,000 AIDS-related deaths, with 2.3 million people living with HIV and 140,000 new infections, highlighting significant challenges in curbing the epidemic.

Between January and June 2024, 13 deaths related to HIV were reported in Fiji, compared to 82 in the same period in 2023. From January to September 2024, there have been over 1000 new cases of HIV reported - three times more than in 2023 and a nine-fold increase compared to 2019.

“Declaring an outbreak enables prompt public health response measures and mobilises domestic and international resources to respond to the crisis," the WHO says.

Fiji's Health Minister Dr Ratu Atonio Rabici Lalabalavu says the outbreak reflects the alarming reality that HIV is evolving faster than Fiji’s current services can accommodate. Photo/Fiji Parliament

Almost 60 per cent of inmates in Fiji's prisons have been diagnosed with HIV, Dr Jalesi Nakarawa, the commissioner of Corrections, told local media.

He says inmates who have contracted HIV are mostly remandees - those who were doing drugs by bluetoothing.

Nakarawa says it's "quite alarming" for the institution because Corrections officers are also having to deal with inmates diagnosed with HIV.

Experts warn that the rising drug crisis, particularly meth use, is driving the HIV outbreak in Fiji, which can lead to a surge in cases across other Pacific nations.

As of 2023, 6.7 million people were living with HIV in the Asia-Pacific region, making it the largest epidemic globally after eastern and southern Africa, as reported by the United Nations AIDS agency.

Fiji's Corrections Services reports that almost 60 per cent of inmates in the country's prisons have been diagnosed with HIV. Photo/Fiji Corrections

It says the Pacific-Asia region accounts for 23 per cent of all new HIV infections worldwide, with Fiji and Papua New Guinea (PNG) being the only Pacific nations with available data on HIV.

By the end of 2019, PNG had an estimated 51,000 people living with HIV, UNAIDS reported, with the HIV prevalence among 15 to 49-year-olds reaching 0.85 per cent.

UNAIDS says that between 2010 and 2023, infections in Fiji increased by 241 per cent. Eamonn Murphy, the head of UNAIDS in the Pacific, warns that the increase in infections in Fiji could “put the entire Pacific region at risk".

"Prioritisation of HIV by the Government is critical for not only the people of Fiji but the entire Pacific," he says.

"Political will is the essential first step. There must also be community leadership and regional solidarity to ensure these strategies work."

Fiji health workers ensure services for people with chronic diseases, including care for those living with HIV. Photo/Fiji govt

The New Zealand Government has been urged to support Kiwis living with HIV if it aims to reach its goal of eliminating transmission by 2030.

In 2023, New Zealand reported 97 new HIV diagnoses, a 30 per cent decrease from the average of 138 cases recorded between 2016 and 2020, with most new infections occurring among men who have sex with men (MSM).

Sharon McLennan, a senior research fellow at the School of Health, Te Herenga Waka, Victoria University of Wellington, says Fiji is a regional hub for education and business and attracts students and economic migrants from across the region.

She warns that there is a “real risk” of the virus spreading to other island nations through returning workers and students, possibly travelling undetected for long periods.

McLennan also says that Fiji is a popular tourist destination where visitors engaging in drug use or unsafe sexual activities may be at risk of exposure.

By the end of 2019, PNG had an estimated 51,000 people living with HIV, UNAIDS reported, with the HIV prevalence among 15 to 49-year-olds reaching 0.85 per cent. Photo/Supplied

She says the situation poses a “reputational” threat to the tourism industry, which relies on marketing Fiji as a safe and enjoyable destination, especially as the country continues to recover from the impacts of Covid-19.

In a recent paper, McLennan argues that Fiji’s HIV crisis is a regional challenge that requires a coordinated response.

She says Fiji is also experiencing significant outward migration (five per cent net in 2023), mostly due to New Zealand and Australia, which raises the risk of virus spread through established migration pathways, including labour mobility policies like New Zealand’s Recognised Seasonal Employer (RSE) and the Pacific Australia Labour Mobility (PALM) schemes.

She says the economic impact of the HIV surge will be considerable for both Fiji and the region, as HIV/AIDS can strain household finances through lost income and increased healthcare expenses, diverting public spending from other critical areas and impacting national and regional economies.”

The UN has classified Fiji’s epidemic as the second fastest-growing in the Asia-Pacific region after the Philippines. It is believed that many cases remain undetected, meaning official figures do not reflect the true magnitude of the outbreak.

While the HIV epidemic is growing in PNG and Fiji, and the overall number of infected individuals may still be small in the Pacific, the UN warns that per capita case rates can be higher in areas like Tahiti, Guam, and New Caledonia.

Several factors hinder HIV prevention efforts in the Pacific, including high rates of other sexually transmitted diseases (STDs), international travel and migration, social and cultural barriers, and a lack of empowerment for women to negotiate safer sex practices.

The experts say there is a need for improved data collection, community-led programmes, better communication, and prevention programmes for people who use drugs, including harm reduction strategies like needle exchange and PrEP.

Fiji’s Health Ministry has expressed concern over the rapid increase in HIV infections and fears that the health system is struggling to keep up. Half of the Fijians living with HIV are not receiving treatment and cannot be contacted, making it more challenging to manage the situation.

Fijian doctors have long tried to alert the government to the outbreak, which is closely linked to the country’s escalating drug problem. About 50 per cent of new HIV cases are caused by intravenous drug use, the ministry says.

The WHO says that in 2023, the Western Pacific region saw 53,000 AIDS-related deaths, with 2.3 million people living with HIV and 140,000 new infections, highlighting significant challenges in curbing the epidemic. Photo/Fiji Health Ministry